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This book investigates how a study of Shakespeare's plays may enhance empathy in doctors, nurses, and other healthcare professionals. Addressing the widely perceived empathy gap in teaching and medical practice that emerged after the Covid-19 pandemic, the book presents a new study into the psychosocial elements of human interactions. It offers invaluable insights into how students and practitioners may be supported in dealing appropriately with their emotions as well as with those of their patients, thereby facilitating more humane medical care. Fostering an empathic patient-doctor relationship, the author explores the emotional, cognitive and moral dimensions of care and describes how Shakespeare studies can be realistically incorporated into the medical curriculum through group reflections, workshops and special study modules.

Over recent decades, the decline of trust, mounting of fears, and increasing denial of science appear as a marked shift of societal attitudes towards many institutions and professionals. This book analyses these developments and looks at their role in medicine and healthcare, both in terms of the patient-physician relationship and for delivering high-quality healthcare, in order to establish why we need trust and what can be done to restore it. The book begins by offering a conceptual analysis and definition of trust, using a ‘pattern definition'based upon typical features and common usage of the term, as well as the related concepts of hope, fear, and belief. It charts evidence for the decline of public trust in various professions, and then looks at the causes, as well as the accompanying growth of fear and the rejection of science. The study addresses possible options for restoring trust in medicine and healthcare, be it in individual physicians, in hospitals, or in managed care institutions. Written jointly by a medical doctor and an academic specialising in biomedical ethics, the book will be of interest to those working in the areas of biomedical ethics and law, medicine and healthcare, public health, philosophy, sociology, politics, and psychology.

Explores human dignity and care in the face of disease and disability.Complex contemporary experiences with disease, death, and disability in the United States have made the concept of human dignity seem outdated. In Doing Dignity: Ethical Praxis and the Politics of Care, Christa Teston challenges conventional notions of dignity and, based on analyses of clinical observations, interviews, and focus groups, encourages a new understanding of care.This thought-provoking book presents a practice-based approach to human dignity through three compelling case studies: US health care professionals'COVID-19 caretaking experiences, legislative debates about medical aid in dying, and clinical interactions between wheelchair users and health care professionals. Teston demonstrates how dignity is not an abstract idea but rather is a set of practices embedded in the politics and complexities of care. Drawing from feminist care ethics, rhetorical theory, disability studies, and critical Black studies, Doing Dignity offers a fresh perspective on the moral underpinnings of modern-day medicine. Teston explores how health care professionals enact dignity despite the challenges of market-based medicine, the commodification of care, and shifting societal discourse on disease, dying, and disability. This book transcends philosophical debates and provides practical insights for both patients and practitioners. Without falling into sentimentality or hopelessness, Doing Dignity honors human vulnerability while revealing how situational factors influence the practice of dignified care.

Commemorating its 175th anniversary, this new edition of the American Medical Association's (AMA) Code of Medical Ethics (AMA Code) has undergone another comprehensive update. Much has changed in medicine and society since the AMA Code was created 175 years ago, and the AMA Code has changed as well. The Annotations, an important research and reference tool, in the AMA Code has been significantly updated to include more up-to-date and relevant cases, as well as the removal of outdated cases. To celebrate its 175th anniversary, this new edition of the AMA Code also includes artwork and poetry and literary excerpts—all selected to reflect our society and to highlight the importance of diversity and equity—to reflect the AMA's mission to promote the art of medicine and its ethos of putting patients first.The only national code of ethics for all physicians, the AMA Code articulates the core values and ethical responsibilities of physicians who are charged with curing the sick when possible and comforting the dying. Hence, its wide recognition as the most authoritative guide for physicians who strive to practice ethically. This modernized and updated edition of the AMA Code breathes new energy into this living document, while staying true to what it means to be a good physician. The AMA Code is grounded in the nine Principles of Medical Ethics, which are the standards of conduct that define the essentials of ethical behavior for physicians. While the AMA Code provides essential guidance for professional conduct for physicians, it is also regularly cited as the medical profession's authoritative voice in legal opinions, journal articles and media outlets. It is an indispensable resource that deserves to be in every physician office, medical library, hospital, and place where the public's health is promoted. This book includes: Updated and increased number of case annotations, offering synopsis of facts and legal issues. focusing on the court's reference to the AMA Code's Principle(s) or Opinion(s) and the role it played in their decisions.Intuitive topical chapter structure makes finding pertinent ethical guidance easy.A uniform format that improves the readability and application of specific guidance.Consolidation of previously disparate guidance on related topics that streamlines the AMA Code.Use of accepted definitions and consistent terminology that minimize misinterpretation of guidance. • Inclusion of a new preface to clarify the different levels of ethical obligation in the offered guidance.

Boken klargjør og diskuterer etiske problemer og kommunikasjonsutfordringer i denne delen av medisinsk praksis. Boken er en revisjon av Etikk og kommunikasjon? i prehospitalt medisinsk arbeid som kom i 2010. Forfatteren har skrevet to nye kapitler ett om ledelse og ett om veiledning. Alt stoffet er bearbeidet og gjennomgått fra forrige utgave. Prehospitalt medisinsk arbeid kan enkelt defineres som akuttmedisinske tiltak som settes inn før pasienten kommer til sykehus. Prehospitalt arbeid foregår ofte i det offentlige rom, og kan være preget av liv?død-problematikk, liten tid og begrensede personalressurser. Ved hjelp av praktiske eksempler viser forfatteren hvordan det er mulig å løse etiske problemer og sikre god kommunikasjon i akuttmedisinsk førstelinjetjeneste.

This book explores a new way of applying clinical ethics. Empathy-based ethics is based on the patient–doctor relationship and seeks to encourage a more humane form of medical practice. The author argues that the current emphasis on the biomedical model of medicine and a detached concern form of professionalism have damaged the patient–doctor relationship. He investigates examples of the dehumanization of patients and demonstrates a contrasting view of humane care. The book presents empathy as a relational construct - it provides an in-depth analysis of the process of empathizing. It discusses an empathy-based ethics approach underpinned by clinical examples of the practical application of this new approach. It suggests how empathy-based ethics can be embedded in clinical practice, medical education and research. The book concludes by examining the challenges in implementing such an approach and looks to a future which redresses the current imbalance between biomedical and psychosocial approaches to medicine.

Diagnosis is a practically-oriented guide to the complex reasoning, observations, and judgment that health professionals draw on to make a clinical diagnosis. Built on the cornerstone of the patient-physician relationship, this volume combines rigorous yet accessible conceptual analysis with actionable strategies for navigating uncertainty, making effective use of diagnostic tests, and understanding the economic, interpersonal, and ethical considerations influencing diagnosis. Across six chapters, Ashley Graham Kennedy tackles such thorny issues as overdiagnosis, underdiagnosis, and new complications from the Covid-19 pandemic, supplemented by carefully chosen medical case studies. In so doing, she demonstrates that even'ordinary'cases require a delicate balance of medical and ethical considerations in order to promote the patient's physical and mental well-being. Ultimately, this volume demonstrates that clinical diagnosis is not just about acquiring knowledge but also facilitating the health of the people it serves. With clarity and compassion, Diagnosis illuminates the ethical and philosophical underpinnings of the diagnostic process for the medical practitioner.

Focusing on a matter of continuing contemporary significance, this book is the first work to offer an in-depth exploration of exploitation in the doctor-patient relationship. It provides a theoretical analysis of the concept of exploitation, setting out exploitation's essential elements within the authors'account of wrongful exploitation. It then presents a contextual analysis of exploitation in the doctor-patient relationship, considering the dynamics of this fiduciary relationship, the significance of vulnerability, and the reasons why exploitation in this relationship is particularly wrongful. Two case studies – sexual exploitation and assisted dying – are employed to assess what the appropriate legal, ethical and regulatory responses to exploitation should be, to identify common themes regarding the doctor's behaviour (such as the use of undue influence as a conduit through which to take advantage of and misuse patients), and to illustrate the effects of exploitation on patients. A recurring question addressed is how exploitation in the doctor-patient relationship is and should be dealt with by ethics, regulators and the law, and whether exploitation in this relationship is a special case. The book provides a critical, interdisciplinary evaluation of exploitation in the doctor-patient relationship that will be of interest to health care lawyers, bioethicists, legal academics and practitioners, health care professionals and policymakers.

The Doctor Still Knows Best explores an answer to the question: how can medical culture still be marked by paternalism despite the focused attempts by the medical community to put doctor and patient on more equal footing? The recent push within medicine has been on shared decision-making, truth-telling by the doctor, and creating a medical culture that is patient-centered. The author has discovered that, in practice, medicine tells a very different story. Since entering the medical world twenty years ago seeking treatment for infertility through IVF, subsequently seeking treatments for her disabled son through the present day, Janet Farrell Leontiou has continually encountered a medical culture where she is not treated as an equal. As a professor of communication, the author has developed an ear for language and is able to deconstruct the ways in which communication choices create a patriarchal medical culture. Dr. Farrell Leontiou also understands how no communication can create a culture without her participation. She, therefore, invites the reader to recognize how we can endorse and recreate a culture that does not serve our interests. Through an examination of her own experience, the book offers insight on how medical paternalism has survived for as long as it has and argues that it never serves the best interest of the patient. The book provides the reader, medical student and/or health communication student with a fresh way of thinking about how communicative choices create culture.

This book provides an account of the ethics of chronic illness. Chronic illness differs from other illnesses in that it is often incurable, patients can live with it for many years, and its day-to-day management is typically carried out by the patient or members of their family. These features problematise key distinctions that underlie much existing work in medical ethics including those between beneficence and autonomy, between treatment and prevention, and between the recipient and provider of treatment. The author carries out a detailed reappraisal of the roles of both autonomy and beneficence across the different stages of treatment for a range of chronic illnesses. A central part of the author's argument is that in the treatment of chronic illness, the patient and/or the patient's family should be seen as acting with healthcare professionals to achieve a common aim. This aspect opens up unexplored questions such as what healthcare professionals should do when patients are managing their illness poorly, the ethical implications of patients being responsible for parts of their treatment, and how to navigate sharing information with those directly involved in patient care without violating privacy or breaching confidentiality. The author addresses these challenges by engaging with philosophical work on shared commitments and joint action, responsibility and justice, and privacy and confidentiality. The Ethics of Chronic Illness provides a new, and much needed, critical reappraisal of healthcare professionals'obligations to their patients. It will be of interests to academics working in bioethics and medical ethics, philosophers interested in the topics of autonomy, responsibility, and consent, and medical practitioners who treat patients with chronic illness.

Narrative medicine is a fresh discipline of health care that helps patients and health professionals to tell and listen to the complex and unique stories of illness. The Principles and Practice of Narrative Medicine expresses the collective experience and discoveries of the originators of the field. Arising at Columbia University in 2000 from roots in the humanities and patient-centered care, narrative medicine draws patients, doctors, nurses, therapists, and health activists together to re-imagine a health care based on trust and trustworthiness, humility, and mutual recognition. Over a decade of education and research has crystallized the goals and methods of narrative medicine, leading to increasingly powerful means to improve the care that patients receive. The methods described in this book harness creativity and insight to help the professionals in being with patients, not just to diagnose and treat them but to bear witness to what they undergo. Narrative medicine training in literary theory, philosophy, narrative ethics, and the creative arts increases clinicians'capacity to perceive the turmoil and suffering borne by patients and to help them to cohere or endure the chaos of illness. Narrative medicine has achieved an international reputation and reach. Many health care settings adopt methods of narrative medicine in teaching and practice. Through the Master of Science in Narrative Medicine graduate program and health professions school curricula at Columbia University, more and more clinicians and scholars have obtained the rigorous training necessary to practice and teach narrative medicine. This text is offered to all who seek the opportunity for disciplined training in narrative medicine. By clearly articulating our principles and practice, this book provides the standards of the field for those who want to join us in seeking authenticity, recognition, affiliation, and justice in a narrative health care.

Hospital intensive care units have changed when and how we die--and not always for the better. The ICU is a new world, one in which once-fatal diseases can be cured and medical treatments greatly enhance our chances of full recovery. But, paradoxically, these places of physical healing can exact a terrible toll, and by focusing on technology rather than humanity, they too often rob the dying of their dignity. By some accounts, the expensive medical treatments provided in ICUs also threaten to bankrupt the nation. In an attempt to give patients a voice in the ICU when they might not otherwise have one, the living will was introduced in 1969, in response to several notorious cases. These documents were meant to keep physicians from ignoring patients'and families'wishes in stressful situations. Unfortunately, despite their aspirations, living wills contain static statements about hypothetical preferences that rarely apply in practice. And they created a process that isn't faithful to who we are as human beings. Further confusing difficult and painful situations, living wills leave patients with the impression that actual communication with their physicians has taken place, when in fact their deepest desires and values remain unaddressed. In this provocative and empathetic book, medical researcher and ICU physician Samuel Morris Brown uses stories from his clinical practice to outline a new way of thinking about life-threatening illness. Brown's approach acknowledges the conflicting emotions we have when talking about the possibility of death and proposes strategies by which patients, their families, and medical practitioners can better address human needs before, during, and after serious illness. Arguing that any solution to the problems of the inhumanity of intensive care must take advantage of new research on the ways human beings process information and make choices, Brown imagines a truly humane ICU. His manifesto for reform advocates wholeness and healing for people facing life-threatening illness.

A Patient-Centered Approach to the Chronically-Ill addresses the unique needs of chronically-ill patients and the challenges they present for medical doctors. This book features four principles of the patient-centered approach that can be used by physicians in treating chronically-ill patients. By adhering to these four principles, physicians will be able to humanely treat chronically-ill patients with the care and attention that they need in order to encourage them to manage their symptoms in the best possible way.

Person-centred health care is increasingly endorsed as a key element of high-quality care, yet, in practice, it often means patient-centred health care. This book scrutinizes the principle of primacy of patient welfare, which, although deeply embedded in health professionalism, is long overdue for critical analysis and debate. It appears incontestable because patients have greater immediate health needs than clinicians and the patient-clinician encounter is often recognized as a moral enterprise as well as a service contract. However, Buetow argues that the implication that clinician welfare is secondary can harm clinicians, patients and health system performance.Revaluing participants in health care as moral equals, this book advocates an ethic of virtue to respect the clinician as a whole person whose self-care and care from patients can benefit both parties, because their moral interests intertwine and warrant equal consideration. It then considers how to move from values including moral equality in health care to practice for people in their particular situations. Developing a genuinely inclusive concept of person-centred care – accepting clinicians as moral equals – it also facilitates the coalescence of patient-centred care and evidence-based health care.This reflective and provocative work develops a constructive alternative to the taken-for-granted principle of primacy of patient welfare. It is of interest to students and academics in the health and caring sciences, philosophy, ethics, medical humanities and health management.

For many health care professionals and social service providers, the hardest part of the job is breaking bad news. The news may be about a condition that is life-threatening (such as cancer or AIDS), disabling (such as multiple sclerosis or rheumatoid arthritis), or embarrassing (such as genital herpes). To date medical education has done little to train practitioners in coping with such situations. With this guide Robert Buckman and Yvonne Kason provide help.Using plain, intelligible language they outline the basic principles of breaking bad new and present a technique, or protocol, that can be easily learned. It draws on listening and interviewing skills that consider such factors as how much the patient knows and/or wants to know; how to identify the patient's agenda and understanding, and how to respond to his or her feelings about the information. They also discuss reactions of family and friends and of other members of the health care team.Based on Buckman's award-winning training videos and Kason's courses on interviewing skills for medical students, this volume is an indispensable aid for doctors, nurses, psychotherapists, social workers, and all those in related fields.

Taking an interdisciplinary approach to conceptualise interpersonal trust between patients and medical practitioners, Katja Beitat introduces a unique model to describe the dynamics of trust building and deterioration with particular relevance to incidents in health care. Empirical findings from studies in Australia and Germany, the two systems focused on in this book, broadly support and expand the proposed dynamic model of trust. Specific communication, competence and care related aspects impact on the trust relationship between patients and practitioners which in return is considered essential for other trust relations in health care.

Freud promised his patients absolute confidentiality, regardless of what they revealed, but privacy in psychotherapy began to erode a half-century ago. Psychotherapists now seem to serve as “double agents” with a dual and often conflicting allegiance to patient and society. Some therapists even go so far as to issue Miranda-type warnings, advising patients that what they say in therapy may be used against them.Confidentiality and Its Discontents explores the human stories arising from this loss of confidentiality in psychotherapy. Addressing different types of psychotherapy breaches, Mosher and Berman begin with the the story of novelist Philip Roth, who was horrified when he learned that his psychoanalyst had written a thinly veiled case study about him. Other breaches of privacy occur when the so-called duty to protect compels a therapist to break confidentiality by contacting the police. Every psychotherapist has heard about “Tarasoff,” but few know the details of this story of fatal attraction. Nor are most readers familiar with the Jaffee case, which established psychotherapist-patient privilege in the federal courts. Similiarly, the story of Robert Bierenbaum, a New York surgeon who was brought to justice fifteen years after he brutally murdered his wife, reveals how privileged communication became established in a state court. Meanwhile, the story of New York Chief Judge Sol Wachtler, convicted of harassing a former lover and her daughter, shows how the fear of the loss of confidentiality may prevent a person from seeking treatment, with potentially disastrous results.While affirming the importance of the psychotherapist-patient privilege, Confidentiality and Its Discontents focuses on both the inner and outer stories of the characters involved in noteworthy psychotherapy breaches and the ways in which psychiatry and the law can complement but sometimes clash with each other.

Medizinethik wie auch Pflegeethik werden allgemein als Disziplinen verstanden, die das Handeln von Menschen auf die Geltung seiner Ziele, Motivationen und Resultate hin untersucht. Ausgangspunkt solcher Formen der Ethik bildet die zum Problem gewordene Situation, in der vermeintlich eindeutige Grundziele, wie zum Beispiel Lebensverlängerung einerseits und Leidensverminderung andererseits, miteinander in Konflikt geraten. Es stellensich dann Fragen, deren praxisanleitende Beantwortungen von einer Pflegeethik gefordert werden. In der theoretisch fundierten Beantwortung dieser Fragen jedoch entfernen sich Medizin- und Pflegeethik von dem, was Menschen tun und erleiden. Mit Hilfe der seinsgeschichtlichen Hermeneutik Heideggers und des amerikanischen Pragmatismus, vertreten durch John Dewey und Richard Rorty, entwickeln die Autoren eine Methode, die - jenseits sogenannter Grundfragen einer medizinischen Ethik - alltägliche Krisen des heutigen klinischen Miteinanders im Spannungsfeld technischer Medizin und individueller Situation lösungsorientiert neu verstehen lässt. Jene werden - derart als Fragen von Mitgefühl und Selbstbestimmung neu verstanden - zu Chancen einer verantwortungsvollen klinischen Praxis. Die Krankenpflege bildet dabei als neu belebter metaphorischer Fundus den poietischen Horizont dieser Praxis, deren methodischer Vollzug von der Ausbildung bis zum beruflichen Handeln ärztlichen und pflegenden Klinikpersonals reicht. Die kulturellen, sprachlichen, rechtlichen und institutionellen Bedingungen des Handelns in Kliniken werden auf den Prüfstand gestellt und neu bewertet. Schließlich wird die Methode eines Klinischen Pragmatismus, als neue Ethik der Pflege, anhand von einschlägigen Fallbeispielen aus der Praxis beispielhaft angewandt.

In the era of health democracy, where a patient's right to be informed is not only widely advocated but also guaranteed by law, what is the real situation regarding patient information? Do patients receive the information that they request with regard to their diagnosis, prognosis or treatments? And what information do patients themselves give to their doctors? Drawing on observational research in hospitals and covering the exchanges between doctors and patients on the subject of cancer treatment and that of other pathologies, this book reveals that the practice of telling lies is widespread amongst parties on both sides of the medical relationship. With attention to the manner in which information of various types is withheld and the truth concealed on either side of the doctor-patient relationship, the author explores the boundaries between what is said and what is left unsaid, and between those who are given information and those who are lied to. Considering the misunderstandings that occur in the course of medical exchanges and the differences between the lies told by doctors and patients, An Anthropology of Lying: Information in the Doctor-Patient Relationship analyses the role of mendacity in the exercise of, and resistance to power. A fascinating study of the mechanisms at work and social conditions surrounding the accomplishment of lying in medical settings, this book casts fresh light on a subject that has so far been overlooked. As such, it will appeal not only to sociologists and anthropologists of health and medicine, but also to medical professionals.

The health-care system in the United States is by far the most expensive in the world, yet its outcomes are decidedly mediocre in comparison with those of other countries. Poor communication between doctors and patients, Dennis Rosen argues, is at the heart of this disparity, a pervasive problem that damages the well-being of the patient and the integrity of the health-care system and society. Drawing upon research in biomedicine, sociology, and anthropology and integrating personal stories from his medical practice in three different countries (and as a patient), Rosen shows how important good communication between physicians and patients is to high-quality—and less-expensive—care. Without it, treatment adherence and preventive services decline, and the rates of medical complications, hospital readmissions, and unnecessary testing and procedures rise. Rosen illustrates the consequences of these problems from both the caregiver and patient perspectives and explores the socioeconomic and cultural factors that cause important information to be literally lost in translation. He concludes with a prescriptive chapter aimed at building the cultural competencies and communication skills necessary for higher-quality, less-expensive care, making it more satisfying for all involved.

Un témoignage sur les manipulations sexuelles et affectives La première édition de ce livre-choc, mystérieusement étouffée en 2006, fit l'objet d'une procédure à la Cour Supérieure du Québec. Sans doute parce qu'il constitue le document le plus complet, puissant et osé à ce jour sur le culte des apparences, couronné par un abus médical dont les répercussions sont comparables au viol ou à l'inceste. Voici un témoignage sans précédent, et bouleversant de vérité, questionnant l'emprise d'un chirurgien borderline sur sa patiente, les vrais enjeux de la chirurgie esthétique, et les limites de la psychanalyse. Sans tabou, ce livre dissèque l'obsession du miroir, mais aussi la psychologie de l'homme misogyne et de « l'infir-mère » vengeresse. Un journal intime teinté de poésie pour en finir avec la dictature de la séduction et de la jeunesse, et avec son corollaire: la violence sournoise de « l'adul-taire.» Fruit d'une enquête de sept ans,'Liaison dangereuse'est la première « enquête-témoignage » joignant le double parcours de la psychanalyse et de la chirurgie esthétique. Un livre qui parlera autant aux hommes qu'aux femmes, et qui transformera la garce en son anagramme: la grâce. Un chemin intérieur pour oser l'amour et les vertus qui nous embellissent, plutôt que les séductions qui nous enlaidissent... car le « séduc-tueur » et la femme fatale ne le sont, finalement, que pour eux-mêmes. Oser la beauté est le défi de ce siècle, qui nous demande de lâcher les faux dieux de l'apparat, du pouvoir et des revanches sexuelles pour accorder notre musique à celle de l'univers, imprévisible et saisissante de coïncidences. L'urgence est affective: il est temps d'oser un nouveau plan de conscience, hommes et femmes de tous âges. Ensemble.

Goede communicatie leidt tot betere zorg, daarover is iedereen het wel eens. Veel zorgverleners blijken echter problemen te ondervinden bij de communicatie, vooral met patiënten uit een andere cultuur. Ze krijgen daarbij te maken met denkbeelden en verwachtingen waaraan zij vanuit hun culturele achtergrond niet gewend zijn. De vraag is dan niet zo zeer wát er in de communicatie met deze patiëntengroep moet verbeteren, maar de wijze waaróp dat moet gebeuren. Daarover gaat dit boek. Medische communicatie en etnische diversiteit biedt (para)medici praktische handvatten om de zorg voor en communicatie met migranten te verbeteren. Daarbij moet niet (langer) op de eigen intuïtie worden vertrouwd, maar actief worden geëxploreerd wat de gedachten, gevoelens en verwachtingen van de patiënt zijn. De uitgave omvat twee delen. Het eerste deel - Diversiteit in de zorg - gaat in op de kwaliteit van zorg voor migranten en interculturele zorgverlening. In het tweede deel - Communicatie in een etnisch diverse context - ligt het accent op interculturele communicatie en consultvoering, en komen medisch-ethische dilemma's aan de orde. De uitgave onderscheidt zich van reeds bestaande literatuur door compactheid, toegankelijkheid en directe toepasbaarheid voor zowel de academisch geschoolde als de paramedische beroepsgroep. Bart Wolf en Nordin Dahhan zijn beide kinderarts in Amsterdam. Zij houden zich bezig met de verbetering van de opleiding van medisch specialisten op het gebied van interculturele communicatie en etnische diversiteit.

Relation patients-médecins : des professionnels de la santé racontentUne parole autour de ce que l'auteur - un médecin généraliste - a de plus intime : l'amour de la vie, l'amour des hommes et des femmes qu'il croise, un certain point de vue sur le bonheur...Par petites touches, ce récit tendre, émouvant, drôle, réaliste, nous ouvre à l'humanité de l'autre, qu'il soit soignant ou patient. Il nous raconte l'essence même d'un métier que certains disent en perdition.À lire... À offrir... À méditer... mais sachez-le : vous ne regarderez plus jamais la médecine ni les médecins comme avant!EXTRAIT Ce matin, j'ai découvert un perce-neige, inattendu, une vraie merveille. Ses clochettes paraissent surprises de se retrouver là, dans l'enclos givré que leur forment les dernières croûtes de neige qui luttent contre un pâle soleil. On se prend à guetter l'appel lointain des oies rieuses qui se rassemblent dans les lagunes en attendant que les souffles printaniers les poussent plus au nord, ou le chant de la sarcelle amoureuse appelant au renouveau. En pinçant avec deux doigts un fragment de leurs délicates enveloppes, la main s'assure de la réalité de tant de douceur inespérée hier encore, quand le vent nocturne faisait claquer les volets dans leurs rails.

What makes a good doctor? Are there bad doctors out there - and if so how do we protect patients from them? Can we inject more information, more trust and more assured competence into the medical system to solve these problems? Drawing on his years of dealing with patient concerns, Ron Paterson tackles these important questions. The book makes challenging arguments: that patients don't demand the sort of information about doctors that they should; that doctors who feel put upon by information overload, patient demands, complaints and growing requirements from employers, colleges, medical boards and government, will be resistant to any additional regulation of their activity; that doctors are reluctant to judge problem doctors and prefer the'quiet chat'; and that current law and practice is lax when it comes to checking that doctors remain up-to-date. Paterson concludes the book with proposals to lift the veil of secrecy, to inform patients better and to revalidate doctors periodically, all key ways we might improve patient care. The Good Doctor will be prescribed reading for doctors, patients and policymakers—all of those determined to make sure patients get the medical care they deserve.

Efforts to evaluate the clinical encounter in terms of autonomous agents governed by rationally justified moral principles continue to be criticised. These essays, written by physicians, ethicists, theologians and philosophers, examine various models of the clinical encounter emerging out of these criticisms and explore the prospects they offer for theological and religious discourse. Individual essays focus on the reformulation of covenant models; revisions of principles approaches; and topics such as power, authority, narrative, rhetoric, dialogue, and alterity. The essays display a range of conclusions about whether theology articulates generally accessible religious insights or is a tradition-specific discipline. Hence the volume reflects current debates in theology while analysing current models of the clinical encounter. Students, professionals, and scholars who find themselves at the intersection of theology and medicine will welcome these voices in an ongoing conversation.

This book arises from a two-fold conviction. The first is that autonomy, despite recent critiques about its importance in bioethics and philosophy of medicine, and the traditional resistance of medicine to its'intrusion'into the doctor-patient relation, is a fundamental building block of an individual's identity and mechanisms for dealing with illness, disease, and incapacity. As such it is an essential component in the health care professional's armamentarium employed to bring about healing. Furthennore, it functions in a similar way to assist the health professional in his or her relations to the sick and injured. The second conviction follows from the fITst. Autonomy is far more complex than appears from the philosophical use of the concept. In this conviction we join those who have criticized the over-reliance on autonomy in modem, secular bioethics originating in the United States, but gaining ascendancy in other cultures. This critique relies on appeals to the richer contexts of persons'lives. Elsewhere the contemporary critique of autonomy appears in a variety of alternative ethical models like narrative ethics, casuist ethics, and contextualism. Indeed, postmodern criticism of all bioethics argues that there is no defensible foundation for claims that one ought to respect autonomy or any other principle as a way of ensuring that one is ethical.

The encounter between patient and physician may be characterized as the focus of medicine. As such, the patient-physician relationship, or more accurately the conduct of patients and physicians, has been the subject of considerable comment, inquiry, and debate throughout the centuries. The issues and concerns discussed, apart from those more specifically related to medical theory and therapy, range from matters of etiquette to profound questions of philosophical and moral interest. This discourse is impressive with respect both to its duration and content. Contemporary scholars and laypeople have made their contribution to these long-standing discussions. In addition, they have actively addressed those distinctively modern issues that have arisen as a result of increased medical knowledge, improved technology, and changing cultural and moral expectation. The concept of the patient-physician rela­ tionship that supposedly provides a framework for the conduct of patients and physicians seemingly has taken on a life of its own, inviolable, and subject to norms particular to it. The essays in this volume elucidate the nature of the patient-physician relationship, its character, and moral norms appropriate to it. The purpose of the collection is to enhance our understanding of that context, which many consider to be the focus of the entire medical enterprise. The con­ tributors have not engaged in apologetics, polemics, homiletics, or em­ piricism.

Patients have personal strategies in solving the problems concerning their illness. Doctors have personal and professional strategies in solving the problems with their patients. This book explores the problematic triangle between doctors, patients and the illness, using illustrations from internal medicine, nephrology, cardiology, oncology and neurology. Enhancement of the doctor-patient interaction is an important contribution to the mutual reduction of stress and therefore the improvement of the course of (long-term) illness. The first part of the book describes reasons why the partnership between doctor and patient should be improved. The second part offers concrete and practical options to achieve that improvement.

Talking openly with sick and dying children about their illness is always difficult and often agonizing. It is honesty, however, that these children deserve and need. Dietrich Niethammer, a prominent pediatric oncologist, explains why it is so important to speak frankly and respectfully to young patients about their disease.The question at the heart of this book is how children and adolescents feel and think about death and dying. Dr. Niethammer thoroughly examines the literature on the topic, arguing that children and adolescents not only are capable of discussing their illness but benefit from doing so. Puzzled why it took medical practitioners so long to accept truth-telling in their care of dying children, Niethammer traces the development of this notion from the early twentieth-century work of Sigmund Freud to the discomfort surrounding it still today.Severely sick children and adolescents think about the consequences of their disease, whether adults discuss it with them or not. When adults remain silent, they do a disservice to the children. Dr. Niethammer urges doctors to practice not in silence and denial but in open communication with ill children, giving the children an opportunity to express their fears and anxieties and to cope with their disease on their own terms.Dr. Niethammer's compelling personal experiences combined with the latest research make this a compassionate and invaluable resource for physicians, nurses, social workers, teachers, parents—for all who care for sick and dying children and adolescents.

Addressing the professional challenges faced by physicians today, the Code of Medical Ethics presents guidance through more than 200 ethical opinions, including physician obligation in disaster preparedness and response, physician participation in interrogations, genetic testing and counseling, and electronic mail and health-related online sites

For more than a century, the American medical profession insisted that doctors be rigorously trained in medical science and dedicated to professional ethics. Patients revered their doctors as representatives of a sacred vocation. Do we still trust doctors with the same conviction? In Trusting Doctors, Jonathan Imber attributes the development of patients'faith in doctors to the inspiration and influence of Protestant and Catholic clergymen during the nineteenth and early twentieth centuries. He explains that as the influence of clergymen waned, and as reliance on medical technology increased, patients'trust in doctors steadily declined. Trusting Doctors discusses the emphasis that Protestant clergymen placed on the physician's vocation; the focus that Catholic moralists put on specific dilemmas faced in daily medical practice; and the loss of unchallenged authority experienced by doctors after World War II, when practitioners became valued for their technical competence rather than their personal integrity. Imber shows how the clergy gradually lost their impact in defining the physician's moral character, and how vocal critics of medicine contributed to a decline in patient confidence. The author argues that as modern medicine becomes defined by specialization, rapid medical advance, profit-driven industry, and ever more anxious patients, the future for a renewed trust in doctors will be confronted by even greater challenges. Trusting Doctors provides valuable insights into the religious underpinnings of the doctor-patient relationship and raises critical questions about the ultimate place of the medical profession in American life and culture.

to the Moral Challenges H. Tristram Engelhardt, Jr. and Aaron E. Hinkley 1 Taking Finitude Seriously in a Chinese Cultural Context Across the world, health care policy is a moral and political challenge. Few want to die young or to suffer, yet not all the money in the world can deliver physical immortality or a life free of suffering. In addition, health care needs differ. As a result, unless a state coercively forbids those with the desire and means to buy better basic health care to do so, access to medicine will be unequal. No co- try can afford to provide all with the best of care. In countries such as China, there are in addition stark regional differences in the quality and availability of health care, posing additional challenges to public policy-making. Further, in China as elsewhere, the desire to lower morbidity and mortality risks has led to ever more resources being invested in health care. When such investment is supported primarily by funds derived from taxation, an increasing burden is placed on a country's economy. This is particularly the case as in China with its one-child policy, where the proportion of the elderly population consuming health care is rising. Thesepolicychallengesarecompoundedbymoraldiversity. Defacto,humansdo not share one morality. Instead, they rank cardinal human goods and right-making conditions in different orders, often not sharing an af?rmation of the same goods or views of the right.

Medical error is a leading problem of health care in the United States. Each year, more patients die as a result of medical mistakes than are killed by motor vehicle accidents, breast cancer, or AIDS. While most government and regulatory efforts are directed toward reducing and preventing errors, the actions that should follow the injury or death of a patient are still hotly debated. According to Nancy Berlinger, conversations on patient safety are missing several important components: religious voices, traditions, and models. In After Harm, Berlinger draws on sources in theology, ethics, religion, and culture to create a practical and comprehensive approach to addressing the needs of patients, families, and clinicians affected by medical error. She emphasizes the importance of acknowledging fallibility, telling the truth, confronting feelings of guilt and shame, and providing just compensation. After Harm adds important human dimensions to an issue that has profound consequences for patients and health care providers.

Narrative medicine has emerged in response to a commodified health care system that places corporate and bureaucratic concerns over the needs of the patient. Generated from a confluence of sources including humanities and medicine, primary care medicine, narratology, and the study of doctor-patient relationships, narrative medicine is medicine practiced with the competence to recognize, absorb, interpret, and be moved by the stories of illness. By placing events in temporal order, with beginnings, middles, and ends, and by establishing connections among things using metaphor and figural language, narrative medicine helps doctors to recognize patients and diseases, convey knowledge, accompany patients through the ordeals of illness--and according to Rita Charon, can ultimately lead to more humane, ethical, and effective health care. Trained in medicine and in literary studies, Rita Charon is a pioneer of and authority on the emerging field of narrative medicine. In this important and long-awaited book she provides a comprehensive and systematic introduction to the conceptual principles underlying narrative medicine, as well as a practical guide for implementing narrative methods in health care. A true milestone in the field, it will interest general readers, and experts in medicine and humanities, and literary theory.

Without any warning, in September 1999, David Newman was told he had a rare and life-threatening tumor in the base of his skull. In the compressed space of five weeks, he consulted with leading physicians and surgeons at four major medical centers. The doctors offered drastically differing opinions; several pronounced the tumor inoperable and voiced skepticism about the effectiveness of any nonsurgical treatment. Talking with Doctors is the story of Newman's efforts, at a time of great stress and even impending death, to wend his way through the dense thicket of medical consultations in search of a physician and a treatment that offered the possibility of survival. It is the story, especially, of the harrowing process of assessing conflicting'expert'opinions and, in so doing, of making sense of the priorities, personalities, and vulnerabilities of different doctors. All too often, he found, the leading specialists to whom he was sent were strangers in the consulting room-and strangers who became stranger still, both cognitively and emotionally, when ambiguous findings pushed them to the outer limits of their training and experience. Newman writes poignantly of his sense of powerlessness and desperation, of the painstaking means by which he ascertained what could be known about his tumor, and of the fortuitous events that finally led him to life-saving help. Talking with Doctors is a compelling, absorbing, unsettling story that touches a collective raw nerve about the experience of doctors and medical care when life-threatening illness leads us to subspecialists at major medical centers. Probing the nature of medical authority and the grounds of a trusting doctor-patient relationship, Newman illuminates with grace and power what it now means for a patient to participate in life-and-death medical decisions.

New primary care organisations are demanding personal and practice-based professional development plans to underpin revalidation of clinicians'professional registration or accreditation of practices. This workbook is unique in showing the reader how to combine and integrate the two and matches national guidelines that explain how to apply guidance in real life for maximum effect. With action plans key facts and references it emphasises how to prioritise learning needs provides examples of plans and focuses on a variety of clinical and organisational topics. It will enable general practitioners nurses therapists and practice managers to design and apply personal development plans as individuals and as multidisciplinary practice teams.

Doctors and medical students confront increasingly complicated ethical dilemmas. To respond effectively they need skills in ethical reasoning and an understanding of the law and professional guidance. This book helps them achieve these things. It provides practical advice and guidance that draws upon the large volume of enquiries received by the BMAs Medical Ethics Department. Although rooted in moral theory and legal practice, the book is designed both to provide practical advice for doctors day to day working lives and to stimulate debate on broader areas of public policy.

First published in 2002. The doctor patient relationship starts with a story. Doctors'notes, a patient's chart, the recommendations of ethics committees and insurance justifications all hinge on written and verbal narrative interaction. The practice of narrative profoundly affects decision making, patient health and treatment and the everyday practice of medicine. In this edited collection, the contributors provide conceptual foundations, practical guidelines and theoretical considerations central to the practice of narrative ethics.

Physicians recognize the importance of patients'emotions in healing yet believe their own emotional responses represent lapses in objectivity. Patients complain that physicians are too detached. Halpern argues that by empathizing with patients, rather than detaching, physicians can best help them. Yet there is no consistent view of what, precisely, clinical empathy involves. This book challenges the traditional assumption that empathy is either purely intellectual or an expression of sympathy. Sympathy, according to many physicians, involves over-identifying with patients, threatening objectivity and respect for patient autonomy. How can doctors use empathy in diagnosing and treating patients rithout jeopardizing objectivity or projecting their values onto patients? Jodi Halpern, a psychiatrist, medical ethicist and philosopher, develops a groundbreaking account of emotional reasoning as the core of clinical empathy. She argues that empathy cannot be based on detached reasoning because it involves emotional skills, including associating with another person's images and spontaneously following another's mood shifts. Yet she argues that these emotional links need not lead to over-identifying with patients or other lapses in rationality but rather can inform medical judgement in ways that detached reasoning cannot. For reflective physicians and discerning patients, this book provides a road map for cultivating empathy in medical practice. For a more general audience, it addresses a basic human question: how can one person's emotions lead to an understanding of how another person is feeling?

In Caring for Patients at the End of Life: Facing an Uncertain Future Together, Dr. Quill uses his wide range of clinical experience caring for severely ill patients and their families to illustrate the challenges and potential of end-of-life care. Section one utilizes the near death experiences of two patients to explore values underlying medical humanism, and then presents the case of'Diane'to explore the fundamental clinical commitments of partnership and non-abandonment. Section two explores, illustrates, and provides practical guidance for clinicians, patients, and families about critical communication issues including delivering bad news, discussing palliative care, and exploring the wish to die. In section three, difficult ethical and policy challenges inherent in hospice work, including the rule of double effect, terminal sedation, and physician-assisted suicide, are explored using a mix of real cases and an analysis of underlying clinical, ethical, and policy issues. In a final chapter, Dr. Quill discusses the tragic death of his brother which occurred as this book was being completed, and how his family made the most emotionally challenging decisions of their lives. Dr. Quill exposes readers to an internally consistent and practical way of thinking by simultaneously embracing the potential of palliative care, and also acknowledging that it has limitations. His philosophy of offering forthright discussions with patient and family, mutual decision-making, ensuring medical and palliative care expertise and of committing to see the dying process through to the patient's death is vividly illustrated.

Life is full of tough decisions that must be made ethically and under the pressures of time. This book places readers in realistic situation where they experience the difficulties of making tough medical decisions. The cases are composites of actual cases the authors have seen or managed. In the role of decision-maker, the reader helps to determine what happens in the case as his or her decision often shapes the course of events and the patient's outcome. This gives a compelling sense of the pressures that bear on clinical decision-making. The authors assume that the reader wants to do the right thing, but faces the problem of determining what the right thing will be when information is necessarily incomplete and the future unknown. Ethical theory emerges as others involved in the case offer different views of what is right in a particular medical situation. Two concluding chapters discuss the major theories of medical ethics, but there are no answers in the back of the book. Instead, the book will familiarize readers with some of the ethical principles and issues critical to the practice of medicine to patients and their families.

This is a guide for all doctors - GPs and hospital doctors alike, on the law and how it affects them. It is a practical guide, and it approaches its subject with the use of realistic scenarios throughout. These relevant case histories are used as a basis for discussion and explanation of the legal implications of a doctors actions. Guidelines for best practice are given. This is not a theoretical book. Its aim is to give the reader an understanding of the way in which they may be legally challenged as health professionals, and how to minimize this risk. Unlike many law books,'Law for Doctors'assumes little or no knowledge of law and legal terms.

The germs of the ideas in this book became implanted in me during my experience as a resident in clinical pathology at Boston University Medical Center. At the time, I had inklings that the test results churned out by our laboratories were more than scientific facts. As a philosophically unsophisticated young physician, however, I had no language or framework to analyze what I saw as a deep philosophical problem, a problem largely unrecognized by most physicians. The test results provided by our laboratories were accurate and of great practical importance for patient care. However, most of the physicians who relied on our test results to diagnose and treat their patients either did not have the time or interest to consider the philosophical issues inherent in diagnosis, or, like me, had inadequate means to further analyze them. It was more than ten years later that I began doctoral studies in philosophy, and I was fortunate to find a faculty that was supportive ofmy efforts to address the problem. This book began as my doctoral dissertation in the Department of Philosophy at Georgetown University. I would like to acknowledge the assistance of my mentor, Robert Veatch, Ph. D. Our conversations during my Georgetown years led me in new and often fascinating directions. I would also like to acknowledge the help of Kenneth Schaffner, M. D., Ph. D.

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed. A Cross-Cultural Dialogue on Health Care Ethics provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness.

The real story of the medical campaign against abortionthrough the eyes of pro-choice physicians.The real story of the medical campaign against abortionthrough the eyes of pro-choice physicians.Read more from Beacon Press author Carole Joffe on RHrealitycheck.org'Well-researched and clearly written... Provides a compelling narrative of the dedication of doctors who have braved society's continuing ambivalence toward women's right to choose.'—K. Kaufmann, San Francisco Examiner-ChronicleA fabulous read... intense and absorbing. —Marge Berer, Women's Review of Books

Written with poignancy and compassion, Do We Still NeedDoctors? is a personal account from the front lines of the moral and political battles that are reshaping America's health care system.

A sequel to the author's earlier book: The patient as partner.

The ancient Hippocratic oath that every doctor pledges upon graduation from medical school is a code based on genuine devotion to people and a desire to serve them. It is also a code in urgent need of updating to reflect the technological and moral changes of modern society and the complicated dilemmas facing every practicing physician. This collection of essays by some of the wisest observers of modern medicine probes the various forces affecting health care today: the power of the new technology in diagnosing and treating illnesses, the growing appreciation of mind/body interactions, the emergence of corporate hospitals and health care centers, and, most importantly, the essence of physicianhood—what makes a doctor want to practice medicine. In considering these issues, the essayists question whether the medical-industrial complex will destroy physicians as we know them, making doctors employees of large profit-making institutions and more responsible to their companies than to their patients. Will increasing versatility in technological medicine remove doctors even further from the patient's bedside, weakening the diminishing bond between patient and doctor? Are there points of contact between western'scientific'medicine and holistic practices? Is there a place in modern medicine for work therapy and the placebo effect? Each of these issues prevalent in medicine today has, in its own particular way, an effect upon the core relationship between doctor and patient. In Search of the Modern Hippocrates is dedicated to the premise that current changes in medicine can produce an altered and strengthened medical profession resolved to preserve the inextricable link between commitment and care. Ending with the development of a modern oath of ethics, it provides an important guide to medicine in the complex world we now face.

'The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger.'Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was'c- tain of the ship.'Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of responsibility carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients'rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the'captain of the ship'metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically.

Medicine's changing economics have already fundamentally, permanently altered the relationship between physician and patient, E. Haavi Morreim argues. Physicians must weigh a patient's interests against the legitimate, competing claims of other patients, of payers, of society as a whole, and sometimes even of the physician himself. Focusing on actual situations in the clinical setting, Morreim explores the complex moral problems that current economic realities pose for the practicing physician. She redefines the moral obligations of both physicians and patients, traces the specific effects of these redefined obligations on clinical practice, and explores the implications for patients as individuals and for national health policy. Although the book focuses on health care in the United States, physicians everywhere are likely to face many of the same basic issues of clinical ethics, because every system of health care financing and distribution today is constrained by finite resources.