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1.
Am J Bioeth ; 24(6): 69-71, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38829590
2.
Hastings Cent Rep ; 53(4): 16-25, 2023 07.
Article in English | MEDLINE | ID: mdl-37549361

ABSTRACT

Although the technology for telemedicine existed before the Covid-19 pandemic, the need to provide medical services while minimizing the risk of contagion has encouraged its more widespread use. I argue that, although telemedicine can be useful in certain situations, physicians should not consider it an adequate substitute for the office visit. I first provide a narrative account of the experience of telemedicine. I then draw on philosophical critiques of technology to examine how telemedicine has epistemic and ethical effects that make some of the goods of medicine unavailable. Telemedicine rules out an embodied encounter between physician and patient, in which the sense of touch has special importance. The individualized attention facilitated by the in-person visit may better sustain a caring physician-patient relationship. Physicians should criticize attempts by administrators, insurers, or other parties to incentivize the wholesale replacement of traditional office visits with telemedicine.


Subject(s)
COVID-19 , Mobile Applications , Humans , Pandemics , Morals , Physician-Patient Relations
3.
Am J Bioeth ; 23(6): 70-72, 2023 06.
Article in English | MEDLINE | ID: mdl-37220379
5.
JAMA ; 328(18): 1809-1810, 2022 11 08.
Article in English | MEDLINE | ID: mdl-36346412

ABSTRACT

From the stinging words of disappointment from his attending physician, an internal medicine physician in this narrative medicine essay tells how that moment of bare truth altered him and suggests that medical students may fare better from blunt but kind corrective conversations.


Subject(s)
Physician-Patient Relations , Students, Medical , Humans
6.
J Gen Intern Med ; 36(11): 3537-3540, 2021 11.
Article in English | MEDLINE | ID: mdl-34013471

ABSTRACT

As the extent of health disparities in the USA has been revealed, particularly during the COVID-19 pandemic, physicians have increasingly attended to their roles as advocates for their patients and communities. This article presents "spheres of influence" as a concept that can help physicians think strategically about how to build upon their clinical work and expertise to promote equity in medicine. The physician's primary sphere of influence is in direct patient care. However, physicians today often have many other roles, especially within larger health care institutions in which physicians often occupy positions of authority. Physicians are therefore well-positioned to act within these spheres in ways that draw upon the ethical principles that guide patient care and contribute materially to the cause of equity for colleagues and patients alike. By making changes to the ways they already work within their clinical spaces, institutional leadership roles, and wider communities, physicians can counteract the structural problems that undermine the health of the patients they serve.


Subject(s)
COVID-19 , Physicians , Humans , Leadership , Pandemics , SARS-CoV-2
7.
Theor Med Bioeth ; 40(3): 183-196, 2019 Jun.
Article in English | MEDLINE | ID: mdl-31352556

ABSTRACT

Pellegrino and Thomasma have proposed a normative medical ethics founded on a conception of the end of medicine detached from any broader notion of the telos of human life. In this essay, I question whether such a narrow teleological account of medicine can be sustained, taking as a starting point Pellegrino and Thomasma's own contention that the end of medicine projects itself onto the intermediate acts that aim at that end. In order to show how the final end of human life similarly alters intermediate ends, such as the end of medicine, I describe Thomas Aquinas's concept of pain and explain how his remedies for pain derive from his account of the telos of human life. In turn, this account has implications for the way in which physicians who accept such a telos would manage their patients' pain. If a comprehensive telos for human life is necessary to make sense of even such a routine aspect of medical care, then medical ethicists may not be able to sidestep questions about the good life for human beings.


Subject(s)
Chronic Pain/therapy , Ethics, Medical , Philosophy, Medical , Humans , Practice Patterns, Physicians'/ethics
8.
J Med Philos ; 44(3): 299-313, 2019 May 18.
Article in English | MEDLINE | ID: mdl-31102454

ABSTRACT

The predominant approach of public health experts to cigarette smoking might be described as behaviorist, for it aims to eliminate this behavior without attending to human agency and intention. The requirement that physicians address smoking cessation at every patient visit also constitutes physicians as "managers" who focus narrowly on technical means to achieve predetermined ends. In this paper, I contrast such an approach with the Aristotelian tradition, according to which physician and patient ought to develop the virtue of temperance that would allow the patient to quit smoking. Although this model could potentially mitigate medicine's behaviorist-managerial tendencies, I follow Aristotle to argue that it requires a moral friendship in which participants share a conception of the human good and pursue that good together. Due to the intractable moral pluralism that characterizes contemporary life, physicians and patients are unlikely to achieve this sort of friendship, making Aristotelian medicine impracticable at present.


Subject(s)
Friends/psychology , Morals , Physician-Patient Relations , Smoking Cessation/psychology , Temperance/psychology , Humans , Intention , Philosophy, Medical , Virtues
9.
Linacre Q ; 86(4): 335-346, 2019 Nov.
Article in English | MEDLINE | ID: mdl-32431426

ABSTRACT

In this article, we provide an update to Catholic ethicists and clinicians about the current status of Catholic teaching and practice regarding brain death. We aim to challenge the notion that the question has been definitively settled, despite the widespread application of this concept in medical practice including at Catholic facilities. We first summarize some of the notable arguments for and against brain death in Catholic thought as well as the available magisterial teachings on this topic. Although Catholic bishops, theologians, and ethicists have generally signaled at least tentative approval of the neurological criteria for the determination of death, we contend that no definitive magisterial teaching on brain death currently exists; therefore, Catholics are not currently bound to uphold any position on these criteria. In the second part of the article, we describe how Catholics, particularly Catholic medical practitioners, must presently inform their consciences on this issue while awaiting a more definitive magisterial resolution. SUMMARY: Some prominent Catholic theologians and physicians have argued against the validity of brain death; however, most Catholic ethicists and physicians accept the validity of brain death as true human death. In this paper, we argue that there is no definitive magisterial teaching on brain death, meaning that Catholics are not bound to uphold any position on brain death. Catholics in general, but especially Catholic medical practitioners, should inform their consciences on this intra-Catholic debate on brain death while awaiting more definitive magisterial teaching.

10.
Theor Med Bioeth ; 39(2): 91-110, 2018 04.
Article in English | MEDLINE | ID: mdl-29992371

ABSTRACT

Experts in medical informatics have argued for the incorporation of ever more machine-learning algorithms into medical care. As artificial intelligence (AI) research advances, such technologies raise the possibility of an "iDoctor," a machine theoretically capable of replacing the judgment of primary care physicians. In this article, I draw on Martin Heidegger's critique of technology to show how an algorithmic approach to medicine distorts the physician-patient relationship. Among other problems, AI cannot adapt guidelines according to the individual patient's needs. In response to the objection that AI could develop this capacity, I use Hubert Dreyfus's analysis of AI to argue that attention to the needs of each patient requires the physician to attune his or her perception to the patient's history and physical exam, an ability that seems uniquely human. Human physician judgment will remain better suited to the practice of primary care despite anticipated advances in AI technology.


Subject(s)
Artificial Intelligence/standards , Judgment , Physicians/psychology , Humans , Physician-Patient Relations , Physicians/standards
11.
Teach Learn Med ; 30(3): 303-316, 2018.
Article in English | MEDLINE | ID: mdl-29351403

ABSTRACT

THEORY: In the Project on the Good Physician, the authors propose a moral intuitionist model of virtuous caring that places the virtues of Mindfulness, Empathic Compassion, and Generosity at the heart of medical character education. HYPOTHESES: Hypothesis 1a: The virtues of Mindfulness, Empathic Compassion, and Generosity will be positively associated with one another (convergent validity). Hypothesis 1b: The virtues of Mindfulness and Empathic Compassion will explain variance in the action-related virtue of Generosity beyond that predicted by Big Five personality traits alone (discriminant validity). Hypothesis 1c: Virtuous students will experience greater well-being ("flourishing"), as measured by four indices of well-being: life meaning, life satisfaction, vocational identity, and vocational calling (predictive validity). Hypothesis 1d: Students who self-report higher levels of the virtues will be nominated by their peers for the Gold Humanism Award (predictive validity). Hypothesis 2a-2c: Neuroticism and Burnout will be positively associated with each other and inversely associated with measures of virtue and well-being. METHOD: The authors used data from a 2011 nationally representative sample of U.S. medical students (n = 499) in which medical virtues (Mindfulness, Empathic Compassion, and Generosity) were measured using scales adapted from existing instruments with validity evidence. RESULTS: Supporting the predictive validity of the model, virtuous students were recognized by their peers to be exemplary doctors, and they were more likely to have higher ratings on measures of student well-being. Supporting the discriminant validity of the model, virtues predicted prosocial behavior (Generosity) more than personality traits alone, and students higher in the virtue of Mindfulness were less likely to be high in Neuroticism and Burnout. CONCLUSIONS: Data from this descriptive-correlational study offered additional support for the validity of the moral intuitionist model of virtuous caring. Applied to medical character education, medical school programs should consider designing educational experiences that intentionally emphasize the cultivation of virtue.


Subject(s)
Delivery of Health Care/ethics , Models, Psychological , Professionalism , Students, Medical/psychology , Virtues , Ethics, Medical , Female , Humans , Male , Mindfulness , Personal Satisfaction , Physicians , Surveys and Questionnaires
12.
Fam Med ; 48(7): 511-6, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27472787

ABSTRACT

BACKGROUND: Medical educators and powerful physician organizations agree on the importance of professionalism for the formation of good physicians. However, the many definitions of professionalism found in the literature lack content and differ significantly, undermining attempts to describe and implement professionalism curricula. The work of the contemporary moral philosopher Alasdair MacIntyre on the virtues may help provide some of the content that the concept of professionalism currently lacks. MacIntyre shows the importance of the virtues, particularly justice, courage, and truthfulness, for the success of any "practice," defined as a form of cooperative human activity. Medicine fits his definition of a practice, and accordingly, medical trainees require these virtues, among others, to succeed. This analysis may provide a foundation for a new form of ethical instruction, in which excellent clinician-educators model the virtues for students and residents, thereby combating the "hidden curriculum" that sometimes corrodes these values. This educational model resembles the way in which masters of other practices, such as music, teach their students and help them become lifelong learners. Such an approach requires leaders at academic medical centers to commit to the establishment of communities in which the virtues flourish. Instruction in the virtues could supplement the emphasis on principles and rule following that predominates in medical education. It would also allow physicians and students to engage with the various cultural and religious traditions in which virtue ethics has flourished, enriching the diversity of medical ethics education and promoting trainees' professional development.


Subject(s)
Courage , Ethics, Medical/education , Internship and Residency , Social Justice/psychology , Students, Medical , Virtues , Curriculum , Education, Medical , Humans , Learning
13.
Card Electrophysiol Clin ; 7(3): 547-55, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26304534

ABSTRACT

The 2010 guidelines regarding management of cardiovascular implantable electronic devices (CIEDs) conclude that patient requests to deactivate these devices at the end of life should be honored. Nevertheless, many clinicians and patients report feeling uncomfortable discontinuing such therapies, particularly pacemakers. If the principles of clinical ethics are followed, turning off CIEDs at the end of life is morally permissible. Clinicians managing CIEDs should discuss the option of deactivation with the patient at the time of implantation and be prepared to reopen the question as warranted by the patient's clinical course and respect for the patient's authentic values.


Subject(s)
Defibrillators, Implantable/ethics , Pacemaker, Artificial/ethics , Terminal Care/ethics , Attitude of Health Personnel , Humans , Physician-Patient Relations
14.
J Pain Symptom Manage ; 44(6): 843-51, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22727947

ABSTRACT

CONTEXT: Prior studies suggest that terminally ill patients who use religious coping are less likely to have advance directives and more likely to opt for heroic end-of-life measures. Yet, no study to date has examined whether end-of-life practices are associated with measures of religiosity and spirituality. OBJECTIVES: To assess the relationship between general measures of patient religiosity and spirituality and patients' preferences for care at the end of life. METHODS: We examined data from the University of Chicago Hospitalist Study, which gathers sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center. Primary outcomes were whether the patient had an advance directive, a do-not-resuscitate (DNR) order, a durable power of attorney for health care, and an informally designated decision maker. Primary predictors were religious attendance, intrinsic religiosity, and self-rated spirituality. RESULTS: The sample population (n=8308) was predominantly African American (73%) and female (60%). In this population, 1.5% had advance directives and 10.4% had DNR orders. Half (51%) of the patients had specified a decision maker. White patients were more likely than African American patients to have an advance directive (odds ratio [OR] 2.1; 95% CI 1.1-4.0) and a DNR order (OR 1.7; 95% CI 1.0-2.9). Patients reporting high intrinsic religiosity were more likely to have specified a decision maker than those reporting low intrinsic religiosity (OR 1.3; 95% CI 1.1-1.6). The same was true for those with high compared with low spirituality (OR 1.3; 95% CI 1.1-1.5). Religious characteristics were not significantly associated with having an advance directive or DNR order. CONCLUSION: Among general medicine inpatients at an urban academic medical center, those who were highly religious and/or spiritual were more likely to have a designated decision maker to help with end-of-life decisions but did not differ from other patients in their likelihood of having an advance directive or DNR order.


Subject(s)
Advance Directives/statistics & numerical data , Attitude to Death , Inpatients/statistics & numerical data , Religion , Resuscitation Orders , Spirituality , Terminal Care/statistics & numerical data , Adult , Age Distribution , Aged , Aged, 80 and over , Attitude to Health , Chicago/epidemiology , Decision Making , Female , Humans , Male , Patient Preference/statistics & numerical data , Proxy/statistics & numerical data , Sex Distribution , Young Adult
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