Marc A. Rodwin
- Published in print:
- 2011
- Published Online:
- May 2011
- ISBN:
- 9780199755486
- eISBN:
- 9780199894918
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199755486.001.0001
- Subject:
- Political Science, Comparative Politics
As most Americans know, conflicts of interest riddle the US health care system. They result from physicians practicing medicine as entrepreneurs, from physicians' ties to pharma, and from ...
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As most Americans know, conflicts of interest riddle the US health care system. They result from physicians practicing medicine as entrepreneurs, from physicians' ties to pharma, and from investor-owned firms and insurers' influence over physicians' medial choices. These conflicts raise questions about physicians' loyalty to their patients and their professional and economic independence. The consequences of such conflicts of interest are often devastating for the patients—and society—stuck in the middle. This book examines the development of these conflicts in the United States, France, and Japan. It shows that national differences in the organization of medical practice and the interplay of organized medicine, the market, and the state give rise to variations in the type and prevalence of such conflicts. The book then analyzes the strategies that each nation employs to cope with them. Unfortunately, many proposals to address physicians' conflicts of interest do not offer solutions that stick. But drawing on the experiences of these three nations, the book demonstrates that we can mitigate these problems with carefully planned reform and regulation. It examines a range of measures that can be taken in the private and public sector to preserve medical professionalism, and concludes that there just might be more than one prescription to this seemingly incurable malady.Less
As most Americans know, conflicts of interest riddle the US health care system. They result from physicians practicing medicine as entrepreneurs, from physicians' ties to pharma, and from investor-owned firms and insurers' influence over physicians' medial choices. These conflicts raise questions about physicians' loyalty to their patients and their professional and economic independence. The consequences of such conflicts of interest are often devastating for the patients—and society—stuck in the middle. This book examines the development of these conflicts in the United States, France, and Japan. It shows that national differences in the organization of medical practice and the interplay of organized medicine, the market, and the state give rise to variations in the type and prevalence of such conflicts. The book then analyzes the strategies that each nation employs to cope with them. Unfortunately, many proposals to address physicians' conflicts of interest do not offer solutions that stick. But drawing on the experiences of these three nations, the book demonstrates that we can mitigate these problems with carefully planned reform and regulation. It examines a range of measures that can be taken in the private and public sector to preserve medical professionalism, and concludes that there just might be more than one prescription to this seemingly incurable malady.
Nicole M. Piemonte
- Published in print:
- 2018
- Published Online:
- September 2018
- ISBN:
- 9780262037396
- eISBN:
- 9780262344968
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262037396.003.0004
- Subject:
- Philosophy, Moral Philosophy
Chapter four explores how educators might help cultivate the capacity for authentic patient care among doctors-in-training, including a comportment of humility, openness, and gratitude for patients. ...
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Chapter four explores how educators might help cultivate the capacity for authentic patient care among doctors-in-training, including a comportment of humility, openness, and gratitude for patients. The argument is made that the curative ethos of medicine and its preoccupation with calculative thinking will persist until educators can cultivate within clinicians and clinicians-in-training the capacity to face their vulnerability and the reality of existential anxiety. It is through a pedagogy that values and fosters vulnerability and reflexivity that this capacity can be cultivated. Although recent trends in the professionalism movement, including that of “professional identity formation,” have made progress toward these ends, these movements actually may serve to reinforce calculative thinking, due to their focus on outcomes and assessment. This chapter looks critically at such trends in medical education and contends that ideas concerning professionalism can be enriched and expanded through an understanding of virtue ethics and the Aristotelian concept of phronesis, which emphasize personal development, experiential and habitual learning, and quality mentorship.Less
Chapter four explores how educators might help cultivate the capacity for authentic patient care among doctors-in-training, including a comportment of humility, openness, and gratitude for patients. The argument is made that the curative ethos of medicine and its preoccupation with calculative thinking will persist until educators can cultivate within clinicians and clinicians-in-training the capacity to face their vulnerability and the reality of existential anxiety. It is through a pedagogy that values and fosters vulnerability and reflexivity that this capacity can be cultivated. Although recent trends in the professionalism movement, including that of “professional identity formation,” have made progress toward these ends, these movements actually may serve to reinforce calculative thinking, due to their focus on outcomes and assessment. This chapter looks critically at such trends in medical education and contends that ideas concerning professionalism can be enriched and expanded through an understanding of virtue ethics and the Aristotelian concept of phronesis, which emphasize personal development, experiential and habitual learning, and quality mentorship.
Holly Fernandez Lynch
- Published in print:
- 2008
- Published Online:
- August 2013
- ISBN:
- 9780262123051
- eISBN:
- 9780262278720
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262123051.003.0018
- Subject:
- Biology, Bioethics
This chapter defines the various models of medical professionalism. The challenges to conventional notions of medical professionalism are addressed. The chapter shows that the consent model cannot ...
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This chapter defines the various models of medical professionalism. The challenges to conventional notions of medical professionalism are addressed. The chapter shows that the consent model cannot convincingly be used to support the claim that physicians have a broad obligation to subrogate their personal moral beliefs in order to satisfy patient demands. It demonstrates that the gatekeeper model of professionalism is the only approach capable of laying a solid foundation for the maximum protection of both doctors and patients. In general, the models of professionalism explored in the chapter provide a significant perspective on the conscience clause debate, but only one of them can get out of the current stalemate and move toward a true balancing of interests.Less
This chapter defines the various models of medical professionalism. The challenges to conventional notions of medical professionalism are addressed. The chapter shows that the consent model cannot convincingly be used to support the claim that physicians have a broad obligation to subrogate their personal moral beliefs in order to satisfy patient demands. It demonstrates that the gatekeeper model of professionalism is the only approach capable of laying a solid foundation for the maximum protection of both doctors and patients. In general, the models of professionalism explored in the chapter provide a significant perspective on the conscience clause debate, but only one of them can get out of the current stalemate and move toward a true balancing of interests.
Nicole M. Piemonte
- Published in print:
- 2018
- Published Online:
- September 2018
- ISBN:
- 9780262037396
- eISBN:
- 9780262344968
- Item type:
- book
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262037396.001.0001
- Subject:
- Philosophy, Moral Philosophy
While many commentators have pointed to the lack of compassion and empathy in medicine, their critiques, for the most part, have not considered seriously the deeper philosophical, psychological, and ...
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While many commentators have pointed to the lack of compassion and empathy in medicine, their critiques, for the most part, have not considered seriously the deeper philosophical, psychological, and ontological reasons why clinicians and medical students might choose to conceive of medicine as an endeavor concerned solely with the biological workings of the body. Thus, this book examines why it is that existential suffering tends to be overlooked in medical practice and education, as well as the ways in which contemporary medical epistemology and pedagogy not only perpetuate but are indeed shaped by the human tendency to flee from the reality of death and vulnerability. It also explores how students and doctors perceive medicine, including what it means to be a doctor and what responsibilities doctors have toward addressing existential suffering. Contending that the being of the physician is constituted by the other who calls out to her in his suffering, this book argues that the doctor is, in fact, called to attend to suffering that extends beyond the biological. It also discusses how future physicians might be “brought back to themselves” and oriented toward a deeper sense of care through a pedagogy that encourages intentional reflection and values the cultivation of the self, openness to vulnerability, and a fuller conception of what it means to be a healer.Less
While many commentators have pointed to the lack of compassion and empathy in medicine, their critiques, for the most part, have not considered seriously the deeper philosophical, psychological, and ontological reasons why clinicians and medical students might choose to conceive of medicine as an endeavor concerned solely with the biological workings of the body. Thus, this book examines why it is that existential suffering tends to be overlooked in medical practice and education, as well as the ways in which contemporary medical epistemology and pedagogy not only perpetuate but are indeed shaped by the human tendency to flee from the reality of death and vulnerability. It also explores how students and doctors perceive medicine, including what it means to be a doctor and what responsibilities doctors have toward addressing existential suffering. Contending that the being of the physician is constituted by the other who calls out to her in his suffering, this book argues that the doctor is, in fact, called to attend to suffering that extends beyond the biological. It also discusses how future physicians might be “brought back to themselves” and oriented toward a deeper sense of care through a pedagogy that encourages intentional reflection and values the cultivation of the self, openness to vulnerability, and a fuller conception of what it means to be a healer.
Susan B. Levin
- Published in print:
- 2014
- Published Online:
- August 2014
- ISBN:
- 9780199919802
- eISBN:
- 9780199378159
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199919802.003.0008
- Subject:
- Philosophy, Ancient Philosophy, History of Philosophy
For the first time in the history of bioethics, the possible contributions of ancient philosophy are receiving notable attention. The chapter contends that while this is all to the good, ...
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For the first time in the history of bioethics, the possible contributions of ancient philosophy are receiving notable attention. The chapter contends that while this is all to the good, bioethicists’ focus on Aristotle’s notion of phronêsis(practical wisdom) is misplaced. In the meantime, the promise of Plato remains virtually untapped by those seeking collaborative models of the doctor-patient tie that avoid the pitfalls of paternalism and autonomy. In addition, Plato’s explorations of human nature and his political thought have much to offer bioethics right now in its probing of medical professionalism and medicine’s role in society. Though engagement with Plato will not resolve our own quandaries, his work, particularly the Laws, warrants greater attention from bioethicists than it has heretofore received.Less
For the first time in the history of bioethics, the possible contributions of ancient philosophy are receiving notable attention. The chapter contends that while this is all to the good, bioethicists’ focus on Aristotle’s notion of phronêsis(practical wisdom) is misplaced. In the meantime, the promise of Plato remains virtually untapped by those seeking collaborative models of the doctor-patient tie that avoid the pitfalls of paternalism and autonomy. In addition, Plato’s explorations of human nature and his political thought have much to offer bioethics right now in its probing of medical professionalism and medicine’s role in society. Though engagement with Plato will not resolve our own quandaries, his work, particularly the Laws, warrants greater attention from bioethicists than it has heretofore received.
Stephen Harrison
- Published in print:
- 2015
- Published Online:
- January 2016
- ISBN:
- 9781447313267
- eISBN:
- 9781447313298
- Item type:
- chapter
- Publisher:
- Policy Press
- DOI:
- 10.1332/policypress/9781447313267.003.0004
- Subject:
- Political Science, Public Policy
Although Lipsky made few references to health workers, the autonomy historically associated with physicians' work implies that health 'policy' is significantly determined by the aggregate of ...
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Although Lipsky made few references to health workers, the autonomy historically associated with physicians' work implies that health 'policy' is significantly determined by the aggregate of individual clinical decisions, so that physicians can be regarded as street-level bureaucrats. However, developments in 'evidence-based medicine' and health quasi-markets have undermined the assumed indeterminacy of medicine upon which clinical autonomy is largely based, allowing clinical practice to be bureaucratised through incentivised clinical guidelines and 'patient pathways'. The English National Health Service evidences such bureaucratisation in primary care, though less clearly in secondary care. These developments do not constitute the imposition of 'machine bureaucracy' upon medicine, but do imply that Lipsky's criteria for the manageability of street-level bureaucracy are being approached. More generally, this chapter shows that the potential for bureaucratisation of clinical practice, though not unlimited, is somewhat greater than long-established theories about the esoteric and tacit nature of medical practice would suggest.Less
Although Lipsky made few references to health workers, the autonomy historically associated with physicians' work implies that health 'policy' is significantly determined by the aggregate of individual clinical decisions, so that physicians can be regarded as street-level bureaucrats. However, developments in 'evidence-based medicine' and health quasi-markets have undermined the assumed indeterminacy of medicine upon which clinical autonomy is largely based, allowing clinical practice to be bureaucratised through incentivised clinical guidelines and 'patient pathways'. The English National Health Service evidences such bureaucratisation in primary care, though less clearly in secondary care. These developments do not constitute the imposition of 'machine bureaucracy' upon medicine, but do imply that Lipsky's criteria for the manageability of street-level bureaucracy are being approached. More generally, this chapter shows that the potential for bureaucratisation of clinical practice, though not unlimited, is somewhat greater than long-established theories about the esoteric and tacit nature of medical practice would suggest.
Susan B. Levin
- Published in print:
- 2014
- Published Online:
- August 2014
- ISBN:
- 9780199919802
- eISBN:
- 9780199378159
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199919802.001.0001
- Subject:
- Philosophy, Ancient Philosophy, History of Philosophy
Scholars typically view Plato’s engagement with medicine as uniform and largely positive; this book shows, however, that his handling of medicine unfolds in several key phases and that he views it as ...
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Scholars typically view Plato’s engagement with medicine as uniform and largely positive; this book shows, however, that his handling of medicine unfolds in several key phases and that he views it as an important rival for authority on phusis (nature) and eudaimonia (flourishing). The book’s arguments rest on careful attention both to Plato and to the Hippocratic Corpus. Although Plato’s rivalries with rhetoric and poetry have received much attention, that with medicine has largely escaped notice. An evident but unexpressed tension involving medicine’s status that emerges in the Gorgias is explored in Plato’s critiques of medicine in the Symposium and Republic. In the Laws this rivalry and tension dissolve; why is Plato’s rivalry with medicine put to rest while the other two continue? Developments in Plato’s views of human nature, with their resulting impact on his political thought, drive his striking adjustments involving medicine in the Laws. This book’s investigation of Plato is timely, since for the first time in the history of bioethics, the value of ancient philosophy is receiving notable attention. Most discussions focus on Aristotle’s concept of phronêsis (practical wisdom), leaving Plato’s promise nearly untapped. The book’s discoveries involving Plato show that he has much to offer bioethics as it works to address pressing concerns about the doctor-patient tie, medical professionalism, and medicine’s relationship to society. Since much is at stake here not only for medicine but for all of us as human beings, there is no better time to explore Plato’s distinctive insights.Less
Scholars typically view Plato’s engagement with medicine as uniform and largely positive; this book shows, however, that his handling of medicine unfolds in several key phases and that he views it as an important rival for authority on phusis (nature) and eudaimonia (flourishing). The book’s arguments rest on careful attention both to Plato and to the Hippocratic Corpus. Although Plato’s rivalries with rhetoric and poetry have received much attention, that with medicine has largely escaped notice. An evident but unexpressed tension involving medicine’s status that emerges in the Gorgias is explored in Plato’s critiques of medicine in the Symposium and Republic. In the Laws this rivalry and tension dissolve; why is Plato’s rivalry with medicine put to rest while the other two continue? Developments in Plato’s views of human nature, with their resulting impact on his political thought, drive his striking adjustments involving medicine in the Laws. This book’s investigation of Plato is timely, since for the first time in the history of bioethics, the value of ancient philosophy is receiving notable attention. Most discussions focus on Aristotle’s concept of phronêsis (practical wisdom), leaving Plato’s promise nearly untapped. The book’s discoveries involving Plato show that he has much to offer bioethics as it works to address pressing concerns about the doctor-patient tie, medical professionalism, and medicine’s relationship to society. Since much is at stake here not only for medicine but for all of us as human beings, there is no better time to explore Plato’s distinctive insights.
Ronald M. Green
- Published in print:
- 2014
- Published Online:
- November 2014
- ISBN:
- 9780199926176
- eISBN:
- 9780199396788
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199926176.003.0022
- Subject:
- Philosophy, Moral Philosophy, Philosophy of Religion
This chapter argues that there is a prima facie moral obligation to prevent and relieve suffering. Because pain and suffering are states that all rational people ordinarily want to avoid, this ...
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This chapter argues that there is a prima facie moral obligation to prevent and relieve suffering. Because pain and suffering are states that all rational people ordinarily want to avoid, this obligation does not derive from a specific view of life’s goods and evils. There are limits to the relief of suffering, but they are based on this same duty. Arguments against active euthanasia that point to euthanasia’s adverse long-term impacts on patients and society are examples. On the basis of this understanding, this chapter critiques religious views that appear to valorize suffering. It concludes with an examination of arguments that would limit medical interventions in the name of preventing the medicalization of suffering. Drawing on the concept of “malady” and its conceptually tight relation to suffering, the chapter argues that there are often good reasons for limiting the scope of medical professionalism to the prevention and treatment of diseases (maladies). The prevention and relief of suffering, however, sometimes counsel allowing physicians to assist patients seeking treatments for other, nondisease conditions.Less
This chapter argues that there is a prima facie moral obligation to prevent and relieve suffering. Because pain and suffering are states that all rational people ordinarily want to avoid, this obligation does not derive from a specific view of life’s goods and evils. There are limits to the relief of suffering, but they are based on this same duty. Arguments against active euthanasia that point to euthanasia’s adverse long-term impacts on patients and society are examples. On the basis of this understanding, this chapter critiques religious views that appear to valorize suffering. It concludes with an examination of arguments that would limit medical interventions in the name of preventing the medicalization of suffering. Drawing on the concept of “malady” and its conceptually tight relation to suffering, the chapter argues that there are often good reasons for limiting the scope of medical professionalism to the prevention and treatment of diseases (maladies). The prevention and relief of suffering, however, sometimes counsel allowing physicians to assist patients seeking treatments for other, nondisease conditions.
