Cutting Moral Principles Down to Size

Book reviewed in this article: Morality and Conflict . By Stuart Hampshire. Beyond Subjective Morality: Ethical Reasoning and Political Philosophy . By James S. Fishkin.     

Barriers to organ procurement: why donor cards fail

A recent nationwide survey (see Thomas D. Overcast, et al., "Problems in the identification of potential organ donors," Journal of the American Medical Association, 23-30 March 1984) found a lack of effective state and hospital programs for using donor cards in organ procurement. Although the Uniform Anatomical Gift Act recognizes such cards as legal evidence of a person's intention to donate, physicians cite legal and ethical reasons for requiring family approval before organ removal. The study recommended greater government involvement in organ procurement, stronger legislation to remove perceived legal problems, and education of the medical community and the public to lessen ethical objections.     

Early conjectures that Down syndrome is caused by chromosomal nondisjunction

In 1959, cytologic studies demonstrated that Down syndrome was associated with a nondisjunction now known as trisomy 21. Twenty years earlier (1932-39), at least three writers conjectured, independently of one another, that Down syndrome might be a form of nondisjunction: Petrus J. Waardenburg (1932), Adrien Bleyer (1934), and G. Fanconi (1938). In separate papers, Raymond Turpin (1937), Walter E. Southwick (1939), and Lionel S. Penrose (1939) also proposed that Down syndrome could be a chromosomal anomaly, but without specifying nondisjuction. However, these conjectures were largely ignored by contemporary medical writers. This essay (1) explores the background and context of early conjectures that Down syndrome is a form of nondisjunction, (2) provides some possible reasons why these conjectures were not given greater credence, and (3) traces early efforts to assimilate Down syndrome and other genetic disorders to what Robert Koch called the etiologic standpoint.     

Bringing OSCEs into the 21st century: Why internet access is a requirement for assessment validity

Abstract

Web-based resources are a vital and indispensable component of modern medical practice. However, these resources are often not made available during clinical assessments such as OSCEs, creating a divide between assessment and real-life practice. Open Resource Clinical Assessments (ORCAs) are a novel concept that allows the use of ‘open book’ resources such as the internet (hence ‘open resource’) to improve assessment validity by recreating realistic workplace conditions. This is the first discussion in the academic literature as to why this form of assessment should be a pedagogical requirement within medical education, and how to overcome the inevitable challenges in implementation. Further work is required to understand how this will impact the medical curriculum for both undergraduates and postgraduates, and to pilot this concept.