Mediation in the Medical Field: Is Neutral Intervention Possible?

Neutrality is held to be the touchstone of good mediation. True neutrality is elusive, however, and probably not even desirable, at least when applied to patient-provider disputes over medical care. In this context, mediators should not posture as "neutrals"; they should strive instead to protect their clients' autonomy.     

Is Suffering the Enemy?

The relief of suffering is the great goal of medicine. That physicians give up on suffering when they can do nothing about the underlying condition is one of the contemporary criticisms of medicine. Yet even in irremediable suffering there is something noble, to which physicians should attend.     

Doctor in the house: the medical student as academic,attendant and apprentice?

It is contended that change in the health services should be accompanied by a re-examination of medical education. Changes in professional roles and practices, specialist training and the location of patient care should be more central to informing change in undergraduate medical education. Although innovation in undergraduate curricula is taking place, much of this is in relation to improvement in educational methods. We would argue that these initiatives need to be more firmly linked to the realities of delivering healthcare today.     

Can Autonomy and Equity Coexist in the ICU?

Cohen reviews two collections of essays on ethical issues in critical care medicine: Ethics and Critical Care Medicine, edited by John C. Moskop and Loretta Kopelman (D. Reidel; 1985), and "Ethical Moments in Critical Care Medicine," a symposium issue of Critical Care Clinics, edited by James P. Orlowski and George A. Kanoti (1986 Jan; 2(7): 189 p.). Some of the topics discussed by the contributors include physician beneficence vs. patient autonomy in critical care decision making; the pressures created by the "rescue ethos" of the critical care setting; the selection of patients for admission to intensive care; the equitable distribution of critical care resources; and the increasing need to factor costs into treatment decisions. E. Cassell, E.D. Pellegrino, J. Katz, D. Walton and N. Donen, J. Moskop, J. Perrin, H.T. Engelhardt, R. Veatch, J. Paris and F. Reardon, S. Youngner, and S. Imbus and B. Zawacki are among the essayists.     

Was the black death in India and China?

Firsthand accounts of the Black Death in Europe and the Middle East and many subsequent historians have assumed that the pandemic originated in Asia and ravaged China and India before reaching the West. One reason for this conviction among modern historians is that the plague in the nineteenth century originated and did its worst damage in these countries. But a close examination of the sources on the Delhi Sultanate and the Yuan Dynasty provides no evidence of any serious epidemic in fourteenth-century India and no specific evidence of plague among the many troubles that afflicted fourteenth-century China.     

Is More Life Always Better?: The New Biology of Aging and the Meaning of Life

The social consequences of extending the human life span might be quite bad; perhaps the worst outcome is that power could be concentrated into ever fewer hands, as those who wield it gave way more slowly to death and disease. But the worry that more life would damage individuals' quality of life is not persuasive. Depending on what the science of aging makes possible, and on how people plan their lives, longer life might even facilitate a richer and deeper life.     

Exceptional Suffering? Enumeration and Vernacular Accounting in the HIV-Positive Experience

Drawing on 17 months of ethnographic fieldwork in Freetown, Sierra Leone, I highlight the recursive relationship between Sierra Leone as an exemplary setting and HIV as an exceptional disease. Through this relationship, I examine how HIV-positive individuals rely on both enumerative knowledge (seroprevalence rates) and vernacular accounting (NGO narratives of vulnerability) to communicate the uniqueness of their experience as HIV sufferers and to demarcate the boundaries of their status. Various observers' enumerative and vernacular accounts of Sierra Leone's decade-long civil conflict, coupled with global health accounts of HIV as exceptional, reveal the calculus of power through which global health projects operate. The contradictions between the exemplary and the exceptional-and the accompanying tension between quantitative and qualitative facts-are mutually constituted in performances and claims made by HIV-positive individuals themselves.     

To participate or not participate in unprofessional behavior – Is that the question?

Introduction: Medical education provides students with abundant learning opportunities, each of which is embodied with messages concerning what is expected from students. This paper analyses students? exposure to instances of unprofessional behavior, investigating whether they judge such behavior to be unprofessional and whether they also participate in unprofessional behavior.

Methods: The survey developed in the Pritzker School of Medicine at the University of Chicago was the basis of this questionnaire that was answered by 276 students from two medical schools in Brazil and Portugal.

Results: Unprofessional behavior was observed frequently by students in both universities, and the mean participation rates were similar (26% and 27%). Forty-five percent of students? participation in unprofessional behavior was explained by academic year, prior observation, and judgment.

Discussion: The results indicate that once students have observed, participated in or misjudged unprofessional behavior, they tend to participate in and misjudge such behavior. The frequency with which students judged behaviors they had observed or participated in as ?borderline? or unprofessional could mean that they are experiencing moral distress.

Conclusion: Proper discussion of unprofessional behavior should foster a broad debate to encourage empowered students, faculties, and physicians to co-create a more professional environment for patient care.