象牙塔里的人们依旧如故

我有一个叫Betty的病人，她今年75岁。从我认识她以来，她就一直患有严重的类风湿关节炎，到现在已经快30年。尽管做了髋关节和膝关节的置换，她还是痛得很厉害。而最近丈夫的去世使她的病情更糟了。现在，她又面临一个新的问题：过去对她最有效的止痛剂即将从市场上消失。     

Can compulsory removal ever be justified for adults who are mentally competent?

Section 47 of the National Assistance Act is controversial in that it makes provision for the compulsory removal and care of mentally competent adults in certain limited circumstances. A case is described in which it is argued that compulsory management could be justified. This is because the diversity and potentially conflicting nature of the relevant considerations involved in this and a restricted range of other cases, defies their being captured in any wholly rational moral scheme. It follows that if the law is to be both sensitive and just it cannot always provide definitive guidance as to how the community doctor, as the designated decision-maker, should act. The acceptance of his or her judgement is therefore necessary and depends for its proper working on trust, which can only be gained through compassion and respect for the patients concerned.     

Nosocomial Legionnaires' disease. Epidemiologic demonstration of cooling towers as a source

Investigation of a recent outbreak of nosocomial legionnaires' disease--initially thought to be due to the documented presence of Legionella pneumophila in the hospital potable water--showed that aerosols from one or more cooling towers were the actual source of infection. From June 27 to Aug 25, 1983, nosocomial legionnaires' disease developed in 15 persons at a hospital in Rhode Island. Twelve (80%) of 15 case-patients occupied rooms in building 1, unit B, compared with eight (28%) of 29 control patients (odds ratio = 10.8; 95% confidence interval = 1.4 to 85.6). Subsequent investigation demonstrated that water in a cooling tower located 100 ft upwind of unit B was heavily contaminated with L pneumophila, serogroup 1, subgroup 1, 2, 4, 5. The same strain was isolated from nine of the patients and from the make-up water for the tower. Active surveillance during the ten months following decontamination of the cooling tower identified no additional cases of nosocomial legionnaires' disease, although the hospital potable water had not been treated. While recommendations have been made for controlling nosocomial legionnaires' disease by heating or hyperchlorination of hospital potable water, this outbreak demonstrates the importance of an adequate epidemiologic-environmental investigation in choosing the appropriate control strategy.     

The remote prayer delusion: clinical trials that attempt to detect supernatural intervention are as futile as they are unethical

Extreme rates of premature death prior to the advent of modern medicine, very low rates of premature death in First World nations with low rates of prayer, and the least flawed of a large series of clinical trials indicate that remote prayer is not efficacious in treating illness. Mass contamination of sample cohorts renders such clinical studies inherently ineffectual. The required supernatural and paranormal mechanisms render them implausible. The possibility that the latter are not benign, and the potentially adverse psychological impact of certain protocols, renders these medical trials unethical. Resources should no longer be wasted on medical efforts to detect the supernatural and paranormal.