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Rhetoric, Politics, and Trust in Breast Cancer Research
How Science Is Solving Modern Medicine's Most Perplexing Problem
Once the stuff of science fiction, neural prosthetics are now a reality. Research and technology are creating implants that enable the deaf to hear, the blind to see, and the paralyzed to move. Shattered Nerves takes us on a journey into a new medical frontier, where sophisticated, state-of-the-art medical devices repair and restore failed sensory and motor systems. In a compelling narrative that reveals the intimate relationship between technology and the physicians, scientists, and patients who bring it to life, Victor D. Chase explores groundbreaking developments in neural technology. Through personal interviews and extensive research, Chase introduces us to the people and devices that are restoring shattered lives, from implants that enable the paralyzed to stand, walk, feed, and groom themselves, to those that restore bladder and bowel control, and even sexual function. Signals from the brains of paralyzed people are captured and transformed to allow them to operate computers. Brain implants hold the potential to resolve psychiatric illnesses and to restore the ability to form memories in damaged brains. This timely and important book also explores troubling boundaries between restoration and enhancement, where implants could conceivably endow the able-bodied with superhuman capabilities. Chase concludes this fascinating book with a provocative question: Just because we can, does that mean we should?
Spiritual Perspectives and Clinical Practice
To what extent should spiritual information be part of patients’ medical assessments? How should physicians respond when patients refuse life-saving care on religious grounds? Should doctors pray with their patients? Questions such as these raise deeper ones about the goals of medicine and the nature of healing. In a set of engaging and candid essays, The Soul of Medicine explores the role and influence of spirituality in clinical practice, professionalism, and medical education. The contributors to this volume approach this topic from their own spiritual perspectives—Jewish, Christian, Muslim, Buddhist, Hindu, New Age/Eclectic, secular, Jehovah’s Witnesses, and Christian Scientist. Their thought-provoking essays produce rich insights not only into the needs of patients who share these same world views but also into how spirituality influences the practice of medicine. When their own spiritual issues arise in medical practice, physicians rely on their professionalism, ethics, and education. To better understand how various world views are incorporated into clinical work, doctors must ask themselves—as these contributors have—a series of important questions: What insights about life and healing does your faith provide? How does it challenge or reinforce contemporary medicine? How do you assess and address spirituality in clinical practice? How do your own beliefs influence your interactions with patients? The Soul of Medicine encourages medical students and practitioners to recognize the spiritual dimensions of medicine, to consider how these dimensions inform their own education and practice, and to be compassionate about their patients’—and their own—religious beliefs.
Framing Personhood in Modern Bureaucracies
How and why has the concept of responsibility come to pervade the fabric of American public and private life? How are ideas of responsibility instantiated in, and constituted by, the workings of social and political institutions? What place do liberal discourses of responsibility, based on the individual, have in today's biopolitical world, where responsibility is so often a matter of risk assessment, founded in statistical probabilities? Bringing together the work of scholars in anthropology, law, literary studies, philosophy, and political theory, the essays in this volume show how state and private bureaucracies play crucial roles in fashioning forms of responsibility, which they then enjoin on populations. How do government and market constitute subjects of responsibility in a culture so enamored of individuality? In what ways can those entities-centrally, in modern culture, those engaged in insuring individuals against loss or harm-themselves be held responsible, and by whom? What kinds of subjectivities are created in this process? Can such subjects be said to be truly responsible, and in what sense?
Technology, Ethics, and the Pursuit of Normality
At a time when medical technologies make it ever easier to enhance our minds and bodies, a debate has arisen about whether such efforts promote a process of "normalization," which makes it ever harder to tolerate the natural anatomical differences among us. The debate becomes especially complicated when it addresses the surgical alteration, or "shaping," of children. This volume explores the ethical and social issues raised by the recent proliferation of surgeries designed to make children born with physical differences look more normal. Using three cases—surgeries to eliminate craniofacial abnormalities such as cleft lip and palate, surgeries to correct ambiguous genitalia, and surgeries to lengthen the limbs of children born with dwarfism—the contributors consider the tensions parents experience when making such life-altering decisions on behalf of or with their children. The essays in this volume offer in-depth examinations of the significance and limits of surgical alteration through personal narratives, theoretical reflections, and concrete suggestions about how to improve the decision-making process. Written from the perspectives of affected children and their parents, health care providers, and leading scholars in philosophy, sociology, history, law, and medicine, this collection provides an integrated and comprehensive foundation from which to consider a complex and controversial issue. It takes the reader on a journey from reflections on the particulars of current medical practices to reflections on one of the deepest and most complex of human desires: the desire for normality. Contributors Priscilla Alderson, Adrienne Asch, Cassandra Aspinall, Alice Domurat Dreger, James C. Edwards, Todd C. Edwards, Ellen K. Feder, Arthur W. Frank, Lisa Abelow Hedley, Eva Fedder Kittay, Hilde Lindemann, Jeffery L. Marsh, Paul Steven Miller, Sherri G. Morris, Wendy E. Mouradian, Donald L. Patrick, Nichola Rumsey, Emily Sullivan Sanford, Tari D. Topolski
A Guide for Education and Practice
More than a million patient safety incidents occur every year, and medical error is the third leading cause of death in the United States. Illuminating the experiences of those affected by medical error—patients, their loved ones, and physicians and other medical professionals—Talking with Patients and Families about Medical Error delves deeply into the challenges of communicating honestly and openly about mistakes in medical practice. Based on guidelines from the Institute for Professional and Ethical Practice and the authors' own experiences, the practice-based approaches outlined here offer concrete guidance on • initiating discussions • dealing professionally and compassionately with patients' reactions • who should be included in the conversation • what information should be documented in the medical record • how to respond to questions about financial compensation Aimed at promoting resolution and healing, this book stresses the importance of clear, empathetic communication that will improve clinical and organizational responses to medical missteps and mismanagement. It emphasizes five features of the physician-patient relationship deserving of special attention: transparency, respect, accountability, continuity, and kindness (TRACK). Narrative examples of common situations demonstrate how conversations about medical error can lead to healing.
How Medical Technology Costs Are Destroying Our Health Care System
Technological innovation is deeply woven into the fabric of American culture, and is no less a basic feature of American health care. Medical technology saves lives and relieves suffering, and is enormously popular with the public, profitable for doctors, and a source of great wealth for industry. Yet its costs are rising at a dangerously unsustainable rate. The control of technology costs poses a terrible ethical and policy dilemma. How can we deny people what they may need to live and flourish? Yet is it not also harmful to let rising costs strangle our health care system, eventually harming everyone?
In Taming the Beloved Beast, esteemed medical ethicist Daniel Callahan confronts this dilemma head-on. He argues that we can't escape it by organizational changes alone. Nothing less than a fundamental transformation of our thinking about health care is needed to achieve lasting and economically sustainable reform. The technology bubble, he contends, is beginning to burst.
Callahan weighs the ethical arguments for and against limiting the use of medical technologies, and he argues that reining in health care costs requires us to change entrenched values about progress and technological innovation. Taming the Beloved Beast shows that the cost crisis is as great as that of the uninsured. Only a government-regulated universal health care system can offer the hope of managing technology and making it affordable for all.
Cases and Movies
Organ transplantation allows modern surgeons to give "new life" to chronically ill patients. At the same time, the new opportunities raise ethical questions concerning human identity and the definition of the human body. These concerns do not play out the same in all cultures or in every situation. This collection of 30 case studies illustrates the range of global and local, ethical, social, and cultural problems associated with organ transplantation. The collection also provides a list of popular movies and websites to aid instructors and their students. This work is aimed at educators in medicine, health care, philosophy, and religious studies.
Eugenics, the Supreme Court, and Buck v. Bell
“Three generations of imbeciles are enough.” Few lines from Supreme Court opinions are as memorable as this declaration by Justice Oliver Wendell Holmes Jr. in the landmark 1927 case Buck v. Bell. The ruling allowed states to forcibly sterilize residents in order to prevent “feebleminded and socially inadequate” people from having children. It is the only time the Supreme Court endorsed surgery as a tool of government policy. Paul Lombardo’s startling narrative exposes the Buck case’s fraudulent roots. In 1924 Carrie Buck—involuntarily institutionalized by the State of Virginia after she was raped and impregnated—challenged the state’s plan to sterilize her. Having already judged her mother and daughter mentally deficient, Virginia wanted to make Buck the first person sterilized under a new law designed to prevent hereditarily “defective” people from reproducing. Lombardo’s more than twenty-five years of research and his own interview with Buck before she died demonstrate conclusively that she was destined to lose the case before it had even begun. Neither Carrie Buck nor her mother and daughter were the "imbeciles" condemned in the Holmes opinion. Her lawyer—a founder of the institution where she was held—never challenged Virginia’s arguments and called no witnesses on Buck’s behalf. And judges who heard her case, from state courts up to the U.S. Supreme Court, sympathized with the eugenics movement. Virginia had Carrie Buck sterilized shortly after the 1927 decision. Though Buck set the stage for more than sixty thousand involuntary sterilizations in the United States and was cited at the Nuremberg trials in defense of Nazi sterilization experiments, it has never been overturned. Three Generations, No Imbeciles tracks the notorious case through its history, revealing that it remains a potent symbol of government control of reproduction and a troubling precedent for the human genome era.
The HPV Vaccine and the Politics of Medicine's Simple Solutions
In 2007, Texas governor Rick Perry issued an executive order requiring that all females entering sixth grade be vaccinated against the human papillomavirus (HPV), igniting national debate that echoed arguments heard across the globe over public policy, sexual health, and the politics of vaccination. Three Shots at Prevention explores the contentious disputes surrounding the controversial vaccine intended to protect against HPV, the most common sexually transmitted infection. When the HPV vaccine first came to the market in 2006, religious conservatives decried the government's approval of the vaccine as implicitly sanctioning teen sex and encouraging promiscuity while advocates applauded its potential to prevent 4,000 cervical cancer deaths in the United States each year. Families worried that laws requiring vaccination reached too far into their private lives. Public health officials wrestled with concerns over whether the drug was too new to be required and whether opposition to it could endanger support for other, widely accepted vaccinations. Many people questioned the aggressive marketing campaigns of the vaccine's creator, Merck & Co. And, since HPV causes cancers of the cervix, vulva, vagina, penis, and anus, why was the vaccine recommended only for females? What did this reveal about gender and sexual politics in the United States? With hundreds of thousands of HPV-related cancer deaths worldwide, how did similar national debates in Europe and the developing world shape the global possibilities of cancer prevention? This volume provides insight into the deep moral, ethical, and scientific questions that must be addressed when sexual and social politics confront public health initiatives in the United States and around the world.