Biomedical subjects
Publications and source records attributed to C Bayley.
In focusing their view on Kuhn, Robert Veatch and William Stempsey ignore alternative sources of insight from other voices that could help move us beyond incommensurability. Richard Rorty and Helen Longino, for example, offer another view of science and objectivity with constructive insight for the practice of science and medicine.
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We report the use of the bacteriophage P1 Cre-lox system for generating conservative site-specific recombination between tobacco chromosomes. Two constructs, one containing a promoterless hygromycin-resistance gene preceded by a lox site (lox-hpt) and the other containing a cauliflower mosaic virus 35S promoter linked to a lox sequence and the cre coding region (35S-lox-cre), were introduced separately into tobacco plants. Crosses between plants harboring either construct produced plants with the two constructs situated on different chromosomes. Plants with recombination events were identified by selecting for hygromycin resistance, a phenotype expressed upon recombination. Molecular analysis showed that these recombination events occurred specifically at the lox sites and resulted in the reciprocal exchange of flanking host DNA. Progenies of these plants showed 67-100% cotransmission of the new transgenes, 35S-lox-hpt and lox-cre, consistent with the preferential cosegregation of translocated chromosomes. These results illustrate that site-specific recombination systems can be useful tools for the large-scale manipulation of eukaryotic chromosomes in vivo.
Homeopathy is a form of complementary medicine which relies heavily on observation and experience. The three distinguishing characteristics of homeopathy are that remedies are prescribed on the totality of a person's symptoms, that the remedy likely to cure a person is a dilution of that substance which would cause the same symptoms in a healthy person, and that remedies are prepared using microdoses of substances which are diluted and then vigorously shaken. Mainstream medicine criticizes homeopathy by saying that its gentleness has outlived its usefulness and treatment successes are probably no more than placebo action. In addition, its critics charge that homeopathy is unscientific, runs counter to the "laws of nature" and will not stand up to scientific scrutiny. Homeopaths reply that mainstream medicine is dangerous, that homeopathy works in children and animals (usually thought resistant to placebo), and that several good controlled clinical trials have shown positive results. There is a difference between showing that homeopathy works and adequately accounting for its mechanism of action. Clinical trials have concentrated on the former and remain unexplained in the latter.
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Medical technology has created dilemmas for those who make decisions regarding whether to prolong life in the face of severe, irreversible illness. Two questions usually arise: who should decide, and what standards should the decision makers use? These questions can be particularly difficult for members of religious institutes. The basic legal standard for such decisions is the patient's autonomy or self-determination; the patient's wishes are paramount. If the patient has been determined incompetent, a person who has the patient's best interests at heart should make the treatment decisions. Sometimes it may be necessary for the court to appoint a conservator. In California a recent law enables a person to create a Durable Power of Attorney--that is, to designate someone to make all health care decisions if the designator becomes incompetent. The surrogate can base decisions on either of two basic legal standards: substituted judgment or best interests. The substituted-judgment standard holds that the decision should be the one that the patient would have made if competent. The decision should be based on any available information about the patient's values and preferences. If these are not sufficiently known, the decision maker may have to resort to the best-interest standard, evaluating all options to determine what is "best" for the patient. In the case of a religious who becomes incompetent and has no family members, the physician probably will accept a member of the institute as a surrogate. If the incompetent religious has family, they and the institute should discuss who should be responsible for communicating with medical personnel. In California, a competent member of an institute should designate a surrogate in advance to avoid any confusion or conflict later.
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The sole question to ask in considering curtailing treatment of incompetent, terminally ill patients is not, Who shall decide? Other philosophical and ethical considerations should be addressed before requesting a judicial ruling which might set dangerous precedents.
Ways in which the library can become involved in hospital educational programs are discussed. The librarian can set out materials on specific topics for discussion among nurses, and can encourage continuing education among physicians. The need for this is stressed, together with the necessity for adequate hospital library standards to meet this demand.
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In response to the challenge of maintaining their Christian values in the face of increasing economic pressures, St. Joseph Health System in Orange, CA, has implemented its VISION program (Values Integration Systemwide in Ongoing Networking). The program consists of values implementation policies, self-assessment, and regular systemwide reporting. The idea for evaluating values implementation took shape in 1987 at a representative task force meeting. After agreeing on a conceptual framework, the group recommended the formation of values committees to assess their organizations' status and develop action plans. The task force provided the first step by identifying nine areas for self-assessment. The committees met in January 1988 to examine their tasks and share ideas. They were encouraged to translate the values concepts into actual attitudes and behaviors that could be applied in their work. Later they gauged the relative stages of their entities' values implementation through surveys, assessments, and interaction.
Society has not reached consensus about the right of patients who are not terminally ill to refuse treatment or about the acceptability of foregoing artificial nutrition and hydration for any patients. Both these issues have been raised by the case of Elizabeth Bouvia, a woman with cerebral palsy whose desire to refuse nasogastric feeding has been the subject of at least three court decisions, the most recent in April 1986. In that decision, the Second District Court of Appeal of California ruled that High Desert Hospital must honor Ms. Bouvia's request that she not be fed through a tube.
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