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Biomedical subjects

S J Reiser

Publications and source records attributed to S J Reiser.

At least 37 records · Page 2Linked to original sources
PubMed1992

Consumer competence and the reform of American health care.

This report examines the role of the expert in the American health care system, both as provider and administrative policymaker. It shows that the guiding assumption of American health care policy, ie, that the medical system can and should be managed by experts on behalf of consumers and patients, does not hold up to scrutiny. It also demonstrates that the important theme in American history of placing authority and responsibility for action in the hands of the individual has not been sufficiently influential in American health care. Drawing on this theme and creating consumer competence and responsibility in health care choices as the keys to health care reform in the United States are advocated.

Adult↗
PubMed1992

The corporate organization of hospital work: balancing professional and administrative responsibilities.

The development of the hospital into a corporation has influenced the care of patients and the work of the professional staff. As a corporate enterprise, the modern hospital has a private agenda aimed at increasing growth and efficiency with an emphasis on technical services, professionals as employees, and patients as customers. These changes have resulted in a decrease in trustee and professional authority and an increase in administrative control. This shift in the control structure has continued in response to the need for accounting and regulation of services and in response to demands for increased growth and efficiency made by an increasingly competitive market environment. Strategies for the reorganization of hospital staff aimed at improving both inpatient and outpatient care are reviewed. The reorganization of the institution and staff, using either a staff group-practice corporation or an administrative staff model, is proposed. Clinicians have new responsibilities for developing collective arrangements for institutional governance, for allocating institutional resources, for providing public accountability regarding the use of these resources, and for defining the missions of care.

Commerce↗
PubMed1992

The intensive care unit. The unfolding ambiguities of survival therapy.

The intensive care unit (ICU), one of the great achievements of modern medicine, is both a set of technologies and a space with a special function. This essay traces the evolution of the ICU's crucial technologies, and how the space bearing this name was carved out in the hospital. Ethical, legal, and social developments, an important part of this story, are incorporated in it.

Adult↗
PubMed1991

Medical ethics reflected in codes of ethics: the Hippocratic Oath and the 1980 AMA code compared.

The Hippocratic Oath and 1980 Code of Ethics of the American Medical Association (AMA) are compared to evaluate the nature of the relationship between students and teachers of medicine and the ethical injunctions that guide practice and make up the essence of the Hippocratic Oath. Such injunctions include the need to take care that harm is not done, to maintain confidentiality, and to avoid acts leading to death. The AMA code is analyzed from the perspective of its injunctions to give competent and compassionate care, to follow the law, to be responsible for guarding patients against incompetent physicians, and to assure that patient care is based on principles of compassion and skill. The centrality of trust in the relationship between patient and doctor as a crucial value in defining a profession is emphasized.

American Medical Association↗
PubMed1988

A perspective on ethical issues in technology assessment.

In doing technology assessments, it is essential to understand the ethical values used and encountered on the way to reaching judgments and making choices. Some of these values, and the context of their application are discussed. Considered are the application of the do-not-harm principle of medical action, the duty to maintain a scientific medicine, the ethical problems of introducing technologic innovations, and using technology assessments in the allocation of health care resources.

Ethics, Medical↗
PubMed1987

Ethical aspects of organ allocation in transplantation.

Of the two major ethical issues surrounding organ allocation-determining criteria for expanding the size of the organ pool and determining criteria for allocation itself-I focus on the issue of allocation, and begin by assuming that there are five main criteria for use in deciding who gets a donor organ: age, medical benefit, merit, ability to pay, and geographical residence. I discuss each of these in turn, eliminating age because it fails to indicate the overall status of a patient's health; eliminating merit because physicians have neither the time nor the ability to act as judges; choosing medical benefit as the best criterion because it is fairest and does not call for such judgements; and leaving open considerations of ability to pay and geographical residence, for application in the event the issue cannot be decided on the ground of medical benefit alone. These criteria, I conclude, are best treated as guidelines, and not as rules.

Journal Article↗
PubMed1986

Survival at what cost? Origins and effects of the modern controversy on treating severely handicapped newborns.

This paper examines the background of technological innovation, ethical debate, and social change, against which the 1980s debate over how to treat severely handicapped newborns in general, and Baby Jane Doe in particular, took place. A commentary follows examining the relative place of government, practitioners, hospital ethics committees, and parents in making decisions about treatment for handicapped newborns.

Abnormalities, Multiple↗
PubMed1985

Responsibility for personal health: a historical perspective.

Reflections about the role of human choice in determining personal health occur in the writings of practitioners and laymen throughout history. THe Greek and Roman writers emphasized the effect of life's activities. During the Middle Ages and Renaissance, disease continued to be seen as a consequence of disorder of the bodily humors, which were under the individual's control. THe rise of the paternalistic national regimes in Europe produced the view that society had the responsibility to maintain health. Jacksonian egalitarianism led to a reaction against the aggressive therapies of established professional experts, a view furthered by the Thomsonian belief that people should wrist control of their health away from orthodox physicians. Among the twentieth century reactions was the movement to urge people to have doctors evaluate laypersons' health. By the 1970s a movement emerged emphasizing again personal responsibility, which, in turn, produced a concern that this was merely "victim-blaming". Views on the role of lay people in determining personal health are heavily influenced by prevailing social, political, and moral climates.

Attitude to Health↗
PubMed1985

A seminar in 'Plain Doctoring'.

Plain Doctoring is an elective, preclinical seminar on the phenomenology of the patient and the physician. Home visits by students serve as the major text for examining the patient's experience of illness and treatment and for reflecting on the process of attending to patients. Readings in the humanities complement the house calls. The students, the patients, and the seminar instructors have all commented favorably on the seminar.

Curriculum↗
PubMed1984

Codes of medical ethics.

With one of the oldest codes of ethics in history, the medical profession continues to arouse controversy. This author examines the fifth major revision of the American Medical Association's code of ethics, published in 1957. Within this revision are the basic premises in establishing a medical code of ethics. Subsequent ethical dilemmas, involving technology, for example, can still be applied to the 1957 fundamental code.

American Medical Association↗