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PubMed1992

Care of the dying: an ethical and historical perspective.

OBJECTIVE: To provide a historical perspective, from ancient Greece to the middle of the 20th century, on ethical issues and principles commonly associated with medical care for the dying in Western civilization. SOURCES: Writings of noted philosophers, historians, ethicists, and physicians, as well as published legal and ethical guidelines. INFORMATION EXTRACTION: The sources used highlight the origins of various ethical principles associated with care of the dying. They also identify the opinions of prominent individuals throughout the history of medical ethics. SUMMARY: Devotion to medical beneficence, concern for the quality of life, and respect for the sanctity of life are all expressed in the earliest medical and philosophical writings of ancient Greece. With regard to care of the dying, these considerations led to a wide acceptance of avoiding or terminating treatment in hopeless cases. They also led to active debate regarding medicine's role in hastening the dying process. The rise of Christianity during the Middle Ages markedly suppressed such debate by strongly reinforcing the principle of sanctity of life. Later, the optimism of the enlightenment added the hope of prolonging life. Finally, modern advances in medical science have made that hope a reality of complex ethical dimensions. CONCLUSIONS: Ethical debates regarding appropriate care for the dying are as old as medicine itself. Although beneficent concerns have characterized the medical community in almost every period of history, tensions have repeatedly arisen as diverse religious and philosophical ideologies have produced varying standards to define such beneficence. In the Christian world, the sanctity of life was often extolled as the paramount standard. For the ancient Greeks and Romans, and again in many post-Renaissance philosophies, quality of life considerations assumed equal or greater importance. Modern life-prolonging technologies heighten the debate by allowing these two standards to dramatically conflict, particularly in the critical care setting.

Beneficence↗

PubMedDate not supplied

[Implementation of modern principles of blood saving methods at cardiac surgery under extracorporeal circulation].

The introduction of principles of bloodless surgery into different areas of practical medicine is favoured by not only risks from donor blood transfusion, but also by the results of the researches dealing with the body's adaptation to acute anemia, with the determination of its allowable limits, and with much experience with bloodless operations used in Jehovah's Witnesses. The present study was undertaken to make a scientific-and-practical assessment of actual own blood funds and their introduction in order to decrease or refuse to use donor blood at cardiac surgery under extracorporeal circulation (EC). A retrospective analysis of hemotransfusion policy in 1993-2001 was conducted in over 2000 patients operated on under EC for coronary heart disease, acquired and congenital cardiac diseases at the Open Cardiac Surgery Department, Russian Surgery Research Center, Russian Academy of Medical Sciences. Own blood saving methods, such as intraoperative autohemotransfusion as two modalities, washed autoerythrocytic reinfusion, autoplasma reinfusion, as well as the use of different pharmaceuticals effective in reducing hemorrhage after EC were evaluated. The introduction of the above own blood saving methods may decrease the use of donor erythrocytes and freshly frozen plasma by 2.6 and 1.8 times, respectively, may completely refuse transfusing thromboplasma, assure adequate hemostasis, reduce the incidence of adverse reactions associated with donor blood transfusion in cardiac surgical patients. A complex use of the developed saving donor blood methods and pharmaceuticals aimed at improving hemostasis allowed donor blood transfusion to be completely refused in more than 70% of patients at aortocoronary bypass surgery under EC.

Blood Loss, Surgical↗

PubMed1999

Religious and spiritual case reports on MEDLINE: a systematic analysis of records from 1980 to 1996.

OBJECTIVE: To undertake a systematic analysis of case reports involving religious or spiritual issues published between 1980 and 1996. DATA SOURCES: MEDLINE, the National Library of Medicine's bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, and the preclinical sciences. STUDY SELECTION: A search of 4,306,906 records indexed on MEDLINE from 1980 to 1996. DATA EXTRACTION: A total of 364 abstracts were found, then subjected to coding analysis. DATA SYNTHESIS: Categories were developed for (1) types of healthcare situations involving religious/spiritual issues, (2) religious and spiritual interventions, (3) collaboration between healthcare and religious professionals, (4) psychopathology and sensitivity themes, and (5) religious faith/spiritual path. Although all of these case reports involved religious and spiritual issues, only 45 (12%) explicitly mentioned a religious professional. Of these, only 8 (2%) indicated any collaboration between healthcare and religious professionals. CONCLUSIONS: A paucity of published case report literature exists on religious and spiritual issues (.008% of the MEDLINE records), indicating that the increasing acceptance of these factors by patients and healthcare professionals is not yet reflected in scientific and clinical journals. A need exists for more documented examples of collaboration between healthcare and religious professionals.

Humans↗

PubMed2000

1999 Seymour B. Sarason Award. Community narratives: tales of terror and joy.

Inspired by a literary-feminist reading of biblical texts, it is suggested that the mission of community psychology/social science can be understood as a calling to use our tools (research methods, critical analysis and observation, scholarship, social influence) to assist others in the job of turning tales of terror into tales of joy. Such work is the essence of personal and social change. These are not things we can do alone; they require collaboration between us and the people of concern. Applying concepts from narrative theory, including description and critical analysis of community and setting narratives, dominant cultural narratives, and personal stories, we can learn from our own communities and we can use our resources to help make known (perhaps even help to imagine new) tales of joy. Some of these themes are illustrated in three very different contexts: a religious community that has made itself inclusive of gay and lesbian people, a mutual help organization that offers a sense of community and hope for the future to people with a history of serious mental illness, and a public elementary school.

Black or African American↗

PubMed2002

The core concepts of the 'four principles' of bioethics as found in Islamic tradition.

Ethics can be described as a sub-branch of applied philosophy that seeks 'what is the right and the wrong, the good and the bad set of behaviours in a given circumstance'. Bioethics, however, is a quasi-social science that offers solutions to the moral conflicts arising in medical and biological science practice. There have been different ethical approaches to the issues in the history of philosophy. Two American philosophers, Beauchamp and Childress, formulated some ethical principles namely 'respect to autonomy', 'justice', 'beneficence' and 'non-maleficence'. These 'Four Principles' which have almost always existed and govern the ethical behaviour of human societies, were presented by the authors as universal and applicable to any culture and society. These 'Four Principles' have been one of the most widely discussed issues in Biomedical Ethics with arguments for and against them. The authors' claim has been tested by research conducted in different cultures and societies. In this study we aim to explore the roots of the 'Four Principles' in Islamic tradition and culture, and show that this particular set of principles are not something new but only one of the latest formulations of age-old common sense principles. It is therefore concluded that these principles are already being applied in Islamic traditional and cultural societies.

Beneficence↗

PubMed2001

[Semen in the works of Hildegard of Bingen].

Hildegard of Bingen (1098-1179), versatile female figure of the late Middle Ages, a passionate lover of music, a mystic, an expert of herbs and medicine, and an abbess in the monastery of Eibingen, besides transmitting the divine word, dedicated her entire life to the study of the natural world. She composed a true encyclopedia of the knowledge of her times, whether it be in regards to natural sciences or medicine, with the conviction that a cure or medical practice could not exist without a theoretical system. The handwritten tradition of her medical achievements relate to the 13th Century; the biographical sources and the protocol of the case for canonization, mention the existence of a medicine handbook entitled Liber subtilitatum diversarum naturarum, handed down from tradition in the form of two distinguished topics: Physica, or Book of medicine for the simple, and Causae et curae, or Composite medicine book. From the reading of her works one gains a vast knowledge of Medieval medicine, basically associated with Galen and Aristotle's philosophy. The analysis of sexuality, which has a very close relationship with astrology, assumes an obvious appearance. If on one hand affliction for the flesh emerges, on the other hand sexuality is seen a divine theorem. Moreover, much space is dedicated to the disorder of sexual life and male impotence, not seen anymore as a remedy to sinful lust, but as a pathology to cure.

Germany↗

PubMed2002

Adaptationism--how to carry out an exaptationist program.

Adaptationism is a research strategy that seeks to identify adaptations and the specific selective forces that drove their evolution in past environments. Since the mid-1970s, paleontologist Stephen J. Gould and geneticist Richard Lewontin have been critical of adaptationism, especially as applied toward understanding human behavior and cognition. Perhaps the most prominent criticism they made was that adaptationist explanations were analogous to Rudyard Kipling's Just So Stories (outlandish explanations for questions such as how the elephant got its trunk). Since storytelling (through the generation of hypotheses and the making of inferences) is an inherent part of science, the criticism refers to the acceptance of stories without sufficient empirical evidence. In particular, Gould, Lewontin, and their colleagues argue that adaptationists often use inappropriate evidentiary standards for identifying adaptations and their functions, and that they often fail to consider alternative hypotheses to adaptation. Playing prominently in both of these criticisms are the concepts of constraint, spandrel, and exaptation. In this article we discuss the standards of evidence that could be used to identify adaptations and when and how they may be appropriately used. Moreover, building an empirical case that certain features of a trait are best explained by exaptation, spandrel, or constraint requires demonstrating that the trait's features cannot be better accounted for by adaptationist hypotheses. Thus, we argue that the testing of alternatives requires the consideration, testing, and systematic rejection of adaptationist hypotheses. Where possible, we illustrate our points with examples taken from human behavior and cognition.

Adaptation, Physiological↗

PubMed2004

Living kidney donor decision making: state of the science and directions for future research.

BACKGROUND: The Federal government and transplantation organizations have called for further study of living donation at a time when 3 new living donor protocols are being introduced throughout the United States that promise to significantly increase the donor pool and change the face of living donation. Donation to a once incompatible and sometimes unknown recipient may now occur through the use of plasmapheresis therapy or paired and nondirected living donor protocols. OBJECTIVE: To describe the state of the science on living kidney donor decision making, and to provide recommendations for future research to guide donor education and care. DATA SOURCES: Automated literature search using PubMed and CINAHL scientific literature databases. STUDY DATA EXTRACTION: Research papers on living donor decision making from 1997 to 2003. Studies available only as abstracts were excluded. DATA SYNTHESIS: Studies of living kidney donor decision making and outcomes have been limited in scope, with small sample sizes and inconsistent reports of racial and ethnic characteristics of the sample. The retrospective nature of the majority of living donor studies is a significant limitation. CONCLUSIONS: Future prospective studies that are diverse by sex, race, and ethnicity will contribute to our knowledge of factors that influence the decision to be a living kidney donor.

Altruism↗

PubMed2006

[Medical professionalism: historical and religious aspects].

The essence of the medical profession resides in the medical act, whereupon a sick human being meets another with the power to heal him or her. The source of this power has evolved from the divinity itself through magic to science or acquired knowledge. This power implies acknowledgement of values that are inherent to the profession as well as responsibility toward one's own conscience and toward society, elements considered constitutive of what we now call professionalism. From antiquity these principles have evolved into behavioral codes containing variable components according to the different ages and cultures, but also permenent core values such as respect for life, altruism, and honesty, among others. Scientific and technological advances have magnified medical power but at the same time they have required that the philosophical and ethical principles that ought to inform professional practice be made explicit. This happens at a time when certitudes are questioned or abandoned, relativism and secularism pervade culture, and traditional medical values are challenged. Therefore, consensus attainment appears for some as the only legitimation of the ethics of professional medical acts, while for others the ancestral principles and values of medicine have permanent validity as objective goods based on the dignity of the human person.

Codes of Ethics↗

PubMed2004

Healing presence.

Medicine is the art and science of restoring and preserving health through the healing process. The science of medicine lies in evidenced based practices and the technological achievements of the last century, which enable practitioners to preserve the physical body. A growing number of research articles and writings have also appeared addressing the spiritual dimension of healing (the art of medicine), which often ignored creates a gap in the medical care of the patient. The spiritual aspects of medical care are explored based on the experience of the doctor-patient encounter. Three case studies of various clinical settings are presented to begin to look at the spiritual aspect of healing and better define its incorporation in the encounters with patients. The author reflects on the skills and concepts that begin to define the spiritual dimension of care: communication (listening, speaking), connection (space, safety, and sacredness), and communion through which healing can occur. As health care professionals we can be a "healing" (Hopeful, Empathetic, Attentive, Loving, Intentional, Nourishing, Grateful) presence taking care of the physical, mental and spiritual needs of our patients in our encounters with them, bringing them back to health and wholeness.

Adult↗

PubMed1991

Gene therapy, human nature and the churches.

Moral analysis must begin with respect for the empirical features, the "facts of the case". Major advances in genetic knowledge and technology -- as in other sciences -- inevitably change mental attitudes. But they could not change human nature, a product of the distinctively human cerebral cortex. Human capacities like compassion and justice are our own and for us to guard. To ask (as some do) about a "right" to inherit a non-manipulated genome is to ask an unanswerable question: the language of rights is inappropriate in this context. Parents have a duty to safeguard and to serve the interests of their potential child. The medical duty is to help in that task in ways which they have limited freedom to choose. The role of churches is to be faithful to their deposit of faith and their theological principles, including that of freedom of conscience. Churches are too easily led in practice to over-rule conscience on grounds of authority, ecclesiastical or biblical, not sustained by convincing reason. This is most evident in some declarations concerning human reproduction. Better were it for them to help their faithful in moral reasoning, the ethics of choice; to keep consciences tender.

Altruism↗

PubMed2002

Witnesses of the body: medico-legal cases in seventeenth-century Rome.

Studying early modern medico-legal testimonies can enrich our understanding of witnessing, the focus of much research in the history of science. Expert testimonies were well established in the Roman Cannon law, but the sphere of competence of expert witnesses - one of the grounds on which seventeenth-century physicians claimed social and intellectual authority- troubled contemporary jurists. By reconstructing these debates in Counter Reformation Rome, and by placing in them the testimonies given by Poalo Zacchia, one of the founding fathers of legal medicine, this article discusses the epistemological and social issues surrounding the definition of expertise about the body in court. It shows how a high-ranking expert witness would define his competence versus the legal authority on the one hand, lower-status expert witnesses on the other. But it also explores the interactions between specific legal constraints, for example about eye witnessing, and the ways in which different kinds of witnesses would use the body as a source of evidence for testimony. While engaging with medico-legal issues including the ambiguous signs of childbirth and the (in)visibility of pain, the article examines their meanings within Counter Reformation social controversies, including control over sexuality, imposition of discipline and the social status of physicians.

Catholicism↗

PubMed1982

[Drug addiction and freedom].

The author, in a historical and philosophical approach, analyses the concept of freedom as opposed to slavery. He also refers to the legal and social restrictions and studies the determinism and free will as the causes of human behaviour. Quoting Spinoza, the author states that man accepts the idea of freedom because he realizes the "how" of his options but ignores "why". Without the hypothesis of causality and determinism, there seems to have no science. Without freedom, there seems to be no anthropos man (Jimeno Valdez). The principles of anticausality, of nonreproducibility and of differentiation characterize the human freedom, but are contrary to the way science works. According to the social and political point of view, it was established that the State has the right to oblige and to violently limit freedom. Practically speaking, though, the State is violent just for being the State; the dominant groups are the government because they are and they have been violent. There is a need to limit and to discipline this right of the State of being violent within the dilemma of safety and freedom. By working, the slave avoided the whip. And by doing this, he encouraged the behaviour of the one who whipped him. The non-aversive attitudes limit the freedom in the modern world more and more for they also enchain our will, a rebellion becoming impossible. One is not granted the freedom; it shall be conquered and kept. Freedom, either as a concept or a phenomenon, is always relative. The concept of toxicomania or pharmacodependance is analysed according to the same perspective. The conclusion is that this is always more a problem of the society than of the individual, and this is how it has to be understood and treated. The present world is described as a millenial human culture specifically characterized by eight groups of phenomena: 1. Transport increased human mobility, reduced the relative dimensions of the earth, mixed peoples, compared cultures and created opportunities for conflicts; 2. The means of communication spread information surpassing their own capacity of being formed, they becoming traumatic; 3. The natural energies and electronic computing disturbed the work and comsumption market, man becoming insecure and disposable; 4. The industrial development produced a mass-culture and old time establishment became unreliable; 5. The demographic boom altered the age groups ratio which now presents an excess of children and grandparents with a relative lack of parents; 6. The diffusion of knowledge on human nature; 7. The religions emerged again, even the most primitive, persuading youngsters and governments; 8. The law, institutions and governments did not keep up with the rhythm of the changings and progress. The result was a generalized dissatisfaction.

Freedom↗

PubMedDate not supplied

Social and psychological perspectives on voluntary sterilization: a review.

This paper reviews social science research on the antecedents and consequences of voluntary sterilization. The major conclusions are that socioeconomic status has little impact on the decision to be sterilized and that sterilizations are rare among those without sons and among male non-whites. Significant others are important sources of encouragement and information, and good marital relations increase the likelihood of having the procedure performed. Most acceptors experience no change in sexual activity, quality of marital relationships, or work-related behavior, and few regret their choice. Negative consequences are more likely among those in India, those coerced into having a sterilization, those who did not understand the consequences of the procedure, those with health complications after sterilization, and those couples who have unstable marriages or who disagree about sterilization.

Adult↗

PubMed2006

The folk psychology of souls.

The present article examines how people's belief in an afterlife, as well as closely related supernatural beliefs, may open an empirical backdoor to our understanding of the evolution of human social cognition. Recent findings and logic from the cognitive sciences contribute to a novel theory of existential psychology, one that is grounded in the tenets of Darwinian natural selection. Many of the predominant questions of existential psychology strike at the heart of cognitive science. They involve: causal attribution (why is mortal behavior represented as being causally related to one's afterlife? how are dead agents envisaged as communicating messages to the living?), moral judgment (why are certain social behaviors, i.e., transgressions, believed to have ultimate repercussions after death or to reap the punishment of disgruntled ancestors?), theory of mind (how can we know what it is "like" to be dead? what social-cognitive strategies do people use to reason about the minds of the dead?), concept acquisition (how does a common-sense dualism interact with a formalized socio-religious indoctrination in childhood? how are supernatural properties of the dead conceptualized by young minds?), and teleological reasoning (why do people so often see their lives as being designed for a purpose that must be accomplished before they perish? how do various life events affect people's interpretation of this purpose?), among others. The central thesis of the present article is that an organized cognitive "system" dedicated to forming illusory representations of (1) psychological immortality, (2) the intelligent design of the self, and (3) the symbolic meaning of natural events evolved in response to the unique selective pressures of the human social environment.

Attitude to Death↗

PubMed1980

[The search for "od." Karl Ludwig Freiheer von Reichenbach (1788-1869) and Karl Wilhelm Mayrhofer (1806-1853), two joined against Justus von Liebig].

The author describes the controversy between Justus von Liebig on one side and Reichenbach and Mayrhofer on the other side. It is a controversy about problems of science and medicine which are characteristic for the late 18th and the first half of the 19th century, when Mesmerism and similar ideas of occultic and comparative phenomenona were discussed and often refused as being "not scientific". Justus von Liebig and Karl Ludwig Freiherr von Reichenbach were both chemists, both interested in scientific progress and working in this field. They were friends in the years 1830 to 1848. But later on this friendship ended when Reichenbach--who in the mean time moved to Vienna--became more and more interested in phenomenons seen by sensitive persons concerning effects of light. Although Reichenbach himself was not able to recognize the phenomenons he was sure that other persons had this ability. He had the impression that there is a special force floating through the universe, and this force he called "od". Liebig, who was not able to follow this theory and rejected it has speculation, turned against Reichenbach in 1852-3. So the controversy began and their old friendship came to an end. Reichenbach's theory of the "od", characteristic for the time of the romanticism and leading back to Mesmerism was accepted and supported by the Austrian physician Dr. Karl Wilhelm Mayrhofer who had aroused his interest by describing similar phenomenos some of this patients had. The letters of both men, the chemist and the doctor, which are well preserved (Technical Museum of Vienna) and discussed here, give a good impression of Reichenbach's ideas concerning his theory of the "od" and his philosophical ideas. As Reichenbach tried to find a philosophy corresponding to his theory and as he meant to have found this in the philosophy of Friedrich Eduard Beneke his remarks in those letters give a good information about Beneke's discussion of Reichenbach's theory. Mayrhofer, on the other hand, following Reichenbach's theory of the "od", rejected Beneke's philosophy because he himself joined another philisophy on the basis of the christian religion. However, when Reichenbach's latest book on these problems appeared in 1854, Beneke and Mayrhofer had died shortly before and no further discussion was possible. But Reichenbach's theory, based on the ideas of Mesmerism, and the controversial discussion about new explanations of the phenomenona seen by sensitive persons are characteristic for this time and also for our time as such perceptions are not entirely denied but thought over in a new way.

Austria↗

PubMed1997

[Ibn Sina--psychology and psychological disorders].

Ebu Ali Husein Ibn Ali Ibn Sina (or Avicenna) was primarily a philosopher with amusing knowledge, who dealt in all aspects of art of medicine, astronomer, poet, musician and psychologist. This giant with an encyclopedic knowledge has dealt in almost all scientific branches or praxis with the great success. Numerous statements of his have been cornerstone of many sciences for centuries; and some of them are (in the era of computers and Internet) still current. The best known treatise on medicine of his is El-Kanun, consisting of five volumes, wherein all medical achievements (including psychology, psychiatry and neurology) of that period were described clearly. In his psychology, Ibn Sina (Avicenna) analyses the essence of human soul, mind, psychical streams, intellectum, dreams and prophecy, man's desires etc. in details. It is unnecessary to point out how much these items are actual in the contemporary psychology. Ibn al-Nefis has described systematically the symptoms and recovery of "head sick" (including headaches, cerebral sick like cranitis, letargy, coma, demency, melancholy, insomnia, nightmares, epilepsy, appoplexy, paralysis, spasm and many others) in his Mujez al-Kanun, that is synopsis of Ibn Sina Kanun. We need much time to see magnificance of this philosopher, that is best known as the great one among the physicians. His writings could be found in whole Bosnia, but there were many few that would study him and his works. It is out task to enable the future generations not only to know those works exist, but, also, to realize the essence of this marvelous genius; because there are very few people that can be compared to him.

History, Medieval↗

PubMed2002

[Bernard Schapiro--an orthodox Jew as an early andrologist in the 20th century].

The unusual history and professional background of one of the first andrologists is reported. Bernhard Schapiro, born in 1888 in Dvinsk in Latvia, then a city in the Russian Pale of Settlements for Jews, grew up as an orthodox (hassidic) Jew receiving exclusively talmudic lessons until he was 18 years old. During the final years of this period of life he was educated at the famous Slobodka Talmud Academy Kenesset Israel in Kovno where he absorbed the ideals of Musar-doctrines, thus being influenced for the rest of his life. The Rogachover Gaon J. Rozin supported his desire to study medicine. After a brief stay in Frankfurt/Main he acquired by own efforts the necessary general knowledge to matriculate for access to university. Medical studies at Zurich University (1913-1919) were followed by a one-year-internship at a dermatologic department in Breslau/Silesia. The thesis for his doctorate at Zurich University in 1920 was on, Relations between Nodular Erythema and Tuberculosis'. He spent two years training in dermatology at Breslau University under Jadassohn. Back in Berlin, he married and had four children, while he worked at Magnus Hirschfeld's Institute for Sexual Sciences. After initial clinical studies in venerology he more and more turned to andrological problems, including treatment of underdeveloped male genitals, premature ejaculation and impotence in general. In this context he tested the new drug Praehormon and developed the two remedies Testifortan and Praejaculin. He was the first to describe the effect of anterior pituitary lobe hormone on the descent of cryptorchid testicles, thus initiating a treatment modality still in motion today. When Hitler came to power he and his family were spared as Swiss citizens, but he lost his base for working after the Institute was looted. He established an andrologic practice at Zurich. What he had witnessed in Germany caused him to set up a Swiss branch of Mizrachi, the spiritually based center of Zionism in Switzerland. He left Europe in 1940 for New York/USA. After compulsory repetition of medical exams in a new language he managed to establish a new existence as andrologist. His practice flourished, the more as he was trusted to treat Jewish patients according to Jewish Law. The decisive step brought him to Jerusalem, in 1951, where he founded and headed an Endocrinologic Department of the University, pursuing andrologic questions, until his death on December 31, 1966. What actually controlled his life can be read on his tombstone: 'He remained a pupil of Slobodka all the days of his life'.

Andrology↗