Perspectives in biology and medicine
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The writings of Henry Beecher (1904-1976) have had an enormous influence on thinking and practice with respect to the ethics of medicine and clinical research. This essay examines the seminal contributions of Beecher as illustrated by four landmark articles concerning the ethics of clinical research, the placebo effect and placebo-controlled trials, the evaluation of invasive procedures, and "brain death" and vital organ transplantation. To appreciate Beecher's legacy, it is salutary to explicate the significance of his enduring contributions and to critically evaluate their limitations.
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Perspect. Biol. Med. · Jan 2012
Historical ArticleThe history of bioethics: implications for current debates in health research.
The assumption that developments in technologies and societies create new ethical issues for health and medical research is intuitively appealing. However, a closer inspection of the history of bioethics reveals a surprising consistency in the core issues that have formed the basis of bioethical debates over time. If the issues involved in bioethical debates remain essentially constant, are new discussions and new guidelines and principles--produced in the wake of research scandals or inspired by the introduction of new technologies--redundant? This article examines some of the implications of the history of bioethics for understanding current ethical debates and for the formation of a culture of ethical conduct in health research.
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Physicians base their practices on scientific knowledge that varies little from one country to another, but their experience and their careers are shaped by the culture in which they live and work. This essay casts light on medical practice in mainland China, based on three months of field work with an elite group of physicians at a tertiary academic medical center in summer 2009. It is a story of a diverse group of Chinese professionals navigating a demanding profession, and of the foreign college student on whom they left an indelible impact. Many of the normative features of the Chinese medical profession-its chain of command, commitment to medical ethics, and scientific orientation-are highly comparable to the working lives of American physicians.
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Perspect. Biol. Med. · Jan 2012
Empathy beyond the conceptual level: core nonspecific factors of psychotherapy.
The human mind contains much more than concepts. By only taking into account the conceptual level, a cared-for person may feel utterly lonely and abandoned, not deeply in contact with the caregiver, not deeply understood for who he or she really is. ⋯ In dealing with chronic pain patients, as with any patients, it is therefore very important to develop a sense of empathy that goes beyond this, towards deeply understanding the patient as complete person. This sheds a profound light on the all-important nonspecific factors of psychotherapy, which according to many researchers form the only profoundly active principle in psychotherapy.
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How should we assess the historical development of health care? Many historians are deeply reluctant to endorse ideas involving progress in human affairs, including the evolution of modern medicine. We tend to think either that our present situation is little better than in the past, or that most kinds of value judgments about history are subjective and inappropriate. ⋯ If we mordantly or relativistically dismiss the unprecedentedly high quality of modern health care, we lose the ability to understand why citizens value it so highly, and this distorts our understanding of current issues. We also lose our sense of the wonders of human and medical achievement.