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MICROECONOMICS
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| SOCIAL AND ETHICAL ISSUES IN MEDICINE "From inability to let alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, and science before art and cleverness before common sense; from treating patients as cases; and from making the disease more grievous than the endurance of the same, Good Lord, deliver us." -Sir Robert Hutchison Clinical ethics is a discipline, which takes into consideration the welfare of patient and also legal issues pertaining to the medical care, including the venue and the nature of the treatment provided, and most importantly it minimizes the harm to the patient. The ultimate goal is to provide improved care to patients. This includes clinical, physical, mental and spiritual care. It focuses on the central importance of patient preferences and choices in the physician-patient relationship and on the moral obligation of physicians, such as the need for honesty, competence, compassion, empathy, and respect for the patient. Clinical ethics teaches physicians about a wide range of specifically ethical issues viz. informed consent, Do Not Resuscitate (DNR), end of life decisions, advance directives, and third-party constraints on the autonomy of both patients and physicians - that arise with increasing frequency in the practice of modern medicine. These are very serious issues and not many physicians feel comfortable dealing with these issues in everyday practice of medicine. The Executive Committee of the Hospital Medical Staff plays a vital role in the leadership of the hospital and it provides a forum for healthcare policy ideas and concerns. It is a dynamic team. As the new millennium rolls on, the medical profession and America's healthcare delivery system are undergoing a great metamorphosis and as the healthcare in the United States faces new challenges, we need support, education, and management skills to further Hospital's mission, Primary Care and Specialty Care Message, and our patient's healthcare needs. During the past generation, the relationship between patients and physicians has become more equal. Most clinical decisions are now reached by a process of shared decision making in which physicians provide information and guidance that allow competent adult patients to make their own decisions based on their personal preferences, comfort, values, goals, and desires. There is no one right answer to solve the complex healthcare dilemma. Active discussion of all reasonable ideas needs to continue. We need to be proactive about helth care reform, especially changes so that confusion and ignorance do not hinder the ability to continue to have the best health care in the world. Competent adult patients have an ethical and legal right to accept and refuse medical care, including life-sustaining treatments, recommended by physicians. Patients are in control of their own health care. In general, patients accept their physician's recommendations because physician and patient share the same goal - improving the patient's health status - and because patients usually trust and have confidence in both the physician's technical abilities and their concerns for their patient as an individual. To improve the delivery system, all involved in the healthcare revolution, including physicians and patients, seek to provide quality, affordability, and access. We also need to ensure a caring healthcare community, with strong community coalition, in which each physician feels connected to and supported by the rest of the medical staff, hospital administration, and the community leaders. Scientific and technologic developments in medicine have created unprecedented ethical dilemmas for physicians. The coming revolution in molecular medicine, gene mapping, cloning, and in-vitro fertilization, to name a few, will generate additional clinical problems. In the last decade, clinical ethics has emerged as a new and useful component of medical practice by emphasizing that technical and ethical concerns are inseparable in the practice of medicine. Clinical ethics focuses on the continuing centrality of the doctor-patient relationship and on how patients and physicians work within existing administrative and political structures to reach mutual agreement on clinical decisions affecting the patients. In addition, clinical ethics offers a language of discourse that broadens the medical model from one that is narrowly technical to one that takes serious account of individual patient preferences. The language and content of clinical ethics have been adopted not only by patients, physicians, nurses, and other health care providers and medical educators but also by health economists, hospital administrators, plicy developers, and judges. In this regard, clinical considerations in medicine are likely to remain an important component of medical education, clinical practice, biomedical research, and the political evolution of our health care system. The physician's role does not end with diagnosis and the prescribing of a treatment regimen. The importance of the empathic physician in helping patients and their families bear the burden of serious illness and death cannot be overemphasized. "To cure sometimes, to relieve often, and to comfort always" is a French saying as apt today as it was five centuries ago - as is Francis Peabody's admonition: "The secret of the care of the patient is in caring for the patient." Almost 2500 years ago, Plato recognized that good clinical medicine is a marriage of scientific knowledge and human care. In Book IV of "The Laws," he described the excellent physician as one who "....treats disease by going into things thoroughly from the beginning in a scientific way nd takes the patient and the family into confidence. Thus he learns something from the sufferer.....He does not give prescriptions until he has won the patient's support, and when he has done so, he steadfastly aims at providing complete resoration to health by persuading the sufferer into compliance......" The best clinical medicine and patient outcomes are achieved when patient and physician have established a relationship in which technical and personal aspects of care are integrated. The practice of ethical medicine in the twenty-first century will require nothing more but demand nothing less. Managed care is rapidly dominating the health care financing and delivery system in the United States. HMO enrollment is over 60 million now. Even traditional plans are adopting principles of managed care, which has become a big business. Three areas of innovation are emerging: 1) In many communities, hospitals and physicians have collaborated to form PHOs or physician-hospital organizations, principally as vehicles for contracting with managed care organizations. 2) carve-outs is another area. Here, there are organizations that have specialized provider networks and are paid on a capitation or other basis for a specific service, such as mental health, chiropractic, and dental. The carve-out companies market their services principally to HMOs and large self-insured employers. 3) The third area of innovations is the one made possible by advances in computer technology Unmanaged care is no longer affordable, but several forces continue to fuel its growth. Purchasers of care, public and private, are unwilling to tolerate the growth in medical costs of the last several years. Purchasers also question the wide and unexplained variations in practice patterns among geographic areas and delivery systems, raising suspicions of widespread waste. Further fueling the growth of unmanaged care are the excesses in provider supply, such as in the numbers of specialists and hospital beds, leading to intense competition for limited health care dollars. Because medical care is such a personal matter, managed care will continue to generate anxiety among some consumers and to raise issues of societal values and public policy.SKK ANOTHER THOUGHT: On April 26, 1882, the day Charles Darwin was buried in Westminster Abbey, The Times of London wrote: The Abbey has its orators and ministers who have convinced senates and swayed nations. Not one of them all has wielded a power over men and their intelligences more complete than that which for the last twenty-three years has emanated from a simple country house in Kent. The preceding statement is a reference to the naturalist Charles Darwin and his legacy as the originator of the theory of evolution. Darwin refuted prevailing ideas regarding the origin and place of human beings in the world, revolutionizing science in the process. Many argue that the impact of Darwin’s evolutionary thought can under no circumstances be overestimated. Irrespective of this consideration, the quote from the Times of London is very bold given the context in which Darwinian thought is evaluated. Westminster Abbey has been a burial ground and memorial for a plethora of monarchs and other famous and influential British figures. The poet Geoffrey Chaucer and Mary Queen of Scots are two such prominent individuals who have been buried there. In order to justify this quote then, an analysis must be made of the impact these people made in comparison to Darwin. Despite the lasting impact that both Chaucer and Mary have had on their respective spheres of society, Charles Darwin has surpassed them and all others buried in Westminster Abbey in the magnitude of his accomplishments. Let us first consider the lasting contributions of Geoffrey Chaucer to society and the relevance of them in terms of their impact. Chaucer was a fourteenth century English writer, credited as being one of the greatest poets of all time. "Setting himself against the weight of medieval authority, Chaucer wrote of English men and women and wrote in the English tongue" (Chute, 322). Writing on a great variety of subject matter, he interjected philosophical issues into his poetry tempered with humor. Chaucer is recognized not only for the aesthetic quality of his poetry, but also for his contributions to writing in terms of literary technique. Geoffrey Chaucer was believed to be born in 1342 in London and he died on October 25, 1400, in London and was buried in Westminster Abbey. It was during this last period that he wrote his most famous work, the unfinished Canterbury Tales, which is unique for its variety, humour, grace, and realism. Chaucer was the first great poet of the English nation; and in the Middle Ages he stands supreme. Queen of Scotland (1542--87) and queen consort of France (1559--60), born in Linlithgow Palace, West Lothian, EC Scotland, UK, the daughter of James V of Scotland by his second wife, Mary of Guise. Queen of Scotland at a week old, her betrothal to Prince Edward of England was annulled by the Scottish parliament, precipitating war with England. After the Scots' defeat at Pinkie (1547), she was sent to the French court and married the Dauphin (1558), later Francis II, but was widowed at 18 (1560) and returned to Scotland (1561). In 1565, ambitious for the English throne, she married her cousin, Henry Stewart, Lord Darnley, a grandson of Margaret Tudor, but became disgusted by his debauchery, and was soon alienated from him. The vicious murder of Rizzio, her Italian secretary, by Darnley and a group of Protestant nobles in her presence (1566) confirmed her insecurity. The birth of a son, the future James VI, failed to bring a reconciliation. While ill with smallpox, Darnley was mysteriously killed in an explosion at Kirk o' Field (1567); the chief suspect was the Earl of Bothwell, who underwent a mock trial and was acquitted. Mary's involvement is unclear, but she consented to marry Bothwell, a divorcé with whom she had become infatuated. The Protestant nobles under Morton rose against her; she surrendered at Carberry Hill, was imprisoned at Loch Leven, and compelled to abdicate. After escaping, she raised an army, but was defeated again by the confederate lords at Langside (1568). Placing herself under the protection of Queen Elizabeth, she found herself instead a prisoner for life. Her presence in England gave rise to countless plots to depose Elizabeth and restore Catholicism. Finally, after the Babington conspiracy (1586) she was brought to trial for treason, and executed in Fotheringay Castle, Northamptonshire. Naturalist, the discoverer of natural selection, born in Shrewsbury, Shropshire, WC England, UK. He studied medicine at Edinburgh (1825), then biology at Cambridge (1828). In 1831 he became the naturalist on HMS Beagle, which was to make a scientific survey of South American waters, and returned in 1836, having travelled extensively throughout the S Pacific. By 1846 he had published several works on his geological and zoological discoveries, and become one of the leading scientists of his day. In 1839 he married his cousin, Emma Wedgwood (1808--96). From 1842 he spent his time at Downe, Kent, working in his garden and breeding pigeons and fowls, and here he devoted himself to his major work, On the Origin of Species by Means of Natural Selection (1859). An epoch-making work, it was given a mixed reaction throughout Europe, but in the end received widespread recognition. He then worked on a series of supplemental treatises, including The Descent of Man (1871), which postulated the descent of the human race from the anthropoid group. He wrote many other works on plants and animals, but is remembered primarily as the leader in the field of evolutionary biology. He is buried in Westminster Abbey. |
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