Responsibility Of Medicine Research Articles

Shifting Responsibilitiesin Medicine 4.0 – A Project Report

"In this contribution, we anticipate the results of the research project “Medicine 4.0 – the ethical basis of digitalization in healthcare” funded by the German Ministry of Health, which investigated the ethically relevant effects of digitalized medicine using mobile health (mhealth) and telemedicine as prime examples, with the final aim of deriving policy-relevant overarching recommendations. In an iterative interdisciplinary approach, we linked social science research with analytic research on the ethically relevant effects of these technologies, including on the doctor-patient relationship, the relationship between responsibility and solidarity in healthcare and on the autonomy of the individual. In both the ethical and social science research, a key focus concerned the identification and analysis of an apparent diversity of stakeholder values and perspectives. In mobile or mhealth, which we concentrate on for this presentation, technology developers, insurances, physicians and public health professionals as well as ‘patient-consumers’ need to be looked at and involved. Their outlook in turn may converge, but also be in tension or collide, e.g. regarding conditions for data access and use, liability in case of malfunction or misuse and the overall question of responsibilities in a context of shifting roles and role anticipations. The research combines ethical insight and expert stakeholder perspectives on the most pressing issues in this fast-moving field. Further, traditional issues such as informed consent, confidentiality and the role of individual autonomy, are in part redefined with the emerging role of automated or algorithmic decision-making. "

German neurology and neurologists during the Third Reich: the aftermath

The article discusses the consequences for neurology as a discipline which resulted from neurologists' participation in the crimes committed under National Socialism (NS). Chronologically, the current literature distinguishes mainly four overlapping stages: (1) a first phase was characterized by legal persecution and "denazification", which was also the time of the Nuremberg doctors' trial in which no neurologists were on trial. A detailed documentation of the trial for the German medical profession was published by Alexander Mitscherlich. (2) In the subsequent practice of wide amnestying and reintegration of former Nazi followers during the 1950s, neurologists were no exception as its elite continued in their positions. The year 1953 was the year of the Lisbon scandal, when chiefly Dutch representatives protested against the participation of Julius Hallervorden in the International Congress of Neurology. The newly founded societies, the German Society for Neurology (Deutsche Gesellschaft für Neurologie, DGN) and the German Society for Psychiatry and Neurology (Deutsche Gesellschaft für Psychiatrie und Neurologie, DGPN), unanimously supported their member. (3) The next period was characterized by a nascent criticism of the prevailing attitude of covering up the crimes committed by physicians during the Nazi period. The discovery of incriminating brain sections at various Max Planck Institutes brought neurology to the focus of the debate. (4) Since the 1980s and 1990s historians (of medicine) have been systematically examining medicine's Nazi past in a professional way, which resulted in a noticeable increase of knowledge. Additionally, a new generation of scholars provoked a change of mind insofar as they recognized medicine's responsibility for the crimes committed between 1933 and 1945. We expect that future historical research will further elucidate the history of neurology during the NS regime and have consequences for our current understanding of research ethics.

Understanding health behavior and speaking out on the uninsured: two leadership opportunities.

The author reviews the growth of managed care and its transforming effect on academic medical centers. He then maintains that in this time of fundamental changes and stress, academic medical centers should not only attend to the organization and financing of the clinical enterprise and the enhancement of biomedical research capacity, but also ask how academic medicine can live up to the unique opportunities and responsibilities it has been entrusted with to improve the health of the public, particularly in two neglected areas. First, if the nation does not expand the research agenda to include social and behavioral factors involved in preventable causes of morbidity and mortality, it will fail to maximize the dividends from the generous public investment in research and fail to learn how to promote healthy personal behavior. Academic medicine can promote such behavior by increasing the science base of prevention and translating into action what is already known, including how to market that knowledge so the public will respond. Second, the number of the medically uninsured is increasing; the largest percentage are the working poor. It is becoming more difficult for teaching hospitals to continue providing a third of the nation's uncompensated care. The author shares a variety of statistics about the uninsured and their care, and maintains that academic medicine, which has been entrusted with the health of the public, can declare that the high number of the uninsured is not acceptable and is a dangerous side effect of the U.S. health care system that must be treated. Doing so will also set an example to medical students and trainees that medicine's responsibility is to all Americans.

The healer's tale: transforming medicine and culture

Contemporary medicine is clearly in a crisis, one brought on by technological miracles that have far outpaced our moral, legal and cultural responses to them. One needs only to glance at the morning newspapers to see the evidence: doctor-assisted suicides, litigation over the custody of artificially conceived children, more litigation over vegetative maintenance of otherwise dead people, the health insurance system run amok, and so on. In fact, Kaufman begins with a gallery of these clippings, each covering moral complexities virtually unimaginable a generation ago. We seem to have lost the connection, once obvious, between what medicine does and what it should do, and it is the quest to recapture that connection that The Healer's Tale pursues. Kaufman's search for answers leads her to seven of the country's most eminent physicians, each now in his or her 80s and each, therefore, a living historian and practitioner of medicine during its transformation. Through the stories of their careers we begin to learn how the ordinary general physicians of 70 years ago have become today's scientific specialists, how they have responded to these changes, and what their hopes and concerns are regarding the profession's current directions. Because these are real, personal stories, told by some of American medicine's most accomplished practitioners, The Healer's Tale offers a directly engaging experience for the reader. We come to know and appreciate these doctors as people with deep concerns about the basic issues of health and illness, about medicine's responsibilities to society, and about the meaning (literally, in this case) of life: what are its origins and ends and who controls them?

Sociology in American medical education since the 1960s: the rhetoric or reform.

Despite recommendations by medical reformers that medical sociology be included in the curriculum, there is currently little evidence of a far-reaching integration of sociological perspectives in American medical education. Yet, support for the relevance of sociological knowledge has since the late 1960s helped to diffuse external pressures for change in health care and medical education. As a symbol of the communitarian commitment of the medical profession, claims in favor of the incorporation of sociological perspectives have thus occasionally, and largely unintentionally, served the public relations interests of biomedicine. However, the more recent interest in medical ethics has to some degree transformed medicine's educational agenda and the definition of medical 'human values'. Whereas the rhetorical expropriation of medical sociology primarily has concerned medicine's responsibility vis-à-vis society as a whole, the new medical ethics education signifies a return to a more individualistically oriented medical morality.

Market research in medical practice. A case study of one practice's site survey.

This feature examines the many new developments in health care delivery. It is in keeping with POSTGRADUATE MEDICINE's responsibility to bring readers information not only on clinical subjects but on changes that are occurring in the social, economic, ethical, and legal aspects of practice.

Expansion of emergency medicine's responsibilities for preclinical education of medical students

Many medical schools have required emergency medicine courses for freshmen medical students, usually through participation in BLS (basic life support) or EMT activities. For several years students at our institution have participated in a required emergency medical technician-ambulance grade (EMT-A) course. While retaining much of the material presented in that original EMT-A course, the course has now been expanded to serve as the medical students' introduction to clinical medicine. This expansion resulted from the belief that emergency medicine provides initial patient contact in the presence of a faculty uniquely suited to introduce the broad domain of clinical medicine to the medical student. Emergency physicians, more than any other specialists, must possess the ability to obtain an incisive history promptly, perform an accurate physical examination, and arrive at an assessment with limited laboratory and radiologic data. Initial access to the clinical education of medical students provides the opportunity to direct their efforts in a prioritized fashion, and thus helps to organize their thought processes for further development as clinicians. Departments of emergency medicine should be willing to accept this incremental responsibility for the introduction of the medical student to the clinical and laboratory assessment of patients.

Expansion of emergency medicine's responsibilities for preclinical education of medical students

Expansion of emergency medicine's responsibilities for preclinical education of medical students

The new hospice Medicare benefit

This feature examines the many new types of health care delivery systems now operating and developing. It is in keeping with postgraduate medicine's responsibility to bring readers information not only on clinical subjects but on changes that are occurring in the social, economic, ethical, and legal aspects of practice.

Free-standing treatment centers. Another member of the competition.

This feature examines the many new types of health care delivery systems now operating and developing. It is in keeping with Postgraduate Medicine's responsibility to bring readers information not only on clinical subjects but on changes that are occurring in the social, economic, ethical, and legal aspects of practice.

Editorial: Resource allocation for the severely brain damaged.

TheArchiveshas usually left to more general journals the important, but by nature imprecise, examinations of medicine's responsibilities to the larger public and we, by and large, plan to continue such a policy. The subject of the following article, however, has become a major issue in the contemporary neurological world, for the outcome of the enormous expenses of critical must be judged by not only the relatively low survival rate (N Engl J Med 294:982-986, 1976), but by the neurological capacities of the survivors as well. Accordingly, the Editors believe that Professor Jennett's thoughtfully expressed point of view deserves wide attention by those involved with care of the severely brain-damaged of any age. Needless to say, the subject has stimulated varying opinions among ourselves and we expect that it will do so among our readers, whose views on this important issue are welcome.—ED.

Range of medicine's responsibility.

The London Post this week comments on a letter published on January 7, 1972, in both the Lancet and the British Medical Journal. The reasons for the simultaneous publication must have been weighty, for such distinction is not usually accorded to the urgent revelations, indignant protests, and wry conceits that arrive in the editor's mail. Perhaps the letter was featured by both of Britain's great medical weeklies because it dealt with overpopulation. Perhaps the impressive list of 55 medical signatories was influential. But perhaps most persuasive was the purpose of the letter: to urge and press for action to contain . . .

Book Reviews

Book reviewed in this article:SURGEON'S SAGA. By SIR FRANCIS GORDON BELLREHABILITATION IN EXTREMITY FRACTURES. By EUGENE MOSKOWITZETHICAL RESPONSIBILITY IN MEDICINE: A CHRISTIAN APPROACH. Edited by VINCENT EDMUNDSTREATMENT OF CARCINOMA OF THE BREAST. Edited by Anthony S. JarrettCANCER THERAPY BY INTEGRATED RADIATION AND OPERATION. Edited by B. F. RUSH, Jr. and ROBERT H. GREENLAWAN OUTLINE OF THORACIC SURGERY FOR MEDICAL STUDENTS. By JOHN HINES KENNEDYTORTICOLLIS IN INFANCY AND CHILDHOOD. By PETER G. JONESAN OUTLINE OF ORTHOPÆDIC SURGERY. By PAUL S. DERIANDRINGLICHE CHIRURGIE DER ERSTEN LEBENSWOCHEN. By GUNTHER BELLMANTHORAX – ANÆSTHESIE. Edited by WILLIAM W. MUSHINORTHOPÆDICS FOR THE UNDERGRADUATE. By W. A. CRABBE

Medicine's Responsibility in the Propagation of Poor Protoplasm

THIS unexpected and undeserved honor has made me acutely aware of my lack of fitness to wear even for this short time the mantle that has graced such distinguished predecessors. Some of them have t...