求一篇关于医院管理的英文文献
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时间：2023-10-29 19:58
In her Lifetime Achievement Award Presentation ring
the annual meeting of the American Society for Bioethics
& Humanities in Washington, on October 20, 2007, the
medical sociologist and bioethicist Rene´e C. Fox addressed
the audience about her ideas about bioethics of the future:
‘‘The bioethics that I envisage’’. In her view, bioethics
should pay more attention to historical aspects of medicine
and health care, and to the history of bioethics itself. Also
the social context of bioethics should be taken more into
account. Finally, she held a plea for a multidisciplinary
approach, thereby also focusing on the philosophical
background of bioethical notions, theories and models. In a
nutshell, this view of the future of bioethics is very similar
to the view from which the scope and aims of Medicine
Health Care and Philosophy have resulted. After all, we
welcome papers from a broad range of disciplines including
history, ethics, anthropology, epistemology, logic,
metaphysics, philosophy of science and technology, sociology
and political science, law, and the philosophy of
culture and religion. Thus we want to place medicine,
health care, and bioethics in the broadest possible context.
Because of its diversity of topics, theories and approaches,
this issue is quite exemplary for the aims and scope of
Medicine Health Care and Philosophy.
The first three papers have a phenomenological orientation
in common. Linda Finlay and Pat Molano-Fisher focus
on cochlear implants. Starting point are the experiences of
Pat, one of the authors and since the age of five post-lingually
profoundly deaf, who received a cochlear implant at the age
of 55. The authors describe and analyse Pat’s experiences
based on an existential phenomenological method. The
authors show how patients after such an implantation have to
come to terms with a changing relationship with the world,
with others and with themselves. Pat has to reorient herself
and learn to cope with her transformed self and world. In the
analysis, typical phenomenological notions such as ‘‘life
world’’, ‘‘embodiment’’, and ‘‘being-in-the world’’ play a
central role. Likewise, the second paper focuses on the
implications of a new medical technology, i.e. tissue engineering,
especially the engineering of heart valves. In this
paper too phenomenological notions such as ‘‘lived integrity’’
and ‘‘the lived body’’ play a crucial role. Mechteld-Hanna
Derksen and Klasien Horstman develop a phenomenological–
ethical perspective on bodies and technologies in which
concrete experiences of health and illness are central. They
attempt to escape from the dichotomy of tissue engineering
being ‘‘morally good’’ or ‘‘morally dangerous’’ based on
specific assumptions of the role of nature in medicine. Instead
they propose that the ethics of tissue engineering should be
framed not in terms of ‘‘natural’’ or ‘‘unnatural’’, but in terms
of ‘‘good embodied life’’ and ‘‘lived integrity’’. In the third
paper, Elling Hulvestad attempts to explain why there are so
few structural aberrations to be found in chronic fatigue
syndrome (CFS) and why a specific treatment is so difficult
to establish. In his view, the CFS can be properly understood
only by taking an integrated perspective in which
evolutionary, developmental and ecological aspects are
considered. Although the phenomenological perspective in
this paper is not so elaborately developed as in the two previous
papers, Hulvestad comes to the conclusion that the
phenomenological dimension enriches biological accounts
of health and disease and adds a new dimension to clinical
studies. When it comes to elucidation of CFS, biological and
phenomenological investigations should be looked upon as
complementing and not competing alternatives.
The next three papers are in the field of psychiatry,
mental health care, and neurology. In the first one, Tim
Thornton takes a stance toward a recently developed
guideline of the World Psychiatric Association (WPA). He
bases his argument on an analysis of an important chapter
in the history of psychiatry, i.e. Windelband’s rectorial
address of 1894 on the distinction between idiographic and
nomothetical understanding. In 2003, the WPA has
emphasized the importance of idiographic understanding as
a distinct component of a comprehensive diagnosis in
psychiatry. In the elaboration of this idea, idiographic
understanding is often assimilated to the notion of narrative
judgement. Thornton argues that we must clearly distinguish
between an idiographic and narrative judgement. In
the call for comprehensive diagnosis, narrative rather than
idiographic elements should have an important role. The
second paper, written by Enric Novella, is about the recent
processes of deinstitutionalization and reform of mental
health services. He starts with a critical review of the most
popular theoretical accounts of these developments, especially
paying attention to the approaches of mainstream
psychiatry and the social sciences respectively. His conclusion
is that it is still a long way to an adequate
explanation of these phenomena. For a comprehensive
understanding of these transformations we need a thorough
evaluation of the facts, a consideration of shifting social
values and needs and a historical analysis of deinstitutionalization
policies. The third paper draws our attention
to the problem of self care in patients with a diminished
capacity of self care, especially persons with Alzheimer’s
disease (AD). Ursula Naue argues that concepts such as
personhood, well-being, autonomy and rationality need to
be re-thought when we try to tackle the problem of
dementia care and of the increasingly aging population.
Naue considers AD a social–medical construct which is to
be understood in the context of power relations. As in the
previous article about mental care, here also Foucault’s
historical and epistemological analyses, for example, about
‘‘technologies of the self’’ play a major role.
Although very different in topic and scope, the next two
papers might be subsumed under the heading of the
patient–physician relationship. The first one, written by
Reidar Pedersen, is an hermeneutically inspired analysis of
empathy, a much discussed phenomenon in the patient–
physician relationship. In the first part of his paper he
criticizes the quite common positive connotation of
empathy: isn’t empathy a wolf in sheep’s clothing? In the
second part he comes up with an alternative description of
empathy, i.e. empathy conceived of as ‘‘appropriate
understanding of another human being’’. In this alternative
description the inherent relationship between empathy and
morality is accentuated. The second paper tackles a new
phenomenon in medicine and health care, i.e. the so-called
‘‘e-medicine’’, in particular the role of Internet in the
communication between patient and physician. Christian
Simon and Sarah Schramm studied the so-called indirect
Internat use among cancer patients and their families. In
indirect Internat use patients report receiving online
information from their relatives and social networks. This
study illustrates that indirect Internat use is a central feature
of the cancer experience. In contrast to other literature
in this area, the authors suggest that indirect Internat use
may have normatively positive and negative implications
for patients.
The last two papers in this issue regard biomedical and
clinical research, but deal with quite different topics.
Deborah Barnbaum analyses the notion of supererogation
(‘‘going beyond the call of ty’’) and its applicability in
clinical research. Supererogation is a much discussed
notion in clinical ethics, but has so far received little
attention in research ethics. According to Barnbaum,
patients, research participants, and also researchers themselves
have, like physicians, the opportunity to perform
acts of supererogation. Such praiseworthy acts, she argues,
should be accorded the moral respect that they deserve.
The final paper in this issue is in line with the plea of Rene´e
Fox for a more socially embedded bioethics. Drawing upon
10 interviews with stem cell researchers Alan Cribb et al.
explore and illustrate the ways in which the role positions
of researchers are shaped by the normative structure of
science and medicine. The emphasis is on the social construction
of role positions in medicine, medical research
and medical ethics. The authors argue that, unless we
understand the social construction of ethical positions, and
the division of ethical labour thereby proced, we will be
unable to understand what is going on in translational stem
cell research
