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This tension is rooted in the circumstance that traditional Christians know things about medical morality unrecognized within secular society purchase sinequan 10mg with visa. In “The Physician’s Con- science discount sinequan 75mg fast delivery, Conscience Clauses effective 10mg sinequan, and Religious Belief: A Catholic Perspec- tive cheap sinequan 25 mg with mastercard,” Pellegrino lays out a geography of some of the resulting moral conficts, giving special attention to the rising reluctance of the state and others to confront honestly what should count as violations of conscience. For example, although religious exemption laws and conscience clauses have protected physicians from being directly coerced to engage in abor- tion or physician-assisted suicide, there is nevertheless often a require- ment that they refer patients to others to do things the Christian physician knows to be immoral (that is, since abortion is equivalent to murder, then referring a woman to an abortionist is equivalent to referring someone to the services of a hit man, even if one will not engage directly in the mur- der oneself). In addition, there are growing constraints on religious insti- tutions, once they receive tax funds, to provide services they would recognize as immoral, though their co-religionists have been forced to pay those very taxes. Among the failures in such public policy approaches is © 2008 University of Notre Dame Press An Introduction not appreciating that institutions, in order to maintain an integrity and commitment to virtue, must preserve the character of their commitments to the particular communities that brought them into existence and sus- tain them. It is through institutions such as sectarian hospitals that indi- viduals realize their concrete lives in moral communities, with the result that the moral integrity of the individual is put at jeopardy if they are not able to protect and maintain the moral character and integrity of their institutions and their moral communities. The last section ofers Pellegrino’s analysis of the ambiguities of hu- manism, the limitations of the Hippocratic Oath, and the challenges to framing a medical ethics for the future. The frst subsection, “Humanities in Medicine,” brings together essays exploring the role of humanism in medicine and medical education. The frst essay, “The Most Humane of the Sciences, the Most Scientifc of the Humanities,” already partially quoted in this introduction, is an early manifesto that in many ways in- spired the development of humanities teaching in medical schools. It in- cludes Pellegrino’s famous synopsis of the relationship of humanities and medicine: “Medicine is the most humane of sciences, the most empiric of arts, and the most scientifc of humanities. Its subject matter is an ideal ground within which to develop the attitudes associated with the human- istic and liberally educated. As he stresses, the humanities have traditionally been recognized as quite diferent from the liberal arts. Pellegrino also stresses a point underscored by Abraham Flexner: “the pull toward specialization and scholarship” tends to transform the study of the humanities from the pursuit of wis- dom to the pursuit of information and pedantry. This point is developed further in the second essay, “The Humanities in Medical Education: Entering the Post-Evangelical Era,” where Pellegrino again emphasizes that the liberal arts, from classical times, have compassed “the intellectual skills needed to be a free man. The humani- ties must be made integral to the life of the medical student and the physi- cian. In actual practice, medical students and physicians must see how the medical humanities support the physician’s virtuous response to actual patients. The next essay locates concerns regarding humanism and the virtue of the physician in the context of Roman Catholic perspectives on medical morality. In “Agape and Ethics: Some Refections on Medical Morals from a Catholic Christian Perspective,” Pellegrino reviews the recent Roman Catholic dialogue with “the dominant cultural ideas of the time” and the competing accounts of morality and ethics which this has produced. He selects for his focus what he terms an agapeistic ethic: a virtue-based ethic which afrms charity as the principle that should structure the relation- ship between physicians and patients. With charity taken as the ordering principle of discernment in moral choice, Pellegrino places the general concerns of the humanities and the liberal arts within the more concrete focus of a particular Roman Catholic understanding. In this fashion, he gives content to the meaning of the virtuous and humane physician. He suggests as well the importance of the tie between Christian belief and vir- tuous practice. This section ends with an essay that locates the previous discussions in terms of the challenge of bringing bioethics to speak to the pressing issues of normative ethics: “Bioethics at Century’s Turn: Can Normative Ethics Be Retrieved? The default position in bioethics and health care policy tends to be procedural rather than substantive, because substance divides and en- © 2008 University of Notre Dame Press An Introduction genders dispute. Quoting Gilbert Meilaender, Pellegrino concludes that bioethics has “lost its soul. The last subsection is a brace of papers exploring the Hippocratic tra- dition and its capacity to inform a bioethics for the future. The frst essay, “Toward an Expanded Medical Ethics: The Hippocratic Ethic Revisited,” begins by recognizing that “Good physicians are by the nature of their vocation called upon to practice their art within a framework of high moral sensitivity. For two millennia this sensitivity was provided by the oath and the other ethical writings of the Hippocratic corpus. No code has been more infuential in heightening the moral refexes of ordinary indi- viduals. Every subsequent medical code is essentially a footnote to the Hippocratic precepts, which even to this day remain the paradigm of how good physicians should behave. This Hippocratic ideal he shows to lie at the heart of the Hippocratic com- mitment to protecting the vulnerability of the patient.

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Simple minds purchase sinequan 75 mg with amex, stupefied by the sterilised pap of television and the bland diet 38 Healthism of bowdlerised culture and semi-literacy discount sinequan 10mg visa, are a fertile ground for the gospel of the new lifestyle cheap sinequan 25mg otc. The American sociologist Renee Fox has argued that the input by the medical profession into the increased preoccu- pation with health is only one variable in the equation sinequan 75 mg lowest price. In the past medicine and magico- religious rituals were fused into one explanatory system that accounted for health, disease, strength, fecundity and invul- nerability, all of them being supernaturally conferred. In modern society, medicine has largely separated from religion, but health has retained its religious, or rather, pseudo- religious, metaphysical, mystical symbolism. For example, Rick Carlson writes in his book The End of Medicine: We have not understood what health is. The pursuit of health and of well-being will then be possible, but only if our environment is made safe for us to live in and our social order is transformed to foster health rather than suppress joy. Fox cites Carlson as an example of the demedicalisation tend- ency, which runs opposite to the professional medicalisation of life. A dying century and a dying culture makes war against death its main preoccupation. Pathological in its psychological origins and inspiration, superstitious in its faith in medical deliverance, the prolon- gevity movement expresses in characteristic form the 45 anxieties of a culture that believes it has no future. In the Utility of Religion, John Stuart Mill thought that It is not, naturally and generally, the happy who are most anxious either for prolongation of the present life or for a 46 life hereafter; it is those who never have been happy. The narcissistic cult of youth, health and beauty, preached by health promotionists, increases the feeling of guilt and anxiety in an ageing population who would give anything for a magic mirror which would tell them that they are beautiful and needed. The pursuit of the Holy Grail of Health is driven by the mistaken belief that health equals happiness. The New Age acolyte is exhorted to eat less fat, produce bulky stools, and buy an exercise bicycle. While gratuitous violence, terrorism and crime are on the increase, the minders of society talk about tackling the causes of this social unrest. There is nothing wrong with these metaphors, except that it is not clear which river, people and lifesavers. The famous Saint Ber- nard dog, Barry, now stuffed and exhibited in the museum of Natural History in Bern, saved 42 human lives - more than any health promotionist I know. At best they will stare at you; at worst they will try to measure your cholesterol. Too many of our inhabitants worry through life with only fairly good health and while they accomplish their daily duties, these fairly well persons may never know the exuberance and happiness of perfect health. Hence, one goal of the future practitioner of medicine will be the attainment and maintenance of exuberant health, which is the inherent right of every person. This instructive passage, though written nearly 70 years ago, sounds surprisingly modern. Health must be more than the absence of disease, it must be exuberant health, super- health. Is the function of medicine to turn people into economically useful, happy robots? The sort of feeling ordinary people may achieve fleetingly during orgasm, or when high on drugs. Old people drifting into the oblivion of dementia, sour spinsters, jilted lovers, ruined 42 Healthism gamblers, wives of drowned fishermen, victims of violence, or immured lunatics would also spoil the picture. Even Chris- tians, in their boundless optimism, have been more realistic in deferring the promise of complete happiness to the afterlife. In the 1980s health expenditure per head of population fell in about half of the African, two thirds of the Latin American 52 and one third of the Asian countries. Even with training in lesser degrees of exactitude, a layman would shake his head. He also pointed out that pre- ventive medicine is not a substitute for curative medicine, but a luxury for the healthy and an additional expense for 44 Healthism the health service. As with our ability to keep the more chronically ill, handicapped and disabled alive, and to enable more people to survive to old age, the inevitable consequence is an increased demand for hospital beds and medical services to deal with the degenerative diseases of vision, hearing, the cardiovascular system, the respiratory system, the musculo- skeletal system, the urogenital system, and, above all, of the brain. The Asian and African countries, with the exception of Ghana and Sudan, did not attend. The signatories of the Ottawa charter pledged: to acknowledge people as the main health resource; to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and well-being.

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Ifat Rubin-Bejerano started a company named ImmuneXcite which seeks to develop a cancer therapy discount sinequan 25mg without prescription. By creating cancer-specific antibodies which conjugate to polysaccharides buy generic sinequan 75 mg on-line, Rubin- Bejerano plans to trick the immune system’s neutrophils into believing that the tumor cells are actually invading fungi cheap sinequan 75mg line. Since neutrophils aggressively attack bacteria and fungi discount 25mg sinequan free shipping, target cells such as cancer cells 16 or simply pathogenic cells will be more aggressively attacked by the immune system than without the conjugate (Dedesma, 2010). The model has already proven effective against resistant cancer cells in mouse model, and the future of ImmuneXcite looks very promising. Use of beta-glucans against biological warfare weapons and pathogens including anthrax. By combining the continuing understanding of microbiology with the increased knowledge about illnesses and cancers as well as the diversity in research throughout the world, many diseases and other ailments seem to be on the verge of being relieved, cured, or even eradicated. One main hindrance to the progression in the medical field is the waiting time for approval of each drug or process. To understand the drawback of the waiting period for an approved drug, consider the average of 400 million cases of malaria per year. The liability of companies and the side effects of the patients is the driving force for this waiting period, and that’s the way it’s going to be. Regardless of the politics of it all, and as important as the development of drugs such as Lovastatin has been, the largest breakthroughs which microbes appear to be able to affect is the treatment of cancer and the spread of malaria. Previously, cancer was either surgically removed or the all of the patient’s dividing cells would be destroyed for the duration of chemotherapy. By finding mechanisms to deliver the potentially deadly chemotherapeutic drugs directly to the tumor cells, the application of bacteria as st drug vehicles looks to have a stunning impact on the oncology field in the 21 century. Even more importantly for lower socioeconomic countries, the use of fungus to decrease Malarial infection could be crucial to the positive development of these nations. If these countries were to decrease the number of Malarial cases from 300-500 million per year to 9-15 million per year, these nations would be giving their children a future. Medicine, which is always looking to make strides in its care of patients, looks to have found very promising partners, but it takes a microscope to see them. This publication refects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein. It aimed to promote harmonisation in the Higher Education sector in support of the Bologna Declaration and subsequent developments. Beginning in 004, the Tuning (Medicine) Task Force has now generated and gained widespread consensus on a set of learning outcomes for primary medical degree qualifcations in Europe. They have been generated through an extensive iterative process of expert review and development, and have been the subject of a Europe-wide internet-based opinion survey and subsequent detailed analysis. The outcomes are expressed as a two-level model, with 1 major ‘Level 1’ outcomes, each being further defned by a set of more detailed ‘Level ’ outcomes. A further set of outcomes has been defned under the heading “Medical professionalism” – many of which are common to graduates of other disciplines in Higher Education. The Level 1 outcomes and ‘Medical professionalism’ are suitable for implementation as “curriculum themes”, and applications such as blue-printing of assessment programmes. The Level outcomes may be used to determine discrete items of teaching, learning and assessment. The outcomes are available for use by educational managers in curriculum planning, or as part of quality enhancement or quality assurance processes. These would provide the core learning outcomes of a primary medical degree programme, although each country, medical school and student would also be expected to achieve additional learning outcomes tailored to their local and individual needs. If applied appropriately and linked to efective assessment, this approach allows each school or country to have a distinct profle and to focus on particular areas of strength (e. Such concerns led to the Bologna Declaration (European Ministers of Education, 1999) and the ongoing ‘Bologna Process’ which seeks to create a system of easily readable and comparable degrees and the establishment of a European Higher Education Area. A three-cycle system of higher education degrees - Bachelors, Masters and Doctorate - normally equating to two or three years of study each.

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