Edmund L. Erde

Prolonged survival with hydranencephaly: report of two patients and literature review

Infants with hydranencephaly are presumed to have a reduced life expectancy, with a survival of several weeks to months. Rarely, patients with prolonged survival have been reported, but these infants may have had other neurologic conditions that mimicked hydranencephaly, such as massive hydrocephalus or holoprosencephaly. We report two infants with prenatally acquired hydranencephaly who survived for 66 and 24 months. We reviewed published reports to ascertain the clinical and laboratory features associated with survival of more than 6 months. This review demonstrates that prolonged survival up to 19 years can occur with hydranencephaly, even without rostral brain regions, with isoelectric electroencephalograms, and with absent-evoked potentials. Finally, the ethical aspects of these findings, as they relate to anencephaly and organ transplantation, are discussed.

THE INADEQUACY OF ROLE MODELS FOR EDUCATING MEDICAL STUDENTS IN ETHICS WITH SOME REFLECTIONS ON VIRTUE THEORY

Persons concerned with medical education sometimes argued that medical students need no formal education in ethics. They contended that if admissions were restricted to persons of good character and those students were exposed to good role models, the ethics of medicine would take care of itself. However, no one seems to give much philosophic attention to the ideas of model or role model. In this essay, I undertake such an analysis and add an analysis of role. I show the weakness in relying on role models exclusively and draw implications from these for appeals to virtue theory. Furthermore, I indicate some of the problems about how virtue theory is invoked as the ethical theory that would most closely be associated to the role model rhetoric and consider some of the problems with virtue theory. Although Socrates was interested in the character of the (young) persons with whom he spoke, Socratic education is much more than what role modeling and virtue theory endorse. It -- that is, philosophy -- is invaluable for ethics education.

On peeling, slicing and dicing an onion: the complexity of taxonomies of values and medicine.

This essay is an array of several taxonomies of values which bear on medicine. The first is a rather low-level list of types of values, meant to be adequate to observational data collection about human valuing. It proceeds to a discussion of levels of valuing so that senses of ‘higher’ and ‘lower’ values are articulated. Next, it offers a consideration of intrinsic versus extrinsic and of fundamental versus domestic (or mediating, enabling) values, along with the notions of a practice and virtues. Finally it offers an analysis of clusters of value types along the lines of personal values, social values and professional values acting as interlocking force fields affecting the judgments, reactions and decisions of persons working in health care. In addition to the anticipated elucidation contained in the dialectic, two conclusions are intended: (1) the topic of ‘values in medicine’ is staggeringly complex, and (2) a medical career is in the best sense a tragic fate in that a noble calling is doomed to many failures because of an inability to reconcile conflicts of values as much as because techniques cannot accomplish everything.

On values, professionalism and nosology : An essay with late commentary on essays by DeVito and Rudnick

The essays by Scott DeVito and Abraham Rudnick are on largely the same topics--the meanings of healthy(y), normal, disease, pathological, diagnosis, etc., and they contain compatible conclusions--that medical precepts are value-laden and less objective than some naive model of scientific objectivity would suggest. This commentary opens with a brief critique of each and ends with a more in-depth account, one complaint being how lacking in weight the analyses are. In the middle portion of this commentary, I consider the sorts of values that are present in some case studies--values that give the project much more weight. These include the values, scientific and self-serving, that professionalism provides. I show how medicine and its disease-related concepts can be thought to evolve in many ways.

The Virtues of Medicine: Meaning and Import

What might ‘the virtues of medicine’ mean? If we start to answer this by asking next what does ‘virtue’ mean and if we try to answer this by reference to ordinary occurrences of the word, we find that it occurs almost exclusively in the context of the idiom ‘by virtue of … ’. This expresses causal or contextual explanation as in ‘By virtue of his great weight, he was able to break down the door’ or ‘By virtue of much world travel, she was able to pass the geography test.’ In this sense, a discussion of ‘the virtues of medicine’ might call for a discussion of what medicine can produce.

Professionalism vs. Medical Ethics in the Current Era: A Battle of Giants?

This chapter focuses on the question, “Which norms should govern the practice and practitioner of medicine—and why those?,” and critically examines the partially overlapping, yet competing, answers given to this question by two rival paradigms: (1) “secular academic medical ethics,” and (2) medical professionalism. After clarifying the nature of both paradigms, the chapter presents a multifaceted case for favoring the norms of secular academic medical ethics. This case emphasizes professionalism’s tendency toward medical paternalism, its encouragement of a “peace in the house” of medicine culture that resists accountability to those outside of medicine, and its insistence on fiduciary standards that are overly demanding and perhaps unworkable in our current era of medicine.

Logical Confusions and Moral Dilemmas in Health Care Teams and Team Talk

The call for teams of health care professionals is pervasive ([8], [12], [56]). The language of teams and teamwork — what I shall call “team talk” — in medical contexts apparently dates from the earlier decades of this century ([5], [8]). In this essay, I will offer what I believe Theodore Brown was calling for in “An Historical View of Health Care Teams”, namely, a philosophical analysis of the concept of team with applications of that analysis to the medical context. My goal is to articulate a synthetic understanding of the salient features of the ethos, ideology, rhetoric, and ethics of teams in health care. I will discuss all four (in various degrees) since I do not believe that any could be understood properly in isolation. Beginning with some brief historical, sociological, and attitudinal observations, I will discuss some ethical issues which emerge from a consideration of medical culture and from the larger social setting of workers’ rights. Finally, I will outline the rhetoric of team talk and critically discuss the ethics of this rhetoric.

Method and methodology in medical ethics: inaugurating another new section.

This essay announces the inauguration of a section ofTheoretical Medicine and invites submissions on the topic “Method and Methodology in Medical Ethics.” It offers some sketches of plausible meanings of “method” and of “methodology” and their relationships as these might apply to work in biomedical ethics. It suggests a broad range of issues, dilemmas or conflicts that may be addressed for help via method and/or methodology.

How abstract is my thinking as an ethicist in clinical settings

Answering how abstract my thinking is in practicing applied ethics in clinical settings involves clarifying the idea of abstraction. I see three categories of cases: 1) those I decide automatically, 2) those I feel oblige extra care, and 3) those that force me to abstract thinking in some sense of the word. I use a method for tracking the values at stake in such cases and use it in all three sorts of cases. In consequence, then, to issues about education or training for clinical ethics, I think one needs a method for problem solving that does not seem very abstract but that depends on analyses of some very abstract notions.

Ethics and the care of persons with Bell's palsy

Much of the bioethics literature focuses on dilemmas physicians face involving life and death issues. We articulate and apply a method of bioethics that can help both in resolving such dilemmas and in the appreciation of many situations and conditions. We apply the method to a case of a person with Bells palsy because such a condition does not involve life and death, has a low cure rate, involves poorly recognized value conflicts, involves several specialties with rival approaches to care and much uncertainty. We show the strengths of the method in the application, and recommend it as generally useful to organize the way one perceives cases and attempts to resolve dilemmas.