Larry R. Churchill

Ethics in Sports Medicine

Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the “team physician” has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.

The Hegemony of Money: Commercialism and Professionalism in American Medicine

Money plays a powerful role in modern medicine, both in terms of how health services are organized and delivered and increasingly in how physicians understand themselves and their work. The phrase “the hegemony of money” is intended to capture that power.

One cheer for bioethics: engaging the moral experiences of patients and practitioners beyond the big decisions

We will argue here that after more than 30 years of talk, theory, and clinical practice, we bioethicists still know far too little about what patients, subjects, and healthcare professionals are up to, morally. Bioethics is still near the beginning in grasping what it means to understand, much less to honor fully, the moral power and perspicacity of those bioethics is designed to serve. This is, of course, a serious charge, but one we will endeavor to show has merit. However, we want to be clear from the start that we do not gainsay the important work that has been done in and through the influence of bioethics, both as a field of practical engagement and as a cultural movement, in improving how healthcare is delivered and how human subjects are treated. Thirty or 40 years—depending on how one marks the beginning point—is a very short time, and it is hard to imagine that wholesale changes, all of them in the right direction, could be the outcome for a field this young. Hence, we do not intend the title, “One Cheer for Bioethics,” as a wholesale indictment, but as an indication that there is a great deal of work yet to be done, and that following the currently dominant direction of the field is not likely to get us there. Our aim is to indicate just where future work should be focused, and to do so we will need to be critical of some of the preoccupations of the last three decades. The authors thank Lida Anestidou, Mark Bliton, Ellen Clayton, Stuart Finder, Elizabeth Heitman, Joshua Perry, Annabeth Schenck, and Lucia Tanassi for helpful comments on earlier presentations and drafts of the ideas in this paper.

Age-Rationing in Health Care: Flawed Policy, Personal Virtue

The age-rationing debate of fifteen years ago will inevitably reemerge as health care costs escalate. All age-rationing proposals should be judged in light of the current system of rationing health care by price in the U.S., and the resulting pattern of excess and deprivation. Age-rationing should be rejected as public policy, but recognized as a personal virtue of stewardship among the elderly.

The dangers of looking for the health benefits of religion

David Hume said that the errors of religion are dangerous; those of philosophy merely ridiculous. Hume wrote this in 1740, in a time when religious wars were a fresh memory in his native Scotland. In Blind Faith: the Unholy Alliance of Religion and Medicine, behavioural scientist Richard Sloan argues that zealotry for research on the health benefi ts of religion is also an error that poses substantial dangers to a health-conscious, but scientifi cally illiterate, public and to vulnerable patients seeking care from proselytising physicians. At risk as well is our understanding of science and its methods, and of religion and its meaning. At the centre of Sloan’s critique are studies of intercessory prayer, that is, prayer for divine intervention to achieve specifi c health outcomes, such as fewer postoperative complications or shorter hospital stays. And it is here, in the philosophy that informs intercessory prayer studies, that Hume’s judgment of “ridiculous” can be fairly echoed, although Sloan himself is more restrained. To be sure, religious people have been praying about their health and asking for specifi c outcomes for a very long time, and religious authorities have been concerned for an equally long time with the theological legitimacy of such requests. One of my examination questions for ordination in the Presbyterian Church three decades ago was whether it is permissible to pray for rain. The examiner knew I was headed for a small congregation of dairy, corn, and tobacco farmers, so the question had particular relevance. Like many, I thought and still think it is fi ne to pray for anything people are concerned about, but that asking for specifi c outcomes can change prayer into a consumer exchange (if you make it rain, we’ll continue to worship you), or a challenge (show how much you love us), and is frequently more about egos than souls. Unlike prayers of confession, adoration, or blessing, intercessory prayer is a near cousin to magic. Students of religion have long noted the similarities between religion and magic, and also between magic and science. In the early 20th century, scholars like Bronislaw Malinowski and Lucien Levy-Bruhl defi ned

The American Association for Thoracic Surgery 2016 ethics forum: Working virtues in surgical practice

&NA; Moral virtues are the complement to ethical principles. They constitute the elements of character that drive habits and daily routines. Certain virtues are especially important in surgery, shaping surgical practice even when no big decisions are at hand. Eight virtues are described and the work they do is explored: trustworthiness, equanimity, empathy, advocacy, compassion, courage, humility, and hope.