Managed care at the bedside: how do we look in the moral mirror?

Managed care per se is a morally neutral concept; however, as practiced today, it raises serious ethical issues at the clinical, managerial, and social levels. This essay focuses on the ethical issues that arise at the bedside, looking first at the ethical conflicts faced by the physician who is charged with responsibility for care of the patient and then turning to the way in which managed care exacts costs that are measured not in dollars but in compromises in the caring dimensions of the patient-physician relationship.     

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.     

The moral significance of the genetic relation

Our ordinary moral attitudes give a prominent place to the principle that each person ought specially to care for any child who is his or her genetic offspring. From this principle of genetic-parental responsibility and other plausible premises, we can derive the principle that each person has the right to control the genetic use of his or her own genes. But there are competing principles of parental responsibility that require consideration. Principles of nurture are among the important competitors. Also, the view that a woman has the right to control her own body for reproductive purposes may be based on a principle that denies the genetic-parental principle. An analysis is developed of the relations that constitute the criteria for the various possible principles of parental responsibility. Causality, temporality, spatiality, and resemblance are considered. The genetic relation is not any one of these relations, but it includes some of them. The justification of any principle of parental responsibility requires a detailed consideration of the principle from the viewpoint of a deontological or consequentialist moral theory. This examination is beyond the scope of this paper, but consideration is given to some issues and problems of justification, and difficult or unusual cases are discussed. There remain, then, complexities that require further study.     

Effects of field-articulation and feedback on perception of intermediate visual-kinesthetic position.

High and low field-articulators were compared on the accuracy with which they could adjust a rod to intermediate visual-kinesthetic positions while blindfolded, under four sensory-feedback conditions. Independent groups of 10 Ss were given auditory, visual, kinesthetic, or no sensory feedback for 16 trials and then tested on 8 trials without sensory feedback. High field-articulators were significantly more accurate on the feedback trials for all sensory-feedback conditions but not in terms of mean absolute error. The mean constant error on the test trials was significantly lower for the high field-articulators on all feedback conditions except for visual feedback where the low field-articulator had a lower constant error. Both the high and low field-articulators became more accurate and learned more in judging visual-kinesthetic position when auditory feedback was given. Low field-articulators showed significant improvement in accuracy with kinesthetic feedback. The results supported the hypothesis that intermediate directions can be learned and supported previous perceptual research.     

Multidimensional rotation and scaling of configurations to optimal agreement

An integrated method for rotating and rescaling a set of configurations to optimal agreement in subspaces of varying dimensionalities is developed. The approach relates existing orthogonal rotation techniques as special cases within a general framework based on a partition of variation which provides convenient measures of agreement. In addition to the well-known Procrustes and inner product optimality criteria, a criterion which maximizes the consensus among subspaces of the configurations is suggested. Since agreement of subspaces of the configurations can be examined and compared, rotation and rescaling is extended from a data transformation technique to an analytical method.     

The Hippocratic Oath and clinical ethics

Its obvious shortcomings aside, this study by H. Steven Moffic, John Coverdale, and Timothy Bayer is disquieting. It comes as no surprise that residents have lapses of cognitive recall. Every medical teacher knows this very well. What is worrisome is that their amnesia concerns the oldest, most revered, and most influential moral statement in the history of the profession...Purely apart from its content, the oath continues to have power as the solemnification of a physician's entry into the profession. It signifies a willingness to submit to a way of life that demands some suppression of self-interest. If studying the oath more explicitly reenforces this solemnification or strengthens the physician's dedication to the welfare of the patient, the effort will be worthwhile.