Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

A teaching framework for cross-cultural genetic counseling

The increasing diversity of American society has brought growing recognition of the need to bridge cultures in the delivery of genetic counseling services. New immigrants and members of diverse ethnic groups face multiple barriers to genetic counseling services. The need to train genetic counselors to deal with cultural diversity is especially crucial in the new genetic era, given the rapid expansion of available technology, with the resulting social and ethical ramifications. A framework for teaching cross-cultural issues in genetic counseling training programs is presented that can be implemented in step-wise fashion, consistent with available resources. Cross-cultural issues can be incorporated into existing teaching and training modalities by expanding the orientation from monocultural to multicultural. Relevant clinical experience, exploration of students' preconceptions and biases, reading materials, and lectures by invited speakers can all enhance students' knowledge and sensitivity. It is critically important that training programs furnish students with the basic tools necessary for the ongoing process of learning about cultural diversity.     

FUNCTIONAL COMMUNICATION TRAINING WITH AND WITHOUT EXTINCTION AND PUNISHMENT

Functional communication training has been reported to be a promising treatment for severe behavior problems. In this study, functional communication training alone and combined with extinction and/or punishment was evaluated for 4 clients with severe retardation, behavior problems, and communication deficits. The participants were inpatients on a hospital unit for treatment of severe behavior disorders. They received individualized interventions based on functional assessment that included reinforcement of a communication response with the same function as their destructive behavior. Results showed that for some patients, functional communication training was not sufficient to produce clinically significant reductions in destructive behavior, and the combination of training plus punishment produced the largest and most consistent reductions.     

Medical education: The training of ethical physicians

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.I wish to thank Dr. Mary Ann Cutter and Melissa M. Amaro for their critical suggestions.     

Whose Gene Is It? A Case Discussion About Familial Conflict over Genetic Testing for Breast Cancer

A multidisciplinary group of genetic and other professionals discuss a complex case of familial conflict over access to genetic information. One twin wishes to know the results of her deceased mother's tests for BRCA1 mutations; a second twin objects to researchers making this information available. As the case discussion unfolds, the apparent facts of this case are called into question and the lines of ethical certainty become less clear.     

The responsibility of engineers, appropriate technology, and lesser developed nations

Projects importing technology to lesser developed nations may raise five important concerns: famine resulting from substitution of cash crops for subsistence crops, the use of products banned in the United States but permitted overseas, the use of products safe in the U.S. but unsafe under local conditions, ecological consequences of technological change, and cultural disruption caused by displacing traditional ways of life. Are engineers responsible for the foreseeable hunger, environmental degradation, cultural disruption, and illness that results from the project? Are engineers guilty of paternalism if they refuse to accept the project for that reason? Criteria are given to help engineers assess the extent of their responsibility when working in lesser developed nations.     

Chaos and God's Abundance: An Ontology of Variety in the Divine Life

The primordial chaos of Genesis 1 may be understood as the Pandemonium Tremendum (or PT), the infinite field of variety or abundance within God. The concept of variety is taken from Claude Shannon's theory of communication. Especially significant is Shannon's notion that communication is the limitation of variety through decision processes. In one model of the divine life suggested by the theory, the PT is the boundless source of potential reaped by an agential God in the act of creation as a communication process. Other models for creation include the PT in a biased mode and creatures themselves as decision agents.     

DIE MARXISMUS – DEBATTE IM “SILBERNEN ZEITALTER”

Im Anfang des 20.Jahrhunderts unterzog eine Reihe von jungen, später berühmt gewordenen Philosophen den Marxismus einer tiefen Kritik. Ihnen ist es gelungen, wichtige Defekte der revolutionären Doktrinen aufzudecken und ihre verhängnivsollen Konsequenzen vorwegzunehmen. Diese Kritik ist auch für die gegenwärtige geistig-politische Situation aktuell.     

TRACING A TRAJECTORY

Abstract. Theology and ethics intersect with sciences at different points depending upon whether the scholars involved are interested in, for example, general epistemological issues or practical moral judgments. The intersection affects theology and ethics in different ways, depending upon various commitments or resistances on the part of theologians. The author surveys his own writings to show how openness to the sciences has had an impact on various phases of his work and what issues remain somewhat unresolved.