Moving beyond bioethics: history and the search for medical humanism

From both within and without bioethics, growing criticism of the predominant methods and practices of the field can be heard. These critiques tend to lament an emphasis on logically derived rules and philosophical theories that inadequately capture how and why people have the moral attitudes they do, and they urge the use of more empirically grounded social sciences--history, sociology, and anthropology--to draw attention to the complex factors behind such attitudes. However, these critiques do not go far enough, as they do not question why debate over ethical categories should have such a central role in voicing concerns about medicine. The importance of using other forms of inquiry, especially that of history, to examine aspects of medical practice and the emergence of bioethics itself is not simply to refine bioethical moral analysis. Instead, history can be employed to counter the preoccupation with translating concerns about medicine into moral terms and to move towards what is more sorely needed: a true medical humanism.     

世界不同地区现代人及现代行为的出现与区域特征

现代人和现代行为在世界不同地区的出现是多年来学术界的焦点问题, 至今关于这方面的研究与讨论仍然非常热烈。本文简要梳理了不同地区现代人及其行为出现的情况及特点, 并在目前的材料和研究的基础上特别关注了东亚地区, 指出有待进一步研究和解释的问题。现代行为和文化具有显著的区域特征, 这应当是现代人在不同自然和社会环境中适应生存的反映。同时各地区在旧石器时代晚期也展现出相似或相同的技术思维、知识和行为方式,暗示出活跃的人群迁徙与交流。     

'Yes:--no:--I have been sleeping--and now--now--I am dead': undeath, the body and medicine

In this paper I propose that, since the mid-eighteenth century medical science has simultaneously generated and disavowed 'undead' bodies, suspended between life and death. Through close analysis of three examples of 'undeath' taken from different moments in medical history, I consider what these bodies can tell us about medicine, its history, cultural meaning, scientific status and its role in shaping ideas of embodiment, identity and death. My first example is Edgar Allan Poe's story 'The facts in the case of M. Valdemar' which imagines the possibility of a man mesmerised at the point of death. I read this story as a response to the rise of professional, scientific medicine in the 1840s. I then look at the recurring issue of brain death in order to consider tensions within twentieth-century medical hegemony. Finally I read the Alder Hey scandal as a reactivation of undead anxiety in response to the emergent culture of medical consumerism at the end of the twentieth century.     

Dynamic neuronal-glial interactions: an overview 20 years later

After commenting on some perceived reasons why our review may have been relatively frequently cited, a brief overview is presented that first summarizes what we knew 25 years ago about the dynamic neuronal-astroglial interactions that occur in response to changes in the physiological state of the animal. The brain system in which these dynamic interactions were studied was the magnocellular hypothalamo-neurohypophysial system (mHNS) of the rat. The mHNS developed as and continues to be the model system yielding the most coherent picture of dynamic morphological changes and insights into their functional consequences. Many other brain areas, however, have more recently come under scrutiny in the search for glial-neuronal dynamisms. Outlined next are some of the questions concerning this phenomenon that led to the research efforts immediately following the initial discoveries, along with the answers, both complete and incomplete, obtained to those research questions. The basis for this first wave of follow-up research can be characterized by the phrase "what we knew we didn't know at that time." The final section is an update and brief overview of highlights of both "what we know now" and "what we now know that we don't know" about dynamic neuronal-astroglial interactions in the mHNS.     

Evolution of specificity in the eukaryotic endomembrane system

Two hundred years after Darwin's birth, our understanding of genetic mechanisms and cell biology has advanced to a level unimaginable in the 19th century. We now know that eukaryotic cells contain a huge variety of internal compartments, each with their own function, identity and history. For the compartments that together form the membrane-trafficking system, one of the central questions is how that identity is encoded and how it evolved. Here we review the key components involved in membrane-trafficking events, including SNAREs, Rabs, vesicle coats, and tethers and what is known about their evolutionary history. Our current understanding suggests a possible common mechanism by which the membrane-trafficking organelles might have evolved. This model of increased organellar complexity by gene duplication and co-evolution of multiple, interacting, specificity-encoding proteins could well be applicable to other non-endosymbiotic organelles as well. The application of basic evolutionary principles well beyond their original scope has been exceedingly powerful not only in reconstructing the history of cellular compartments, but for medical and applied research as well, and underlines the contributions of Darwin's ideas in modern biology.     

Dr. Balfour Mount and the cruel irony of our care for the dying.

Dr. Balfour Mount of Montreal thinks that the health care system, because of its fixation on disease processes, may have forgotten that it also has a mandate to alleviate suffering. "We need to recapture that vision," says Mount, who describes palliative medicine as a "rich combination" of clinical pharmacology, rehabilitation medicine and internal medicine. Mount says there is a cruel irony in our care of the dying. "Although these are the sickest people in our health care system, when medical technology doesn''t know what to do, the quality and quantity of care falls away. How can we justify that?"     

The Ethics and Politics of Human Experimentation, by Paul M. McNeill

...McNeill's book raises some very important questions about the ways in which a society comes to terms with the fact that the practice of medicine is more closely linked with experimentation than ever before. That often puts the doctor-patient relation into a new setting. We have registered our objection to McNeill's tendency to see that relationship, where experimentation is involved, in an adversarial form: there are, we must repeat, more than two sides to this argument, and the medical scientist's commitment is not only to truth at any cost any more than the medical practitioner's is to treatment in all circumstances. Objections do not mean that we cannot learn from this book: on the contrary they may help us to sharpen our perceptions of what should happen. Fair-mindedness would suggest that failure to fulfill expectations is nothing like as widespread or for that matter incurable as McNeill's polemical tone might lead us to believe. When McNeill ceases to be the prosecuting counsel the true worth of his comments will become more apparent.     

Medicine Among New Immigrants and Arab Minorities in Israel

The reaction to modern medicine and the general health of the new immigrants and Arab populations of Israel are described. The material was gathered during a threemonth visit to Israel where the author participated in the medical care of these persons. While these peoples still share many of the traditional medical superstitions and practices, the new immigrants have progressed much more during the 16 years of Israel''s existence. At present over 99% of Jewish women give birth in hospital, whereas only 65% of Israeli Arabs do. The infant mortality rate among the Jews in 1963 was about 21 deaths per 1000 live births, about one-half the rate for Arabs. The importance of understanding the cultural background and social conflicts of these people as a preliminary to the provision of proper medical care is stressed.     

Unraveling male and female histories from human genetic data

The increasing availability of large-scale genetic datasets has made it possible to ask detailed questions about the structure of human genetic diversity, and what that structure can teach us about human demographic history. Global, multi-locus analyses have suggested that human genetic diversity may fall into clusters that correspond approximately to continental origin. Detailed comparisons of mitochondrial DNA and the Y chromosome have revealed a history of sex-biased migration patterns that can vary widely across human populations. These patterns can be understood, however, when we incorporate our knowledge of local histories and cultural practices into our genetic analyses.     

How is a tissue built?

Tissues change in many ways in the period that they are part of a living organism. They are created in fairly repeatable structural patterns, and we know that the patterns are due to both the genes and the (mechanical) environment, but we do not know exactly what part or percentage of a particular pattern to consider the genes, or the environment, responsible for. We do not know much about the beginning of tissue construction (morphogenesis) and we do not know the methods of tissue construction. When the tissue structure is altered to accommodate a new loading, we do not know how the decision is made for the structural reconstruction. We do know that tissues grow or reconstruct themselves without ceasing to continue with their structural function, but we do not understand the processes that permit them to accomplish this. Tissues change their structures to altered mechanical environments, but we are not sure how. Tissues heal themselves and we understand little of the structural mechanics of the process. With the objective of describing the interesting unsolved mechanics problems associated with these biological processes, some aspects of the formation, growth, and adaptation of living tissues are reviewed. The emphasis is on ideas and models. Beyond the objective is the hope that the work will stimulate new ideas and new observations in the mechanical and chemical aspects of developmental biology.     

Skolt Sami ethnicity and cultural revival

The article is centred on a concern with limitations in our knowledge of youth's life experiences. I pose questions about the nature and implications of accounts of childhood by tracing ideas in early ethnographies and comparing these with my own attempts to frame youth differently. Using ideas of heroism and narrative, I examine the life histories of two young activists in order to comment on methodological approaches to exploring the world of youths, to ask how far we have come in catching their voices and experiences, and to comment on how far we have still to go.     

WHAT IS IT TO BE A DAUGHTER? IDENTITIES UNDER PRESSURE IN DEMENTIA CARE

This article concentrates on the care for people who suffer from progressive dementia. Dementia has a great impact on a person’s well‐being as well as on his or her social environment. Dealing with dementia raises moral issues and challenges for participants, especially for family members. One of the moral issues in the care for people with dementia is centred on responsibilities; how do people conceive and determine their responsibilities towards one another? To investigate this issue we use the theoretical perspective of Margaret Walker. She states that ideas about identity play a crucial role in patterns of normative expectations with regard to the distribution of responsibilities in daily practices of care. The results of this study show how the identity of a family‐member is put under pressure and changes during her loved one’s illness that leads to difficulties and misunderstandings concerning the issue of responsibility. These results offer an insight into the complexities of actual practices of responsibility and highlight the importance for those caring for people with dementia of attending carefully to how they see themselves and how they see other people involved (Who am I? Who do I want to be for the other?). Answers to such questions show what people expect from themselves and from one another, and how they, at any rate, are distributing responsibilities in a given situation. Professional caregivers should take into account that family members might have different ideas about who they are and consequently about what their responsibilities are.     

A report from Japan: choices of Japanese patients in the face of disagreement

Background: Patients in different countries have different attitudes toward self-determination and medical information. Little is known how much respect Japanese patients feel should be given for their wishes about medical care and for medical information, and what choices they would make in the face of disagreement.
Methods: Ambulatory patients in six clinics of internal medicine at a university hospital were surveyed using a self-administered questionnaire.
Results: A total of 307 patients participated in our survey. Of the respondents, 47% would accept recommendations made by physicians, even if such recommendations were against their wishes; 25% would try to persuade their physician to change their recommendations; and 14% would leave their physician to find a new one.
Seventy-six percent of the respondents thought that physicians should routinely ask patients if they would want to know about a diagnosis of cancer, while 5% disagreed; 59% responded that physicians should inform them of the actual diagnosis, even against the request of their family not to do so, while 24% would want their physician to abide by their family's request and 14% could not decide. One-third of the respondents who initially said they would want to know the truth would yield to the desires of the family in a case of disagreement.
Interpretations: In the face of disagreement regarding medical care and disclosure, Japanese patients tend to respond in a diverse and unpredictable manner. Medical professionals should thus be prudent and ask their patients explicitly what they want regarding medical care and information.     

Skeletal biology and behavior in ancient humans

For many years, it has been known that archaic hominids had more robust long bones than do living populations, a fact that has been linked to their more physically strenuous lives. But many questions remain. How much stronger, for example, were Neanderthals than living humans? And what does this difference in strength tell us about the behavior of our ancestors? Recent research has shown that some of our earlier assumptions about robusticity and behavior in earlier humans are either simplistic or untrue. For example, it is now clear that although earlier humans were, on the average, stronger than living peoples, this is not invariably the case. Some modern human groups have even stronger humeri than those of Neanderthals. The fact that changes in robusticity do not always neatly coincide with subsistence or technological change suggests that interpretations derived in large measure from stone-tool technology and other artifactual evidence may be misleading. This new information on physical strength in earlier humans necessitates a reassessment of traditional ideas about earlier human behavior.     

The Dying Animal

The study of animal death is poised to blossom into an exciting new interdisciplinary field—and one with profound relevance for bioethics. Areas of interest include the biology and evolution of death-related behavior in nonhuman animals, as well as human social, psychological, cultural, and moral attitudes toward and practices related to animal death. In this paper, I offer a brief overview of what we know about death-related behavior in animals. I will then sketch some of the bioethical implications of this emerging field of research.     

Negotiating “The Social” and Managing Tuberculosis in Georgia

In this paper I utilize anthropological insights to illuminate how health professionals and patients navigate and negotiate what for them is social about tuberculosis in order to improve treatment outcomes and support patients as human beings. I draw on ethnographic research about the implementation of the DOTS (Directly Observed Therapy, Short Course) approach in Georgia’s National Tuberculosis Program in the wake of the Soviet healthcare system. Georgia is a particularly unique context for exploring these issues given the country’s rich history of medical professionalism and the insistence that the practice of medicine is a moral commitment to society. I argue for critical attention to the ways in which treatment recipients and providers navigate what, for them, is “social” about therapeutic practices and their significance for avoiding biological and social reductionism.     

China Art by Phone: Mobile Movies

Jia ZhangKe's film Platform gives crystalline shape to a generation in a group of youth gathered around a tape-recorder in Fenyang city. The tape itself had come from Guangzhou and before that, presumably, from across the border with Hong Kong. Perhaps a Cantonese filtering, a local expression of Western and brand-name product that, viewed positively, marks the largest and most sweeping educational drive in China's history, the distribution and assimilation of fashion, DVDs, CDs, video, and design. This article seeks to know empirically the conditions that lay the groundwork for this educational drive, focusing on social transformation and the impact of digital technologies on theory, approach, practice, consumption. Clearly, mobility is important in this process of social transformation. Platform gives us images of the mobility of people, things, and ideas. This article also looks at the effects of the transport of people, things, and ideas and explores the cultural dimensions of social transformation. The article asks: What is mobility for artists and media producers? What are the urbanistic interconnections that emerge from an engagement with public space? These questions are explored around the social and cultural terrain of the mobile phone.

The article considers the virtual public space of the mobile telephone now opening to cultural producers and consumers. In what way does the mobile telephone, as an instrument for dialogue, a marketing device, and a promotional tool, affect our perception of public space? This article examines several initiatives that bring the mobile phone and cultural production together. One of these is titled “Focus: This Moment,” a program of eight short films by eight contemporary Chinese film directors made for mobile phone and Internet distribution. Another is “Connect to Art,” initiated by Nokia in September 2004 in Helsinki, continued in Monaco in December 2004, and then furthered again in Shanghai in May 2006 with the unveiling of four works by Chinese contemporary artists: Ai Weiwei, Yang Fudong, Zhang Peili, and Feng Mengbo. The article considers how mobile phone movies modify and enrich our understanding of cinema. This is thus an enquiry into the impact of digital technology on the mature film industry. Furthermore, the article asks how public space is enfolded in multiple contextual discourses that create the mobility and interface of the mobile phone.     

Fossils that Change Everything We Know About Human Evolution (...Or Not)

Dramatic headlines touting new fossil discoveries often proclaim that our view of human evolution has been revolutionized. While this is occasionally the case, it is more often true that new fossils enrich our understanding of our own ancestry or answer scientific questions that could not be resolved with previous data. Even spectacular new discoveries, such as the now famous “hobbit” skeleton (Homo floresiensis), can usually be included in the human family tree without any significant change in the inferences about the phylogenetic relationships or taxonomic status of the rest of its members. It is a testament to the power of evolutionary theory and the careful comparative study of human and other fossils that what we know about human evolution changes so little, even when spectacular new discoveries are announced.