The body language of assisted suicide

What the verbal request fails to reveal

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Laws that allow assisted suicide restrict the provision of “aid-in-dying” drugs to patients whose mental status is not impaired and who are capable of sound judgment.

Medscape recently featured a video interview of Timothy Quill, the palliative care specialist and long-term assisted suicide activist.  He is interviewed by the ethicist Arthur Caplan, and the two discuss the psychological evaluation of terminally ill patients who request physician-assisted suicide (PAS).

Several points made by Quill caught my attention.

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The brave new world of contemporary bioethics

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A few months ago, I tweeted that today’s ethicists sometimes serve the function that sophists used to fulfill in Ancient Greece: to provide moral cover for the powerful.  A “consensus statement” issued last week by a committee of philosophers and bioethicists  brings some pertinence to my comment.

These international scholars–all from prestigious Western institutions–had met in June in Geneva, Switzerland to take up the question of conscientious objection in healthcare.  Here are the first five points of their ten-point statement, published on the Practical Ethics blog of the University of Oxford philosophy department:

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Beauty, chemistry, and natural philosophy

Summer reflections

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About a year ago, Theral Timpson interviewed Stanford chemist Carolyn Bertozzi on his Mendelspod podcast.  I only heard the show recently and enjoyed it.  The title caught my attention: “Is the future of biology a return to chemistry?”

Bertozzi made some interesting comments about her field, which she regards as “the central science,” and Timpson probed her about her expectations for the place of chemistry in what is otherwise expected to be “the century of biology.”

The discussion was of interest to me for two reasons.

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The mother of all medical errors

Iatrogenesis in perspective

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A study published a couple of months ago in the BMJ  made headlines for claiming that medical errors are the third leading cause of death.  As expected, the reactions were swift and polarized.

For some, the study confirmed that the self-serving healthcare system is utterly careless about the welfare of patients.  For others, the claim was complete hogwash, based on faulty methodology designed to justify further regulatory oversight.

The two positions are not necessarily mutually exclusive.

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Risk factors, causes, and the diet-lipid hypothesis

A conversation with a reader about medicine's Ptolemaic epicycles

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I shared with a reader an editorial I co-wrote in 2010 entitled “Risk-Factor Medicine: An Industry Out of Control?” Subsequently we had the following e-mail exchange, which I thought might be of interest to other readers of Alert and Oriented.  I was impressed by Robert’s comments and learned a few things from him and from the links he provided.

On April 29, 2016, Robert wrote:

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Mukherjee’s error and his critics’

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I can’t help but take a moment to comment on the heated response to Siddharta Mukherjee’s New Yorker piece.  Theral Timpson summarizes the kerfuffle very well, provides the appropriate links, and gives it its needed context.  The two posts by Jerry Coyne are worth reading, if only as a good education about what’s at stake.

The only interjection I will make is to say that neither side is getting it right or can get it right.  This is an example of the inevitable confusion that arises when one adopts the wrong metaphysical framework or, more precisely, when one pretends that metaphysics doesn’t matter because empirical science will tell us all we need to know. (more…)

Book review: How Doctors Think

By Kathryn Montgomery

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Kathryn Montgomery’s How Doctors Think: Clinical Judgment and the Practice of Medicine is an excellent book that was brought to my attention by Dr. James Gaulte in the comment section of my post on phronesis.  Indeed, much of Montgomery’s monograph deals with the Aristotelian concept of practical wisdom applied to clinical decision-making.

The author is Professor of Medical Humanities and Bioethics and Professor of Medicine at Northwestern University Feinberg School of Medicine.  Her book is too rich to cover deeply in a short review, but I’d like to highlight some of its major strengths as well as a few minor weaknesses.

In the first part of the book, Montgomery thoroughly demolishes the notion that medicine is applied science.

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Flexner versus Osler

Medical education suffers to this day

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In the introduction to a talk I gave at the Mises Institute this year, I noted how, in the early part of the twentieth century, a convergence of interests between social progressivists and ideological empiricists led to the publication of the Flexner report and the subsequent enactment of licensing laws.

That historical context is further treated in an outstanding article by Alfred Tauber, who was professor of medicine and philosophy at Boston University School of Medicine.

In “The two faces of medical education: Flexner and Osler revisited,” Tauber contrasts the radically different views these two men held about the ethos of medicine and the proper approach to medical education.  It is ironic that the victorious position would be the one pushed by Flexner who, as Murray Rothbard put it, was “an unemployed former owner of a prep school in Kentucky…sporting neither a medical degree nor any other advanced degree.”

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From reacting machine to acting person – part 2

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This is part 2 of my paper presentation at AERC 2016 at the Mises Institute. Find part 1 here and the audio here.

Slide11I would therefore like to entertain an interpretation of health rooted in the view that human beings are persons acting purposely, persons who select means to achieve chosen ends, which is the framework of praxeology.

Under a praxeological framework, I would distinguish external means such as land, labor, and capital, which are generally the concern of economic theory, from internal means, such as the physical and mental conditions of the person that allow him or her to pursue chosen ends.

Health, then, may be defined as the state that is present when a person’s physical and mental conditions allow the pursuit of his or her chosen ends.  Disease, then, is the absence of health.

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From reacting machine to acting person – part 1

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This is the transcript of a paper I presented at the Austrian Economics Research Conference at the Mises Institute. I have included the slides below and you can hear the audio here.

The title of the paper is “From reacting machine to acting person: a praxeological interpretation of the patient, his health, and his medical care.”  For more info on praxeology, see my previous article here.

I have split the presentation into two parts. This is a very condensed talk, covering a lot of ground, but I will elaborate on various points I make in the paper in the ‘progress notes’ section of this website over the next few days and weeks.

Thank you for reading and for any feedback you might have.

The elephant in the room in healthcare is that there is no precise definition of health.  I believe that this ambiguity plays a major role in our perennial healthcare crises, and I am hopeful that Austrian insights can be helpful.

Here is the outline of my talk.

I will first identify the two dominant modes of thinking about health in modern Western societies.  I will show that those conceptual modes are counterproductive to fostering health, both economically and medically.  I will then propose a praxeological interpretation of health, and sketch the possible benefits and ramifications of that interpretation.

Slide3The dominant mode of thinking about health in Western societies owes its origins to René Descartes who, at the beginning of the scientific revolution, proposed the machine concept of the organism.  Descartes’ proposal was a radical departure from pre-existing notions which were rooted in the idea that organisms have essences and natures.  Instead, he proposed that every material body is an assemblage of tiny particles moving mechanically according to physical laws.  In the case of plants and animals, God directs the laws and the motions.  In the case of humans, the mechanical bodies are under the control of a separate human soul acting like a “ghost in the machine.”

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