Linacre Quarterly最新文献

At age 21, following a severe traumatic brain injury, Zack Dunlap was declared brain-dead according to the American Academy of Neurology guideline (Guideline) when he met the clinical criteria of brain death (minus apnea testing because of bradycardia) with technetium-99m diethylene-triamine-pentaacetate scintigraphy reported as showing no intracranial blood flow. His parents agreed to organ donation. During preparations for organ donation, Zack manifested a purposeful movement in response to a noxious stimulus made by his cousin. Following subsequent neurological recovery, he has returned to a normal life, holding steady employment and raising a family. During an interview, he reported that while in coma, he heard a doctor say that he was brain-dead and felt angry about it. His experience fits the phenomenon of cognitive-motor dissociation. Recently, Zack's medical records were made available to the first author. A critical review of the records uncovered a problem inherent in the logic of the Guideline algorithm regarding brain blood flow scintigraphy. This article discusses the lessons drawn from Zack's case, namely, that both the aforementioned problem and the occurrence of cognitive-motor dissociation in patients deemed to be brain-dead can pose a significant risk of a false-positive declaration of death.

Physician burnout, studied for over fifty years in scientific literature, has been shown to negatively affect physician health, patient care, and the healthcare system. While various commendable systemic and individualistic approaches have been described and actively implemented to minimize burnout, it is important to also consider approaches to maximize physician wellness. For the Catholic physician, the ultimate model of wellness is Jesus Christ, the Divine Physician. In this article, we propose that the physician can follow the spiritual progress model of wellness presented in The Imitation of Christ by Thomas à Kempis to address burnout.

Despite our being created in right relationship with the Sabbath and holy time, we often have a dysfunctional relationship with rest, time, and ceasing. Our dysfunctional relationship with time, our hurriedness, has created an illness: "hurry sickness." In medicine, our hurry sickness is often transformed into a supposed virtue we call efficiency. As a surgical resident, I am evaluated on and celebrated for my efficiency. If hurry and efficiency have created an illness, what is our remedy? Theologians propose the Sabbath as the cure to our hurry sickness. The Sabbath is the proper treatment but cannot be traditionally observed by most surgical trainees. Therefore, I explore elements of the Sabbath that can be practiced by surgical residents.

Editor's Note: Issues of conscience are of increasing importance in medicine, especially when it comes to the Catholic physician. Nearly fifteen years ago, this alarm was sounded regarding the connection between physician conscience and patient autonomy. First published Vol 76, No 4, November 1, 2009. The development of patient autonomy within healthcare has created new challenges in the physician-patient relationship. When a patient demands a service that violates the conscience of a physician, it creates conflict within that relationship. This has become particularly problematic when a patient demands abortion or artificial contraception and the physician is morally bound to refuse. This article argues that the integrity of the physician's conscience must be maintained in order to uphold the integrity of the patient's autonomy. If the physician is forced to violate his conscience, then the guarantee that a patient's desires and wishes will be respected will be lost because a great moral inequality will be created between the physician and the patient. To safeguard both the physician-patient relationship and the patient's autonomy, it is vital that the physician's conscience be protected.

Primum non nocere or "first, do no harm" is perhaps the most well-known aphorism in the culture of medical education. While its application to patients is well known, the injunction can also be read with medical trainees in mind. Teaching physicians have an obligation to recognize their role as moral teachers and coaches, who must consider "first, do no harm" not only when considering their patients but also when weighing the moral formation of their trainees, especially in a season in which medical educators are attempting to clarify the "harms" of medical training. This multi-valent vision of "first, do no harm" offers an alternative way to frame the contemporary difficulties of medical education while inviting a more candid, nuanced discourse between teachers and learners about the experiences of medical training, in which it can be difficult to discern between that which is truly harm and that which is merely "hard." For those situations in which it is unclear-or indeed when harm is unavoidable-it may be through communal practices of reharmonization, reincorporation, and "reharm" that master educators might learn to tell the story of good medicine with their trainees anew, fostering moral articulacy for the trainees to whom they must also "first, do no harm."

Summary: Primum non nocere or "first, do no harm" is among the most well-known proverbs in medical education. While its application to patients is well known, the injunction can also be read with medical trainees in mind. Teaching physicians might consider "first, do no harm" not only when considering their patients but also when considering the moral formation of their trainees. In a season when medical educators are attempting to clarify the "harms" of medical training, this reading can invite a more candid, nuanced discourse between teachers and learners about the experiences of medical training.