Medical Humanities最新文献

Dental ethics is a specialised branch of dentistry addressing ethical issues in dental practice. However, dental ethics and diversity are thought to be at odds within the practice of dentistry. Dentistry centres on ethical clinical practices which assume dental ethics are both value neutral and singular with no need for diverse perspectives. Dental ethics are thought to be static, and yet, they are dynamic and problematic in terms of values in dentistry: cosmetic dentistry and its aim for a white smile and the dentist as a clinician, businessperson when there are glaring oral health disparities in communities. In this paper, we use the artefact of George Washington's complete dentures to tell an alternative story of dentistry that demonstrates just how ethics and diversity are relevant to dentistry. As two dental educators and social scientists, we bring an interdisciplinary praxis to problematise dental ethics and reframe it through a diversity lens. Instead of having a monolithic discourse of dental ethics, we invite critical reflectivity to decentre white, Eurocentric bioethics. Using the implosion method, we deconstruct this dental object to connect it with global history, centring key ethical dilemmas often missed in dental ethics: settler colonialism, biopolitics, whiteness, power and racial capitalism. Every country has its own myth-making, and part of US oral health lore is this complete denture from the country's first president. The denture is problematic because it is possibly composed of teeth from enslaved African people. Unnamed African people are removed from history, and yet their teeth are national lore. As an object, the denture is not a mere artefact of history, but is celebrated to show a nation's founding father's connection to a profession. To celebrate the denture without appreciating these ethical dilemmas is to miss the importance of critically engaging history and context in both oral health practice and dental education.

Purpose: Stigmatisation and lack of awareness about many women's health concerns constitute a major public health problem. This study analyses the impact of a narrative medicine (NM) intervention designed for obstetrical-gynaecological (OB-GYN) professionals and patients in a teaching hospital. It used a cocreated, site-specific poem based on patient and clinician lived experience narratives to stimulate meaningful discussions on taboo topics and provide an opportunity for participants to learn from each other's perspectives and experiences.

Method: This qualitative study employed a thematic analysis of 36 written reflections collected in three 1-hour NM sessions, along with follow-up interviews with 14 participants (aged≥18 years, fluently Dutch speaking).

Results: Analysis of the anonymous written reflections and interviews indicates that OB-GYN professionals and patients valued the commissioned poem as an unexpected and engaging source of inspiration for exploring patients' perspectives. Participants were also deemed NM an appropriate approach to support multidisciplinary discussion. The written responses and interviews also highlighted valuable focus areas for a subsequent NM training.

Conclusions: This study contributes to the field of NM teaching by showing that such interventions can be used in continuing education interventions in the workplace. Our site-specific artwork for a Dutch OB-GYN department encourages meaningful discussions between healthcare providers and patients. Poetry, in this case a cocreated, site-specific work, can reveal new facets of patients' perspectives and needs.

Bertolt Brecht's 1938 poem 'A Worker's Speech to a Doctor' has been used by health educators to direct attention to the health-threatening effects of adverse living and working conditions. However, to date there has not been a systematic analysis of these evocations and their goals (eg, develop clinical skills through promotion of empathy, encourage action to improve living and working conditions, and/or calls for broad societal mobilisation for systemic reform or even replacement). Of particular concern and relevance is the context in which this poem is mentioned, how it was applied, and whether it is presented in fragments or its entirety, thereby leaving intact Brecht's critique of the capitalist economic system and its role in creating illness as well as the Doctor's complicity in this same system. This investigation revealed that while most of the 56 instances found in books, book chapters, journal articles, presentations, and blogs did draw attention to how living and working conditions shape health and in many cases their public policy antecedents, most did not include the entire poem, leaving out Brecht's critique and blunting his message. We suggest 'A Worker's Speech' and other Brecht's poems as a rich source for reflection, discussion, and action to promote health by health and social services workers, researchers, community activists, and the public.

This article examines how different layers of health-related uncertainties emerge and intersect in an algorithmic society. We aim to understand how people's self-care practices co-evolve with digitalised health systems. Sweden stands out among Western countries due to the population's high digital consumption of medical and health products. We conceptualise health-related uncertainties as inherent in care-seeking. The uncertainties are embedded in an algorithmic society and hinge on what we term algorithmised medicine. Methods used are open-ended questionnaires and semistructured interviews with Swedish residents. We identify: First, people are aware of algorithm-embedded digital infrastructure and its impact on information access in everyday life. Second, people oscillate on a trust-distrust nexus in different contexts. And third, lived experiences of the body compete with medical advice and online information. We conclude that while formal health systems strive to be robust, access to medicines remains an uncertain practice at the interplay of medicine, algorithms and bodily experiences of sickness. This study contributes to the field of medical humanities by showing that the digital arena is a porous and emergent entity, with inseparable links to people's lived experiences.

This work explores recent industrial action by doctors in the British National Health Service (NHS) through a psychoanalytic lens, exploring psychosocial context and the role of unconscious phantasy. Doctor strikes are conceptualised as a protest against devaluation. Expressed motivation for strike action, a real-term pay reduction, is symbolic of deeper societal devaluation of healthcare and those who provide it; pay restoration serves as a phantastic object through which amends can be made. Layers of holding and containment are identified, from the function of the health, or rather anti-death, service in containing deep-rooted anxiety around illness and death, to the holding, typically in limited supply, experienced by staff members working in health services, to the containing function individual staff provide for their patients.Strike action shatters the NHS as a container, primitive anxieties emerge and primitive defences are activated. Anger expressed through protest causes an impact, expressing a demand to be recognised and valued. The time and space of the strike has generative potential; implications of breaking the 'broken' NHS give impetus to finding a way forward. Exploration of unconscious phantasy underpinning industrial action and public response may bring insight to negotiations, enabling grounded and coherent solutions to be derived.

The present study aims at establishing if anything has been learnt from 140 years of modern architecture when it comes to designing for inpatient mental health and to identifying how architecture can contribute to the development of low stress psychiatric units. Creative architects have generally rejected the 'classical language' of architecture. The principles of modern architecture can be applied to the design of psychiatric units. The effects of living conditions on the human mind had already been addressed in the 1920s. More recent studies have looked at links between ward design and aggression, aimed at identifying environmental stress-reducing factors. Environmental psychology studies, along with the work of 261 architects over a span of 140 years and of 32 major architectural firms, were reviewed. Aggression seems to be linked to factors such as crowding, noise, lack of privacy and the lack of stress-reducing positive distractions. Out of 261 architects, 22 (8.42%) designed hospital buildings and only five (1.91%) were involved in designing psychiatric hospitals. Out of 69 recently built modern hospitals, 18 were psychiatric hospitals (26.08%). Principles of modern architecture have been sporadically implemented in older hospital buildings, rarely in psychiatric units, more frequently in some recently built psychiatric hospitals, hopefully to create low stress environments that could speed up recovery, reduce costs, enhance staff satisfaction and recruiting.

The development of replacing human organs with those from genetically modified pigs holds immense potential for alleviating the shortage of organs necessary for patients in need of transplants. This medical advancement is also accompanied by significant social changes, including the emergence of a bioeconomy, new modes of biotechnology governance, altered human-animal relations and increased public engagement. Some aspects, such as the impact on the transplant allocation system, effects on clinical practice and healthcare provision, global trajectories and most importantly the consequences for patients and their families remain unpredictable. Given that xenotransplantation occurs within a societal context and its success or failure will not be confined to technical feasibility alone, it is essential to engage a social sciences perspective to highlight the social implications and emphasise the importance of social research in accompanying future developments.

The article scrutinises Rohini S. Rajagopal's work, what's a lemon squeezer doing in my vagina (2021), to illustrate the escalating medicalisation of infertile bodies. In a cultural context where reproductive concerns are construed as medical disorders demanding treatment and surveillance, medical professionals and pharmaceutical companies exploit these sociocultural dynamics to provide infertile couples with immediate solutions through Assisted Reproductive Technologies. Consequently, the study contributes a critical perspective to the field of medical humanities, initiating a nuanced discourse that interrogates the impact of terms such as 'living laboratories', 'baby machine', 'mother machine' and 'hope technology' on our comprehension of future motherhood. Drawing on feminist critiques of medicalisation, the article argues that biotechnology perpetuates the eighteenth-century biomedical metaphor of the body as a machine with replaceable parts. Notably, contemporary advancements in reproductive medicine allow for the replacement of perceived 'flawed' body parts, further objectifying them within this framework.

In Malawi, there exists a group of medical professionals known as clinical officers (COs) who assume responsibilities typically carried out by doctors due to the current scarcity of the latter. This paper seeks to explain how the introduction of COs as part of implementing task shifting in healthcare, unintentionally became a terrain for the contestation of power between COs and physicians. The research from which this paper originates used a qualitative research approach. It was carried out in state-owned facilities, encompassing four district hospitals and one central hospital in Malawi. This paper develops a conceptual framework on power and then uses it to demonstrate that task shifting through the introduction of COs as substitutes for physicians, became a source of interprofessional conflicts. The paper argues that unequal power relations between COs and physicians in healthcare contribute to interprofessional conflicts. The paper further demonstrates that unequal power relations between COs and physicians are manifested through differences in educational backgrounds and work experiences as well as unequal responsibility and authority. The paper concludes that the interprofessional conflicts between COs and physicians arising from unequal power relations ultimately aggravate poor psychosocial well-being among COs.

Providing for people with psychosocial conditions in crisis is a complex and controversial endeavour that has gained significant attention over the past decade. This increased focus is driven by global calls to reduce coercion, including by the United Nations Committee on the Rights of Persons with Disabilities, who interpret Article 12 of the United Nations Convention on the Rights of Persons with Disabilities in General Comment 1 to advocate for the replacement of substituted decision-making with supported decision-making. Psychiatrists occupy a central role in determining how to care for and respond to individuals with psychosocial conditions in crisis in the midst of these debates. They must protect the rights of people with psychosocial conditions in crisis and provide appropriate support within challenging and dynamic contexts. This responsibility includes promoting the autonomy of people with psychosocial condition while ensuring their long-term health, safety and well-being.In this study, we conducted a phenomenological analysis with a sample of nine psychiatrists in South Africa to explore their experiences with involuntary care and the complex dilemmas they face in delivering healthcare to individuals with mental health conditions. Our findings indicate that psychiatrists encounter significant challenges in preserving patient autonomy, particularly within the resource-limited context of South Africa. Pervasive stigma and insufficient support infrastructure complicate efforts to prioritise autonomy. At the same time, professionals must address the critical need to ensure the long-term safety and well-being of their patients. The absence of involuntary care can exacerbate a person's vulnerability to community stigma and inadequate community support, posing severe risks to their welfare. Balancing between protecting a person's autonomy and addressing the limitations of support structures creates a complex predicament for mental health professionals, often resulting in feelings of isolation and moral distress among psychiatrists.