The Religion & Culture Web Forum
Commentary Footnotes
May 2005
Footnotes for
Red Medicine, Blue Medicine: Pluralism and the Future of Healthcare
by Farr A. Curlin (University of Chicago) and Daniel E. Hall (Duke University, University of Pittsburgh)
1 The argument presented here proceeds within the context of the medical literature which is admittedly not the most sophisticated theological or philosophical resource. Many of the ideas we reference are more adequately and definitively explored outside the medical literature, but because this forum is decidedly inter-disciplinary, we reference the literature with which we are most familiar.
2 Curlin FA, Hall DE. Strangers or friends? A proposal for a new spirituality-in-medicine ethic. J Gen Intern Med. 2005; In press. Dunne J. Back to the rough ground: Practical judgment and the lure of technique. Notre Dame, IN: Univ of Notre Dame Press; 1993.
3 Hall DE, Koenig HG, Meador KG. Conceptualizing "religion": How language shapes and constrains knowledge in the study of religion and health. Perspect Biol Med. Summer 2004;47(3):386-401.
4 Kaptchuk TJ, Eisenberg DM. Varieties of healing. 1: medical pluralism in the United States. Ann Intern Med. 2001;135(3):189-195.
5 Starr P. The social transformation of American medicine. New York: Basic Books; 1982.
6 Curlin FA, Hall DE. Politics and science cannot be separated (letter). Obstetrics and Gynecology. 2005; In press.
7 McKenny GP. To relieve the human condition: bioethics, technology, and the body. Albany, N.Y.: State University of New York Press; 1997.
8 MacIntyre AC. Three rival versions of moral enquiry: encyclopedia, genealogy, and tradition: being Gifford lectures delivered in the University of Edinburgh in 1988. Notre Dame, Ind.: University of Notre Dame Press; 1990.
9 Bellah RN. Habits of the heart: individualism and commitment in American life. Berkeley: University of California Press; 1985.
11 In response to the ethical quandaries of modern medicine, standard bioethics attempts to resolve moral disagreement through the principles of autonomy, beneficence, and justice. Given the plurality of definitions of both beneficence and justice, autonomy often emerges as the final arbiter of moral decision-making in the medical setting. The limits of this approach have been noted by many critics, perhaps most persuasively by H.Tristram Engelhardt, Jr.)
12 Engelhardt HT. The foundations of bioethics. 2nd ed. New York: Oxford University Press; 1996.
13 Elliott C. Better than well: American medicine meets the American dream. 1st ed. New York: W.W. Norton; 2003. p. xvii.
15 Elliot describes the hopes and practices of “apotomnophiliacs” who claim that they feel alienated from their body until one or more of their limbs are surgically amputated.
16 Laine C, Davidoff F. Patient-centered medicine. A professional evolution. JAMA. 1996;275(2):152-156.
17 Kagawa-Singer M, Blackhall LJ. Negotiating cross-cultural issues at the end of life: "You got to go where he lives". JAMA. 2001;286(23):2993-3001; Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130(10):829-834; Crawley LM, Marshall PA, Lo B, Koenig BA. Strategies for culturally effective end-of-life care. Ann Intern Med. 2002;136(9):673-679.
18 Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286(15):1897-1902.
19 Gordon JS. Holistic medicine: advances and shortcomings. West J Med. 1982;136(6):546-551.
20 Robeznieks A. Battle of the conscience clause. American Medical News; 2005:9-10.
21 Lockwood CJ, Greene MF. Playing politics with women's health: The FDA and Plan B. Contemporary Ob/Gyn. 2004;49:11-15; Grimes DA. Emergency contraception: politics trumps science at the U.S. Food and Drug Administration. Obstet Gynecol. 2004;104(2):220-221; Dickerson VM. Statement of the American College of Obstetricians and Gynecologists on the failure of the FDA to approve OTC status for Plan B: American College of Obstetricians and Gynecologists; May 7 2004.
22 Annas GJ. "Culture of life" politics at the bedside--the case of Terri Schiavo. N Engl J Med. 2005;352(16):1710-1715.
23 Blackburn E. Bioethics and the political distortion of biomedical science. N Engl J Med. 2004;350(14):1379-1380.
26 Childress JF, Siegler M. Metaphors and models of doctor-patient relationships: their implications for autonomy. Theor Med. Feb 1984;5(1):17-30.
27 The moral fragmentation constitutive of modernity has increasingly forced the legal system to bear the burden of resolving moral disagreements throughout our society, including medicine. In the absence of a shared moral tradition, legal license is forced to stand for moral license. Yet it is not clear that the legal tradition can or should sustain this burden because the legal system itself codifies a particular moral tradition that may not be universally acceptable despite the claims of Enlightenment political philosophers. Indeed, to the extent that the American legal tradition emphasizes property rights and autonomous agency, it reinforces the contemporary bias in medicine for patient autonomy without resolving the moral disagreements confronting contemporary medicine.
28 Quill TE. Terri Schiavo -- A Tragedy Compounded. N Engl J Med. 2005;352(16):1630-1633.
29 Jonsen AR, Siegler M, Winslade WJ. Clinical ethics: a practical approach to ethical decisions in clinical medicine. 5th ed. New York: McGraw Hill Health Professions Division; 2002. p.85.
30 Cassell EJ. Consent or obedience? Power and authority in medicine. N Engl J Med. 2005;352(4):328-330.
31 Although patients rarely look for a “good” physician, many people recommend “great” doctors, but this subtle change sidesteps the moral character of the physician to describe great technical competence (perhaps in surgery), great bedside manner or great diagnostic acumen.
32 Inui TS. A flag in the wind: Educating for professionalism in medicine. Washington, D.C.: Association of American Medical Colleges; February 2003.
33 Curlin FA, Hall DE. Politics and science cannot be separated (letter). Obstetrics and Gynecology. 2005; In press.
34 This pattern of moral withdrawal, though driven primarily by a reverence for patient autonomy, is exacerbated by a punitive legal system that encourages physicians to limit their legal (and financial) liability by shifting the responsibility for medical decisions onto the patient.
35 Pellegrino ED, Thomasma DC. For the patient's good: the restoration of beneficence in health care. New York: Oxford University Press; 1988.
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