Evaluation of Maternal and Fetal Outcomes in Mothers with Spinal Analgesia in Comparison with the Control Group

Background: Proper reduction of labor pain has always been one of the most important goals of medicine and the patient's request for labor pain relief is a sufficient necessity for the use of pain relief methods. The aim of this study was to evaluate the maternal and fetal outcomes of mothers who underwent spinal analgesia in comparison with the control group in mothers who referred to the maternity ward of Ali Ibn Abitaleb Hospital in Zahedan in 2020. Methods: The present study was a case-control study that was performed on 200 pregnant women in 1398. Pregnant women whose criteria for admission and selection of an anesthesiologist were divided into painless (spinal) delivery groups. The control group was selected by simple random sampling from among those who met the inclusion criteria but did not want to have a painless delivery. The two groups were compared using ANOVA, Kruskal-Wallis, Linear regression, Chi-Square and Fisher's exact tests. A significance level of 0.05 was considered. Results: The length of the first and second stages of labor in the non-intervention group was significantly shorter than the painless groups. In the analgesic method used, the Apgar score of the infant had no negative effects on the type of delivery and did not lead to complications in the mother in the postpartum stage. Conclusion: Findings from this study showed that spinal analgesia had no negative effects on maternal and neonatal outcomes.

The pharmaceuticalisation of life? A fictional case report of insomnia with a thought experiment

Background The safety of sleeping pills has increased dramatically during the last 100 years, from barbiturates to bensodiazepines to modern day so-called Z-drugs. Methods The circumstances of prescribing sleeping pills in the early 20th century are illustrated by summarizing the main storyline of a novel by Swedish writer Vilhelm Moberg. This is followed by a thought experiment and a theoretical discussion. Results In his 1937 novel Sömnlös (Swedish for sleepless) Vilhelm Moberg portrayed existential and relational distress in relation to insomnia. In a thought experiment, past progresses in sleeping pills safety are projected into the future. Thereby, it is claimed that important issues in the area of philosophy of medicine come to the fore. This leads to a theoretical discussion about broader questions concerning the role of the physician, the goals of medicine (as described by Lennart Nordenfelt), the concept of pharmaceuticalisation (as described notably by sociologist of sleep Simon J. Williams and co-workers), and health enhancement (c.f. Carl Elliott and the alleged wish to be better than well). Conclusion Insomnia is a prism through which important philosophical and sociological questions related to the practice of medicine can be asked.

Central European Psychiatry: World War I and the Interwar Period

During World War I, soldiers from all warring countries suffered from mental disorders caused by the strains and shocks of modern warfare. Military psychiatrists in Germany and the Austro-Hungarian Empire were initially overwhelmed by the unexpected numbers of psychiatric patients, and they soon engaged in fierce debates about the etiology and therapy of “war neuroses.” After early therapeutic approaches relying on rest and occupational therapy had failed to yield the necessary results, psychiatry faced increasing pressure by the state and the military. After 1916, the etiological debate coalesced around the diagnosis of “war hysteria,” and psychiatric treatment of war neurotics became dominated by so-called active therapies, which promised to return patients to the frontline or the war industry as quickly and efficiently as possible. War psychiatry became characterized by an unprecedented rationalization of medical treatment, which subordinated the goals of medicine to the needs of the military and the wartime economy. Brutal treatment methods and struggles over pensions led to conflicts between patients and doctors that continued after the war ended.

On Postcolonial Suffering: George Floyd and the Scene of Contamination

If, as Eric J. Cassell suggests in The Nature of Suffering and the Goals of Medicine, “Suffering occurs when an impending destruction of the person is perceived; [and] continues until the threat of disintegration has passed or until the integrity of the person can be restored in some manner,” and that suffering is due to both emotional and physical conditions, then there has been much suffering concentrated into the year that was 2020.1 All definitions of suffering have to find a way of aligning two central vectors: the Self as category has to be defined in all its variegated possibilities and contradictory levels and then correlated to the category of World. But often Self and World are not easily separable even for heuristic purposes given the boundaries of one overlap with the other and the two are often completely co-constitutive. Although the Self may disintegrate in direct response to reversals of fortune, it may also, properly speaking, suffer an experience of painful biographical discontinuity simply at losing the capacity to produce a coherent account of the world to itself and to others.2 This sense of incoherence is central to the conditions that were experienced under colonialism and its aftermath in many parts of the world, where the instruments for making meaning both communally and individually were often seen to have been compromised by the impositions of colonial history.

Physicians, Assisted Suicide, and Christian Virtues

The debate about physician-assisted suicide has long been entwined with the nature of the doctor–patient relationship. Opponents of physician-assisted suicide insist that the traditional goals of medicine do not and should not include intentionally bringing about or hastening a patient’s death, whereas proponents of physician-assisted suicide argue that this practice is an appropriate tool for doctors to relieve a patient’s suffering. In this article, I discuss these issues in light of the relevance of a Christian account of the doctor–patient relationship. I argue that Christians typically object to assist suicide independently of the doctor–patient relationship. I argue that a focus on the Christian virtues of charity, compassion, and humility helps to explain why doctors should not assist their patients in suicide.

Does Medicine Have Common Goals? An Analysis of US Medical Organizations’ Ethics Statements

Background: A philosophical framework defines medicine. Multiple competing frameworks lead to varying and sometimes conflicting understandings of the physician–patient relationship, medicine’s goals, and physicians’ duties. The objective of this study is to categorize the various goals, identify the underlying philosophical framework, and determine inconsistency among US medical organizations. Method: Twenty-five American Board of Medical Specialties-related organizations, the American Medical Association, and the American Osteopathic Association were searched for key goal-related terms in their ethics-related statements. Direct goal statements were also analyzed. Key terms were grouped as physician-centric/objective (best interest, treat disease, prevent disease, cope with illness, health care/promotion) representing the traditional ends of medicine, patient-centric/subjective (welfare/well-being, patient benefit) reflecting social constructionist methodology, or relational (services to humanity, medical/patient care). Each organization was characterized overall as traditional, social constructionist, or relational. Inconsistency was defined as the smaller between the social constructionist and traditional with relational possibly inconsistent. Definitions of key terms and references to philosophical frameworks were reviewed. Results: Twenty-two organizations were included; 73 percent of statements as a whole reflected a social constructionist model with 18 percent having traditional ends and 9 percent a relational framework. There was an 18 percent to 27 percent inconsistency among organization statements as a whole; 68 percent of organizations had direct statements; 47 percent of direct statements reflected a social constructionist methodology, 33 percent the traditional ends, and 20 percent the relational model; 33 percent to 53 percent of direct statements were inconsistent among organizations. No definitions of key terms or explicit references to philosophical frameworks were found. Conclusion: There is substantial inconsistency regarding the direct goals of medicine without any definitions of key terms. This inconsistency and lack of clarity underlie disagreement regarding physicians’ roles and their duties. Clear core goals such as treat and prevent disease would consistently define the physician–patient relationship, restore medicine’s objectivity, and provide a distinct understanding of physicians’ obligations. Summary: American medical organizations use a multiplicity of terms and have substantial inconsistency regarding the direct goals of medicine with neither a clear underlying theoretical basis nor a definition of key terms. Our analysis suggests the most common theoretical basis for the goals of medicine was the social constructivist view followed closely by the traditional ends of medicine (e.g., treat and prevent disease) and finally the relational model. The authors contend that the traditional ends of medicine are the best option for a core mission of medicine whereby the physician–patient relationship is consistently defined, and a physician’s duties derived.

Exposing futility by searching beneath the concept

The concept of futility in medicine refers to the incapability of an intervention to achieve its goal. Futility determinations form the basis for withholding and withdrawing life-sustaining interventions. Criticisms of attempted futility definitions relate to inconstant probability and value judgements concerning the goal pursued. This variability frustrates efforts to define futility. Language modifications and procedural approaches, both important ancillary measures, inherently lack the ability to resolve this difficulty. Beneath the notion of futility lie foundational factors whose revised understanding is required to advance a definition. These factors include autonomy, death and the goals of medicine. Reconsidering the essence and influence of foundational factors is necessary to move beyond a seemingly irresolvable problem. In this essay, I assert that defining futility is not pointless but rather possible, necessary and unavoidable. With this assertion, I respond to the criticisms of futility. These responses together with a corrective understanding of foundational factors lead to a definition of futility. This definition balances respect for patients’ autonomy whilst allowing for interventions that do not undermine the essence of medicine and integrity of those practising it. Defining futility is an exercise in necessity requiring renewed perceptual foundations.

Possible Barriers Further Down the Slope

This chapter examines hypothetical barriers on the slope below where the somatic/germline and disease/enhancement walls once were. The first is the goals of medicine barrier, where any trait that the medical profession defines as a disease could be modified. The second is the family genes barrier, where people would be allowed to modify their children to any set of traits that the parents could in principle produce through sexual reproduction. The third is the boundary of humanity barrier, where any genes from outside of the human species are not allowed. Finally, the liberal eugenics barrier would allow any genetic modification that did not harm someone else.

Palliative and End-of-Life Care: More Work is Required

There is currently growing recognition of the complex care needs of patients with life-limiting conditions and their family members, prompting the need to revisit the goals of medicine. This Special Issue reflects a broad research agenda in the field of palliative and end-of-life care. A total of 16 papers of empirical studies and systematic review are included spanning five domains, namely, patient, caregiver, healthcare provider, policy, and methodology. The results generally suggest the merits of palliative care and reveal room for further improvement in palliative care education, manpower, infrastructure, and legal and policy frameworks.