Trusting Doctors: The Decline of Moral Authority in American Medicine

Princeton University Press
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Free sample

For more than a century, the American medical profession insisted that doctors be rigorously trained in medical science and dedicated to professional ethics. Patients revered their doctors as representatives of a sacred vocation. Do we still trust doctors with the same conviction? In Trusting Doctors, Jonathan Imber attributes the development of patients' faith in doctors to the inspiration and influence of Protestant and Catholic clergymen during the nineteenth and early twentieth centuries. He explains that as the influence of clergymen waned, and as reliance on medical technology increased, patients' trust in doctors steadily declined.

Trusting Doctors discusses the emphasis that Protestant clergymen placed on the physician's vocation; the focus that Catholic moralists put on specific dilemmas faced in daily medical practice; and the loss of unchallenged authority experienced by doctors after World War II, when practitioners became valued for their technical competence rather than their personal integrity. Imber shows how the clergy gradually lost their impact in defining the physician's moral character, and how vocal critics of medicine contributed to a decline in patient confidence. The author argues that as modern medicine becomes defined by specialization, rapid medical advance, profit-driven industry, and ever more anxious patients, the future for a renewed trust in doctors will be confronted by even greater challenges.



Trusting Doctors provides valuable insights into the religious underpinnings of the doctor-patient relationship and raises critical questions about the ultimate place of the medical profession in American life and culture.

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About the author

Jonathan B. Imber is the Class of 1949 Professor in Ethics and professor of sociology at Wellesley College. He is the author of Abortion and the Private Practice of Medicine.
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Additional Information

Publisher
Princeton University Press
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Published on
Aug 25, 2008
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Pages
280
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ISBN
9781400828890
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Language
English
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Genres
Medical / Ethics
Medical / General
Medical / History
Medical / Physician & Patient
Social Science / Disease & Health Issues
Social Science / Sociology / General
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Content Protection
This content is DRM protected.
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Eligible for Family Library

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David Rothman gives us a brilliant, finely etched study of medical practice today. Beginning in the mid-1960s, the practice of medicine in the United States underwent a most remarkable--and thoroughly controversial--transformation. The discretion that the profession once enjoyed has been increasingly circumscribed, and now an almost bewildering number of parties and procedures participate in medical decision making.

Well into the post-World War II period, decisions at the bedside were the almost exclusive concern of the individual physician, even when they raised fundamental ethical and social issues. It was mainly doctors who wrote and read about the morality of withholding a course of antibiotics and letting pneumonia serve as the old man's best friend, of considering a newborn with grave birth defects a "stillbirth" thus sparing the parents the agony of choice and the burden of care, of experimenting on the institutionalized the retarded to learn more about hepatitis, or of giving one patient and not another access to the iron lung when the machine was in short supply. Moreover, it was usually the individual physician who decided these matters without formal discussions with patients, their families, or even with colleagues, and certainly without drawing the attention of journalists, judges, or professional philosophers.

The impact of the invasion of outsiders into medical decision-making, most generally framed, was to make the invisible visible. Outsiders to medicine--that is, lawyers, judges, legislators, and academics--have penetrated its every nook and cranny, in the process giving medicine exceptional prominence on the public agenda and making it the subject of popular discourse. The glare of the spotlight transformed medical decision making, shaping not merely the external conditions under which medicine would be practiced (something that the state, through the regulation of licensure, had always done), but the very substance of medical practice--the decisions that physicians made at the bedside.

For nearly half a century, social scientists have made claims that there is a "therapeutic ethos" with extensive influence upon numerous aspects of American society. In Therapeutic Culture, twelve authors address the implications of this ethos and its effects on a wide range of social institutions, extending from the family to schools, and operating in religious behavior and within the legal system. Has there been, as the sociological theorist Philip Rieff argued in 1966, a "triumph of the therapeutic?" If so, in what kinds of institutions has it been most pervasive? At the same time, what aspects of modern culture has it replaced or defeated? Therapeutic Culture addresses these questions, and raises others. Part 1 of this volume examines the emergence of the idea of "authenticity" as it defines the manipulation of emotions and behavior both in the United States and Great Britain. Contributors include Elisabeth Lasch-Quinn, Frank Furedi, Jonathan B. Imber, and Alan Woolfolk. Part 2 illustrates specific cases of the effects of therapeutic culture within institutions, including courts, schools, religious communities, and the "virtual community" of the Internet. Contributors include James L. Nolan, Jr., John Steadman Rice, Felicia Wu Song, and James Tucker. Part 3 extends the analyses of specific social institutions to the broader consequences that have resulted as a therapeutic ethos has taken root in contemporary life. Contributors include Digby Anderson, Ellen Herman, and James Davison Hunter. Part 4 is devoted to a previously unpublished essay by Philip Rieff whose significant influence can be seen in many of the contributions. Rieff revisits the highly controversial confirmation hearings of Supreme Court Associate Justice Clarence Thomas in 1991 and offers ample evidence of the therapeutic uses of politics as well as the political manipulations available within a therapeutic culture to provide a fitting conclusion. This volume establishes a benchmark for further theoretical reflection and empirical research on the nature of therapeutic culture. It will be of interest to sociologists, psychologists, political scientists, and cultural studies specialists. Jonathan B. Imber is editor-in-chief of Society and Class of 1949 Professor in Ethics and professor of sociology at Wellesley College.
For many doctors, their role as powerful healer precludes thoughts of ever getting sick themselves. When they do, it initiates a profound shift of awareness-- not only in their sense of their selves, which is invariably bound up with the "invincible doctor" role, but in the way that they view their patients and the doctor-patient relationship. While some books have been written from first-person perspectives on doctors who get sick-- by Oliver Sacks among them-- and TV shows like "House" touch on the topic, never has there been a "systematic, integrated look" at what the experience is like for doctors who get sick, and what it can teach us about our current health care system and more broadly, the experience of becoming ill. The psychiatrist Robert Klitzman here weaves together gripping first-person accounts of the experience of doctors who fall ill and see the other side of the coin, as a patient. The accounts reveal how dramatic this transformation can be-- a spiritual journey for some, a radical change of identity for others, and for some a new way of looking at the risks and benefits of treatment options. For most however it forever changes the way they treat their own patients. These questions are important not just on a human interest level, but for what they teach us about medicine in America today. While medical technology advances, the health care system itself has become more complex and frustrating, and physician-patient trust is at an all-time low. The experiences offered here are unique resource that point the way to a more humane future.
The findings of scientific research often provide an important baseline to the formation of public policy. However, effective communication to the larger public about what scientists do and know is a problem inherent to all democratic societies. It is the prerogative of democratic societies to determine what kind of scientific research will be funded. Searching for Science Policy offers innovative ways of thinking about how the rhetoric and practice of science operates in various institutional contexts.

The book is divided into two parts. Part 1, "Policy Uses and Misuses of Science," explores the various ways in which scientific claims are inevitably mediated by how they are used. Joel Best, draws on statistics involving missing children, violence against women, and attendance figures at political demonstrations to demonstrate how the motivations to use inaccurate and misleading numbers stems directly from the ideological and organizational interests of those using them. Judith Kleinfeld analyzes recruitment policies for women scientists at MIT, showing how hiring practices that may be justifiable on extra-scientific factors are carried out based on pseudo-scientific studies not subject to public scrutiny. Robert MacCoun addresses the journalistic misuse of drug and drug abuse statistics and shows how this profoundly distorts policy implications drawn from them. And Allan Mazur examines the role scientific evidence has come to play in the law, pointing out the pitfalls of its intrinsic quality and how such evidence may be interpreted or misinterpreted by judges and juries.

Part 2, "Searching for Science Policy," extends discussion of the role of science to specific ideas about how public policy-making might be improved in matters of law, family, environment, drug use, and health. Mark Kleiman weighs the sometimes conflicting claims of science and social order in formulating drug policy. Norval Glenn calls for closer cooperation between professional associations, the media, and researchers in reporting provisional social science findings to the public. Stanley Rothman and S. Robert Lichter examine the dynamic by which environmental organizations shape public perceptions of risk and harm. And in the concluding chapter, Sheila Jasanoff looks closely at differences between the provisional nature of science as normally practiced and the more contentious sphere of litigation that demands ultimate resolution.

In a time when scientists find themselves subject to more public scrutiny than ever before, the well-informed citizen is no longer a moral ideal but rather a social imperative. Searching for Science Policy helps to clarify the grounds and the circumstances of more effective use of science in public discourse.

Jonathan B. Imber is editor in chief of Society and Class of 1949 Professor in Ethics and professor of sociology at Wellesley College.
Winner of the NBCC Award for General Nonfiction

Named on Slate's 50 Best Nonfiction Books of the Past 25 Years, Amazon's Best Books of the Year 2015--Michael Botticelli, U.S. Drug Czar (Politico) Favorite Book of the Year--Angus Deaton, Nobel Prize Economics (Bloomberg/WSJ) Best Books of 2015--Matt Bevin, Governor of Kentucky (WSJ) Books of the Year--Slate.com's 10 Best Books of 2015--Entertainment Weekly's 10 Best Books of 2015 --Buzzfeed's 19 Best Nonfiction Books of 2015--The Daily Beast's Best Big Idea Books of 2015--Seattle Times' Best Books of 2015--Boston Globe's Best Books of 2015--St. Louis Post-Dispatch's Best Books of 2015--The Guardian's The Best Book We Read All Year--Audible's Best Books of 2015--Texas Observer's Five Books We Loved in 2015--Chicago Public Library's Best Nonfiction Books of 2015

From a small town in Mexico to the boardrooms of Big Pharma to main streets nationwide, an explosive and shocking account of addiction in the heartland of America.

In 1929, in the blue-collar city of Portsmouth, Ohio, a company built a swimming pool the size of a football field; named Dreamland, it became the vital center of the community. Now, addiction has devastated Portsmouth, as it has hundreds of small rural towns and suburbs across America--addiction like no other the country has ever faced. How that happened is the riveting story of Dreamland.

With a great reporter's narrative skill and the storytelling ability of a novelist, acclaimed journalist Sam Quinones weaves together two classic tales of capitalism run amok whose unintentional collision has been catastrophic. The unfettered prescribing of pain medications during the 1990s reached its peak in Purdue Pharma's campaign to market OxyContin, its new, expensive--extremely addictive--miracle painkiller. Meanwhile, a massive influx of black tar heroin--cheap, potent, and originating from one small county on Mexico's west coast, independent of any drug cartel--assaulted small town and mid-sized cities across the country, driven by a brilliant, almost unbeatable marketing and distribution system. Together these phenomena continue to lay waste to communities from Tennessee to Oregon, Indiana to New Mexico.

Introducing a memorable cast of characters--pharma pioneers, young Mexican entrepreneurs, narcotics investigators, survivors, and parents--Quinones shows how these tales fit together. Dreamland is a revelatory account of the corrosive threat facing America and its heartland.
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