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Restoring Humane Values to Medicine

Restoring Humane Values to Medicine

A Miles Little Reader

Edited by Ian Kerridge, Christopher Jordens and Emma-Jane Sayers

CONTENTSREVIEWS
Does reading poetry make you a better clinician?
Can euthanasia be understood in terms of the meaning of a life?
What is the moral and existential significance of life-threatening experiences?

Australian surgeon, poet, philosopher and humanist, Miles Little addresses these and other fascinating questions in this collection of papers.

Miles Little is one of the most original and engaging voices in contemporary medical ethics and philosophy. He ranges across the sciences and the humanities, creating hybrid fields of inquiry ("ethonomics"), interrogating orthodoxies and engaging different fields of human knowledge and experience.

The papers in this collection were chosen by his readers, who also engage here with Miles Little's work in a short commentary that follows each paper. The range of the commentators reflects the breadth of Little's appeal and influence: academics and clinicians, philosophers and ethicists, novelists, public health practitioners and cancer survivors - each reflects, agrees or disagrees.

Like Little's work itself, this Reader is an open and unfolding dialogue that includes many different perspectives.

Commentators include:
Murray Bail, Robin Downie, Nancy Dubler, Stan Goulston, Jill Gordon, Paul Komesaroff, Steve Leeder, Paul McNeill , Gavin Mooney and Bernadette Tobin


CONTENTS

Foreword by The Hon Justice Michael Kirby AC CMG

Introduction

Ian Kerridge, Christopher Jordens and Emma-Jane Sayers

PART 1: ETHICS IN MEDICINE

Is there a distinctively surgical ethics?
Commentaries by Michael Fearnside and Bernadette Tobin
The fivefold root of an ethics of surgery
Commentaries by Paul McNeill and Russell Gruen
Does reading poetry make you a better clinician?
Commentaries by Murray Bail, Jill Gordon and Stan Goulston
Euthanasia and the meaning of a life
Commentary by Roger Magnusson

PART 2: PHILOSOPHY AND MEDICINE

Assignments of meaning in Epidemiology
Commentary by Alison Moore and Jason Grossman
Better than numbers - a gentle critique of evidence-based medicine
Commentaries by Rachel Ankeny, Les Bokey, Robin Downie, Steve Leeder, Melissa Sweet, Rob Simons and Natalie Gray
Research, ethics and conflicts of interest
Commentary by Nancy Dubler
Logic, hermeneutics and informed consent
see Commentary by Michael Carey
On trust
Commentary by Merrilyn Walton and Michael Carey
Resource constraints and moral pressures
see Commentary by Paul Gatenby
Ethonomics
Commentaries by Paul Gatenby and Gavin Mooney
Discourse communities and the discourse of experience
Commentary by Paul Komesaroff

PART 3: ILLNESS EXPERIENCE AND SURVIVORSHIP

Liminality: a major category of the experience of cancer illness
Commentary by Heather McKenzie
Survivorship and discourses of identity
Commentaries by Phyllis Butow, Jane Cruikshank and Samantha Miles
The skull beneath the skin
Commentary by Mira Crouch
Postscript by Martin Adson

Miles Little: A select bibliography



REVIEWS

Emeritus Professor Miles Little has had an illustrious career as a surgeon, academic, author, ethicist and philosopher. More than this he is a great humanitarian if this Reader sample of his work is indicative. …
Professor Little depicts modern medicine as having lost the very values society expects of its practitioners - humane values. The outcome is a wholesale decline of public trust … His papers challenge current practices and orthodoxies. The ethics of surgery, euthanasia, research funding, treating cancer survivors - all are dissected. Little sees a profound dichotomy at the heart of modern medicine: a reductionist, as opposed to a wholistic approach to illness and care in our society – a search for objectivity, which is part of the problem not the solution. …
Added attractions in this Reader are commentaries by an assortment of authors, including Little’s peers, sociologists, ethicists, even a poet. The range of writers is not surprising when Little’s own sources are appreciated. He moves with ease through the ideas of a who’s who of philosophers, ancient and modern, linguistic scholars, scientists, theoretical sociologists, and the so-called post-modernists of our time. His commentators sometimes agree, sometimes disagree with him.
Chapter 6 subtitled “A gentle critique of evidence-based medicine” (EBM) should be mandatory reading for medical litigation lawyers. Little portrays EBM as having reached cult status. He then demolishes its claims as paternalistic, arrogant, and yet to show validity. EBM’s purpose is to benefit doctors, not patients, and it encourages defensive medicine, which diminishes patient care. It replaces professional judgment with treatment protocols, which become ’the gold standard’ and form the career path for lawyers in an adversarial system where the distinction between legal and moral is often ignored. But, as Little notes, the ‘truth’ about what constitutes ‘best’ treatment can shift radically every few years, a point taken up gleefully by commentator Professor Stephen Leeder in predicting EBM will go under to “the current epidemic of genetic reductionism”.
Importantly, Little does not just expose the weaknesses of the system. He aims to reconcile rather than entrench division. The crux of this Reader is that modern medicine is greedy, fallible, dishonest and driven by vested interest, but his writing is a plea for change, with constructive proposals to effect it. …
You will not be the same after reading this book. The insights are at once of the 21st century and timeless. Justice Michael Kirby’s foreword notes a personal family experience with Professor Miles Little. To his Honour, Little’s work evidences the love of human beings at the heart of human dignity and universal human rights, which is the root of ethics, especially perhaps bioethics. Little’s clarion call is for the restoration of exactly those humane values to medicine by rebalancing science and ethical values. Let us hope that what Little fears and calls ‘moral indeterminacy’ does not instead prevail.

Angela Mende, NSW Law Society Journal, Dec 2004

   

Published August 2003
Publisher Desert Pea Press
Paperback/320pp
ISBN 9781876861087
Australian RRP $39.95
International Price $36.50
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