Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making

by Rothman,David J.

• ISBN13: 9780202307251
• ISBN10: 0202307255
• Format: Nonspecific Binding
• Copyright: 2003-09-30
• Publisher: Routledge

Summary

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. David J. Rothman is Bernard Schoenberg Professor of Social Medicine and director of the Center for the Study of Society and Medicine at the Columbia College of Physicians and Surgeons, and professor of history at Columbia University. Among his books are The Discovery of the Asylum and Conscience and Convenience, featured on pages 34 and 35. "For anyone wishing to become acquainted with this field, I would recommend reading [ Strangers at the Bedside] for a situated, historical account." -Kathryn Ehrich, Medical Sociology News

Author Biography

David J. Rothman is Bernard Schoenberg Professor of Social Medicine, Director of the Center for the Study of Society and Medicine, and Professor of History at Columbia University.

Table of Contents

Acknowledgments
Introduction: Making the Invisible Visible	p. 1
The Nobility of the Material	p. 15
Research at War	p. 30
The Guilded Age of Research	p. 51
The Doctor as Whistle-Blower	p. 70
New Rules for the Laboratory	p. 85
Bedside Ethics	p. 101
The Doctor as Stranger	p. 127
Life Through Death	p. 148
Commissioning Ethics	p. 168
No One to Trust	p. 190
New Rules for the Bedside	p. 222
Epilogue: The Price of Success	p. 247
Afterword	p. 263
Appendix A	p. 273
Notes	p. 276
Index	p. 303
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