Among the most significant findings of SUPPORT was that 50% of ICU patients suffered from moderate to severe pain during the last days of life. At the time of its publication late in 1995, SUPPORT was merely the latest in a long series of articles in the medical literature documenting the widespread and significant undertreatment of pain, beginning with a 1973 study of hospital inpatients. Much has been written about the phenomenon of undertreated pain and inadequate care of patients at (...) the end of life, and many positive suggestions for reform of clinical education and clinical practice have been iterated and reiterated in the two decades separating the studies. Proposals for modifying clinician behaviors in this aspect of patient care have tended to focus on particular barriers to effective pain management and palliative care. (shrink)

Curiosity and imagination have been neglected in epistemology. This paper argues that the role of curiosity and imagination is central to the way we think, regardless of whether it is thinking about problems of ethics or problems of science. In our ever more materialistic society, curiosity and reason are either discouraged or narrowly channeled. I shall argue that the role of curiosity and imagination for both science and ethics is so important that nurturing them can be seen as an ethical (...) obligation and suppressing them as ethically problematic. (shrink)

When physicians in training enter their clinical years and first begin to become involved in clinical decision making, they soon find that more than the technical data they had so carefully learned is involved. Prior to that time, of course, they were aware that more than technology was involved in practicing medicine, but here, for the first time, the reality is forcefully brought home. It may be on the medical ward, when a patient or a patient's relatives ask that no (...) further treatment be given and that the patient be allowed to die; it may be in ob/gyn, when a 4- or 5-month pregnant lady with two other children and just deserted by her husband pleads for an abortion; it may be in the outpatient setting, where patients unable to afford enough to eat cannot afford to buy antibiotics for their sick child or provide him or her with the recom mended diet. Whatever the setting, students soon find themselv. es con fronted with problems in which an answer is not given by the technical possibilities alone; indeed, students may have to face situations in which, all things considered, the use of these technical possibilities seems ill-advised. But choices need to be made. Some of us may choose to hide behind a mastery of technology. (shrink)