Shoutout to lil to motivate me to post this one, It's been a busy few weeks for me. Remember to include why you like your quote!
'In order to maintain coherent debate on the topic of patient autonomy, and to keep this book out of the realms of metaphysics, we must ask the reader to operate under the assumption that human beings do in fact have free will.'
-Taking Sides: Clashing Views on Biomedical Ethics, Fifteenth Edition
I like this quote because in the context of my Bioethics class, it helps us structure debate and immediately sussed out the single Determinist Christian (God already has a plan, nothing we do can change it) in the class. In the context of patient autonomy it provides a fundamental assumption that allows for the creation of an operational framework to discuss how much control a patient should have over their own care. Personally, I believe that every patient should be an informed, and well informed patient, and for any kind of chronic disease that patient should know their illness well and stay abreast of their own care and research in the area of their illness. However we've got a pretty heated debate running in my class which is arguing for a return to a more paternalistic approach to medicine, where you just do exactly what the doctor says and don't expect to understand the issue. Also within my own paradigm I struggle to understand people who don't want to understand their disease, but they do exist apparently.
Shout out time!
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Edit to say that these are AWESOME! I love these threads, the conversation is always really interesting.
Just curious, are you a medical student? In a perfect world, I think your perspective is ideal. Unfortunately we live in a far-from-perfect world. Your view requires the following: -Patients must be able to understand and digest complex medical information, the majority of which simply isn't that clear or even accessible to the average layman. The study that clearly demonstrates superiority of one therapy over another is rare; most are simply various shades of gray that requires a calculus of sorts to come at a decision. The fact is that a not-insignificant number of physicians fail to read research articles critically. These people (we) are, theoretically, smart. How can you expect a layman to do what many physicians fail to do? -Not every patient wants to know or cares about their disease process. Based on how you're talking about it, you sound like a pre-clinical student (assuming you're in medical school). It will be interesting to see how your perspective changes once you start seeing patients. Many patients want little more than to show up, be told what to do, and feel better. It is the exception rather than the rule for patients to want to know how or why their disease occurs, how our interventions work, etc. etc.. Many young medical students - and I used to be in this category - think that if they can simply distill their medical knowledge to easily understandable terms and make clear the importance of treatment, then patients will "care" about their disease and be more motivated to adhere to therapy. This has not borne out in my experience, unfortunately. -Tangent about the above note: being in the medical profession - and this is going to sound elitist, I know, but hopefully I can successfully get the point across - you have likely been among a group of peers that is intellectually at the right side of the bell curve. Statistically, you are more than likely from a solidly middle class family; if you're in medical school, it is more likely than not that you have at least one parent as a physician and came from a household in the top quintile of income. I say all this to point out that your perspective of "average" is likely very, very skewed. The people you think of as whatever pejorative you can think of are, more than likely, still above average when viewed in the context of our entire society. Your note about people that "apparently exist" that do not care about their own health not only don't exist but are exceedingly common. I will let you come to these realizations yourself and not beat you over the head with this point, but this is something that you perhaps might consider. -In my view, people see a physician because they want the physician to exercise their judgment, which they have gained from years and years of training and practice. Let's pretend for a second that 100% of the information on WebMD is accurate and that patients can 100% understand everything presented there or at an even higher quality source (e.g., UpToDate). That is all knowledge that a second year medical student has largely been exposed to. They may not know everything from memory, but they will understand that information. And yet a second year medical student is hardly a competent clinician. More than likely, they'll look like a complete fool once they start their third year. The difference between WebMD and JamesTiberiusKirk, MD is that I have seen tens or hundreds or thousands of patients with the disease you have, and I have treated those patients with a variety of medications using a variety of modalities. I have the ability to pick up on subtle differences that might result in different treatments between Ann and Bob even though to the layman they seem identical. I am more familiar with what various treatments mean and can more likely translate what a patient wants from a treatment into an appropriate medical intervention (I'm thinking of more chronic diseases here where therapy can be a burden). These are not things you can gleam from WebMD. And again - that's putting aside the fact that the average layman can accurately digest medical information (hint: they can't - at least not to the degree necessary to diagnose and treat disease). In my own view, we have swung too far on the opposite side of the pendulum in pursuit of the "patient-centered decision-making" model. Like you, I agree that patients should be - MUST be - informed about their disease and their various options for treatment. It is the clinician's job to provide that information in such a way such that they are able to make a truly informed decision. We do a terrible job of this in medicine. There is need for improvement. But that said, I also think it's unfair to put this burden at the foot of the patient and say, "you decide." This is doubly true for clinical situations where many different treatment options exist and there is no real winner. Yes, patients should be informed, but I think it's the whole job of the physician to say, "...but this is what we should do." They should listen to and heed patient concerns or reservations about a therapy, and no patient should be forced to do anything against his/her will, but I think it is critically important to understand that patients do not understand - and should not be expected to understand - the myriad of subtleties you learn throughout your clinical training. Expecting them to puts an unfair burden on those folks and could very well lead them to make a definitively bad decision (for a prime example, see how end-of-life care happens in the U.S.). Hopefully you aren't offended with what I've said, but your view strikes me as hopelessly naive and working under the expectation that your average patient is going to be like you. They will not be. Some will, but they will undoubtedly be the minority. A surprising number of people still don't know what the difference between a virus and a bacterium is, yet you expect to be able to inform them enough to do the calculus required to decide on things like cancer therapies, whether an elective procedure with significant risk (but potentially significant reward) is a good idea, and other clinical quagmires? Contrary to helping the patient and giving them agency, I think that approach leaves them to drown in what they don't know. But perhaps I'm just an elitist curmudgeon. Edit: Having seen the other comments here, it seems I didn't understand the purpose of this post. Regardless, I hope this is some food for thought for the OP and anyone else with an interest in medical ethics.
It's not at all off topic. In my mind, this thread exists largely for the conversation about the quotes. I appreciate your post, it's great perspective.
I'm not a medical student, but if I may be a bit facetious for a moment, I would consider myself a student of medicine. I'm an undergrad pursuing medical research administration, but I do not plan on going to med school. I understand I am more than a little bit of an idealist in this particular regard. I'm a cardio patient, have been for a while and I have a good summary of my condition here so I definitely have an unusual perspective on the matter. And I definitely cope with my condition with knowledge. I plan on working in a hospital for most of my life, and have already spent a lot of time in them, so I have a deep and personal interest in medical ethics.
I happen to agree with you on that point, but I think it's a failing of the methods of disseminating and interpreting information. There's also the point that the reason we pay doctors so much is because they learn all this stuff so that the average person doesn't have to. But I believe that society advances as we increase peoples ability, personal utility and capacity to self-actualize, and we need to be constantly working towards that goal wherever possible.In my own view, we have swung too far on the opposite side of the pendulum in pursuit of the "patient-centered decision-making" model
No, I very much appreciate your points. Contrary to helping the patient and giving them agency, I think that approach leaves them to drown in what they don't know. What is the alternative? I imagine ruthlessly educating each patient, locking the doors until they understand their disease.Edit: Having seen the other comments here, it seems I didn't understand the purpose of this post. Regardless, I hope this is some food for thought for the OP and anyone else with an interest in medical ethics.
A surprising number of people still don't know what the difference between a virus and a bacterium is, yet you expect to be able to inform them enough to do the calculus required to decide on things like cancer therapies, whether an elective procedure with significant risk (but potentially significant reward) is a good idea, and other clinical quagmires?
– Bleeding Edge, Thomas Pynchon A father to a daughter. Unexpected beauty in a cynical book.“You were always like this. I kept waiting for you to give it up, let it go, turn as cold as the rest of us, praying all the time you wouldn’t. You’d come back from school, history classes, some new nightmare, the Indians, the Holocaust, crimes I hardened my heart against years ago, taught them but didn’t feel them so much anymore, and you’d be so angry, passionately hurting, your little hands in fists, how could anybody do these things, how could they live with themselves? What was I supposed to say? We handed you the tissues and said, it’s grown-ups, some act that way, you don’t have to be like there, you can be better. Best we could ever come up with, pathetic, but you know what, I never found out what we should have said. Think I’m happy about that?”
Gravity's Rainbow is one my faves, but it requires some dedication. Crying of Lot 49 is his Portrait of the Artist, in terms of accessibility.
I've tried Gravity's Rainbow a couple of times now and just haven't been able to get through more than 40 or 50 pages of it. Read the Crying of Lot 49 and loved it though. One of these days I'll read all of Gravity's Rainbow...
I struggled through GR, but I don't recommend it. Gems in there, but it's a damn hard slog.
"V" is similarly cryptic, but for some reason I enjoyed that quite a lot; it's probably half as long as GR.
Hahaha, I'm sorry. I meant how is Bleeding Edge? Would you recommend Pynchon?
I've been awfully curious as to how Pynchon has weathered, especially when faced with subject matter so, well, modern. I have faith in his ability to choose subject matter but whenever I see Bleeding Edge I get the feeling that, if I ever read it, it'll be with my fingers crossed hoping he doesn't come across as a withered old man in a foreign landscape.
I'm re-reading The Lord of the Rings for probably the 10th time. I love that book. (This is a quote from Gandalf in The Fellowship of the Ring)Many that live deserve death. And some that die deserve life. Can you give it to them? Then do not be too eager to deal out death in judgement. For even the very wise cannot see all ends. I have not much hope that Gollum can be cured before he dies, but there is a chance of it. And he is bound up with the fate of the Ring. My heart tells me that he has some part to play yet, for good or ill, before the end…
A bloated carcass of a dog lay lolled on a bladderwrack. Before him the gunwale of a boat, sunk in sand. Un coche ensablé, Louis Veuillot called Gautier's prose. These heavy sands are language tide and wind have silted here.At last proud Odysseus said to his wife: 'My dear one, we have not yet reached the issue of our trials. In store for us is immeasurable toil prescribed, and needs must I fulfil it to the end. The day I went down into Hades' realm, the ghost of Teiresias warned me of everything when I asked after my home-coming and my company's. Wherefore let us to bed, dear wife, there at long last to renew ourselves with the sweet meed of sleep.'
Homer's Odyssey, translated by T. E. Lawrence.He climbed over the sedge and eely oarweeds and sat on a stool of rock, resting his ashplant in a grike.
James Joyce's Ulysses. It's a bit... hallucinogenic.
Konstantin Dmitrich Levin, or Levin, is one of the main characters in Tolstoy's Anna Karenina. He's a bit of an oddball, eschewing the balls and high society of Petersburg and Moscow to live in the country. There is a part in the novel where Levin has an especially irksome conversation with his half-brother who visits him, so Levin decides to let out a little steam and go mow wheat with the muzhiks, the peasants, remembering how he liked the physical exertion. Tolstoy describes Levin joining an old man and a young lad in the line of muzhiks --
"What do you say to my home-brew, eh? Good, eh?" said he, winking. And truly Levin had never drunk any liquor so good as this warm water with green bits floating in it, and a taste of rust from the tin dipper. And immediately after this came the delicious, slow saunter, with his hand on the scythe, during which he could wipe away the streaming sweat, take deep breaths of air, and look about at the long string of mowers and at what was happening around in the forest and the country. The longer Levin mowed, the oftener he felt the moments of unconsciousness in which it seemed not his hands that swung the scythe, but the scythe mowing of itself, a body full of life and consciousness of its own, and as though by magic, without thinking of it, the work turned out regular and well-finished of itself. These were the most blissful moments.Levin kept between them. In the very heat of the day the mowing did not seem such hard work to him. The perspiration with which he was drenched cooled him, while the sun, that burned his back, his head, and his arms, bare to the elbow, gave a vigor and dogged energy to his labor; and more and more often now came those moments of unconsciousness, when it was possible not to think what one was doing. The scythe cut of itself. These were happy moments. Still more delightful were the moments when they reached the stream where the rows ended, and the old man rubbed his scythe with the wet, thick grass, rinsed its blade in the fresh water of the stream, ladled out a little in a tin dipper, and offered Levin a drink.
What is striking in this passage by Tolstoy is the description of "unconsciousness" - as rendered by the translator. We might call this getting into the zone of focussed attention so that you lose yourself as the agent of activity. On first read, the passage is completely understandable. On second read, i wondered about Tolstoy or the translator trying to describe a consciousness of an unconsciousness which the act of writing makes necessary. I'm not sure if I'm being clear.
I know what you mean, and it would be ironic if Tolstoy wasn't so ardent a champion of single-entendre meaning. I think you're on point when you say that the act of writing or describing the scene would make necessary describing a consciousness of an unconsciousness.On first read, the passage is completely understandable. On second read, i wondered about Tolstoy or the translator trying to describe a consciousness of an unconsciousness which the act of writing makes necessary.
Infinite Jest, DFW Okay, but seriously, I love DFW as an essayist and for his short stories, and he is bleeding Pynchon everywhere, which is great, but I'm about 100 pages in and this better start going somewhere soon. He is definitely anti-quotable in this work so far.I am in here.
Some people say that you have to get past the first 200 pages or so before it really gets going. I've been meaning to post one of my favourite passages up here on Hubski, but it'd take a while to transcribe.
Here's one of my highlighted quotes from about halfway into the book: And another from near the end: Keep reading, iammyownrushmore. I know for me, it took a couple times to really get to know the book. But now I've reread it a couple times, and the innumerable characters, the disjointed storylines, his colloquially prosaic writing style, it all comes together.It's of some interest that the lively arts of the millennial U.S.A. treat anhedonia and internal emptiness as hip and cool. It's maybe the vestiges of the Romantic glorification of Weltschmerz, which means world-weariness or hip ennui. Maybe it's the fact that most of the arts here are produced by world-weary and sophisticated older people and then consumed by younger people who not only consume art but study it for clues on how to be cool, hip — and keep in mind that, for kids and younger people, to be hip and cool is the same as to be admired and accepted and included and so Unalone. Forget so-called peer-pressure. It's more like peer-hunger. No? We enter a spiritual puberty where we snap to the fact that the great transcendent horror is loneliness, excluded encagement in the self. Once we've hit this age, we will now give or take anything, wear any mask, to fit, be part-of, not be Alone, we young. The U.S. arts are our guide to inclusion. A how-to. We are shown how to fashion masks of ennui and jaded irony at a young age where the face is fictile enough to assume the shape of whatever it wears. And then it's stuck there, the weary cynicism that saves us from gooey sentiment and unsophisticated naïveté.
It now lately sometimes seemed like a kind of black miracle to me that people could actually care deeply about a subject or pursuit, and could go on caring this way for years on end. Could dedicate their entire lives to it. It seemed admirable and at the same time pathetic. We are all dying to give our lives away to something, maybe.
Totally. Whenever I hear people talk about DFW and they get caught up on his little juxtaposed, obtuse wordage, I think they're really missing the forest for the trees. I'm definitely gonna keep at it, don't worry. But probably not more than once.his colloquially prosaic writing style
I don't want to turn this whole post into DFW wall, and I'm realizing now that the last time we did this, I posted another DFW quote from this very story (its my favorite, you see), so I'll just add onto your post. Good Old NeonAll right, now we’re coming to what I promised and led you through the whole dull synopsis of what led up to this in hopes of. Meaning what it’s like to die, what happens. Right? This is what everyone wants to know. And you do, trust me. Whether you decide to go through with it or not, whether I somehow talk you out of it the way you think I’m going to try to do or not. It’s not what anyone thinks, for one thing. The truth is you already know what it’s like. You already know the difference between the size and speed of everything that flashes through you and the tiny inadequate bit of it all you can ever let any- one know. As though inside you is this enormous room full of what seems like everything in the whole universe at one time or another and yet the only parts that get out have to somehow squeeze out through one of those tiny keyholes you see under the knob in older doors. As if we are all trying to see each other through these tiny keyholes.
Hope I'm not late for the party. I've been reading a bit of Feynman lately, found this amusing quote: Feynman then goes on to pick apart what is actually in a glass of wine, including that the glass itself is distilled rock. The chapter concludes:A poet once said , "The whole universe is in a glass of wine." We will probably never know in what sense he meant that, for poets do not write to be understood.
If our small minds, for some convenience, divide this glass of wine, this universe, into parts - physics, biology, geology, astronomy, psychology, and so on - remember that nature does not know it! So let us put it all back together, not forgetting ultimately what it is for. Let it give us one more final pleasure: drink it and forget it all!
That quote is found in Dan Ariely's The Upside of Irrationality: The Unexpected Benefits of Defying Logic. In reality there's a lot of great quotes and quotable findings so far, but I really liked that one. I figured since kleinbl00 has talked about Ariely multiple times, I should get around to reading him. I'm more interested in part that relates to dating, but that seems to come later.“At the level of pay that those of you who run banks get, why the hell do you need bonuses to do the right thing?” He was answered by an abyss of silence. So he went on: “Do we really have to bribe you to do your jobs? I don’t get it. Think what you are telling the average worker—that you, who are the most important people in the system and at the top, your salary isn’t enough, you need to be given an extra incentive to do your jobs right.”
~ Congressman Barney Frank.
Piketty actually hit the crazytalk salary thing as well. He made the point that it evolved in the United States because our economy wasn't annihilated by WWII and we had no landed gentry sitting around. However, he also makes the point that there's no correlation between crazy f'in salaries and value or performance, and that crazy f'in salaries are more of a social divider than anything else. In other words, crazy f'in salaries exist to signify royalty, pure and simple. They need the extra incentive so that the world knows that we're serfs and they're nobles.
Funny how that works. Ariely doesn't seem to get into that social aspect, but when you look at the bonus experiment and how the large bonus resulted in poor performance from "average", off the street people who are unaccustomed to such a thing, I can see how that can act as a division. Can I just say that I picked this up today and am already through the first chapter and could keep going if I felt like it? This book has really piqued my interest....there's no correlation between crazy f'in salaries and value or performance, and that crazy f'in salaries are more of a social divider than anything else.
Training managers how to give feedback -- how to push more effectively -- can be helpful. But if the receiver isn't willing or able to absorb the feedback, then there's only so far persistence or even skillful delivery can go. It doesn't matter how much authority or power a feedback giver has; the receivers are in control of what they do and don't let in, how they make sense of what they're hearing and whether they choose to change."
I'm reading Thanks for the Feedback: The Science and Art of Receiving Feedback Well. If you tend to get super-defensive whenever you get feedback, read this book. I'm reading this book because I'd like to turn the theory and examples into interactive exercises.
The Riven Kingdom, by Karen Miller It's the same spirit as one of my favorite essays, Patton Oswalt's The Good Outnumber You.But that's not to say the place is perfect. It's got good folk and bad folk, like everywhere else. And the only reason the bad folk don't get the upper hand is because the good folk don't let them. They see a weed, they pluck it out. They don't let it grow and seed and spread itself further til all the flowers are choked and dead.
- Blood Meridian, Cormac McCarthy“It was a lone tree burning on the desert. A heraldic tree that the passing storm had left afire. The solitary pilgrim drawn up before it had traveled far to be here and he knelt in the hot sand and held his numbed hands out while all about in that circle attended companies of lesser auxiliaries routed forth into the inordinate day, small owls that crouched silently and stood from foot to foot and tarantulas and solpugas and vinegarroons and the vicious mygale spiders and beaded lizards with mouths black as a chowdog's, deadly to man, and the little desert basilisks that jet blood from their eyes and the small sandvipers like seemly gods, silent and the same, in Jeda, in Babylon. A constellation of ignited eyes that edged the ring of light all bound in a precarious truce before this torch whose brightness had set back the stars in their sockets.”
There's a quote (actually two) from my all-time favorite book; Ender's Game, that I wish more people would take to heart. "In the moment when I truly understand my enemy, understand him well enough to defeat him, then in that very moment I also love him. I think it’s impossible to really understand somebody, what they want, what they believe, and not love them the way they love themselves. And then, in that very moment when I love them.... I destroy them." "Perhaps it's impossible to wear an identity without becoming what you pretend to be"
Ender's Game is easily one of my top 10 favorite novels. If I ever doubt the ability or intelligence of children I'll re-read it. I empathized with Ender more than a little bit growing up, always being told I was 'special' and, because of the minor persecution complex I had as a kid, felt like I was thrown to the wolves, or Bonzo's of my school, not that we had much actual bullying. Reading the other stuff, Speaker for the Dead, and the rest of the series, I empathize with adult Ender a lot less, but I still respect those books as just very well written and conceptually very interesting pieces of literature. Personally, I use Card's hierarchy of 'otherness,' Utlanning, Framling, Raman and Varelse when I meet people, especially those from cultures I understand poorly. I have yet to meet a genuine 'Varelse' but I see them on TV, specifically Fox, CNN, etc. So called 'True Aliens' whose motivations and way of being is just completely unintelligible to me.
I like this quote because it's simple and absolute, everything MUST end, it's (as Smith spends the entire movie saying) inevitable, doesn't matter if it was a good thing, bad thing or just a thing. It seems final, and I think that was intentional, because you just spent an entire trilogy of movies finding out that Smith and Neo are equals, but complete opposites. "Everything that has a beginning has an end, Neo." - Agent Smith (The Matrix Revolutions)
-- Theodore Sturgeon, "The World Well Lost"There were only two loverbirds. They came down out of the sky in a single brassy flash, and stepped out of their ship, hand in hand. Their eyes were full of wonder, each at the other, and together at the world. They seemed frozen in a full-to-bursting moment of discovery; they made way for one another gravely and with courtesy, they looked about them and in the very looking gave each other gifts—the color of the sky, the taste of the air, the pressures of things growing and meeting and changing. They never spoke. They simply were together. To watch them was to know of their awestruck mounting of staircases of bird notes, of how each knew the warmth of the other as their flesh supped silently on sunlight.
Glad you liked it. TS has a wonderful way with words, and his short stories especially pack an emotional punch that no one else can match, I think. I almost shared this quote, from later in the same story.A filthy place, Terra. There is nothing, he thought, like the conservatism of license. Given a culture of sybaritics, with an endless choice of mechanical titillations, and you have a people of unbreakable and hidebound formality, a people with few but massive taboos, a shockable, narrow, prissy people obeying the rules—even the rules of their calculated depravities—and protecting their treasured, specialized pruderies. In such a group there are words one may not use for fear of their fanged laughter, colors one may not wear, gestures and intonations one must forego, on pain of being torn to pieces. The rules are complex and absolute, and in such a place one's heart may not sing lest, through its warm free joyousness, it betray one.