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Pro-choice

Pro-choice

Pro-choice is a common self-description used by people who believe that a woman should have the absolute legal right to have an abortion, or that one can choose on issues relating to the life or death of themselves or any part of their body. Additionally, opponents of the right to an abortion often argue that "pro-choice" is a misnomer, because pro-choice activists oppose legislative measures such as "Informed Consent" or "Right To Know" laws, even when such laws merely delay rather than restrict a woman's legal right to choose abortion. Some medical practitioners, and many advocates of what is considered from the pro-choice perspective as a female patient's right to choose abortion, consider informed consent restrictions an inconsistent and arbitrary governmental intrusion into an open, informed and confidential patient-practitioner relationship. They argue that since informed consent is the precursor to all medical treatment, any legislative requirement for additional "facilitation" in this instance amounts to a compromise to the physician's or practitioner's skill and discretion. Some pro-choice activists believe that abortion should be a last resort, if the pregnant woman is unable to raise the child or give it up for adoption, or if the pregnancy risks endangering the life or health of the woman. They also feel that pro-life activists distort this point of view, suggesting that pro-choice activists somehow wish for abortion to be considered a common form of contraception. For moderates on both sides, the subject of abortion as an absolute last resort often provides common ground for reasonable debate. Some pro-choice moderates, who would otherwise be willing to accept certain restrictions on abortion, feel that political pragmatism compels them to fight against any such restrictions, as they could be used to form a slippery slope against all abortions.

Term Controversy

The term "pro-choice" is often used interchangeably with "pro-abortion." Proponents for the usage of "pro-abortion" cite that "pro-choice" is a loaded term implying the negative opposite "anti-choice" instead of "pro-life". Both "pro-choice" and "pro-life" are examples of political framing: they are terms which purposely try to define their philosophies in the best possible light, while by definition attempting to describe their opposition in the worst possible light (being "anti-choice" or "anti-life"). Opponents of the pro-choice view sometimes refer to people who are pro-choice with what can be considered pejorative terms such as "anti-life" or "pro-abortion". Pro-choice individuals object to this nomenclature, and claim that they approve of life, instead emphasizing that an unwanted child ruins the life of both mother and child. This emphasizes their support for increasing the quality of people's lives by having each child be born to a woman who is willing and able to raise the child, rather than just increasing the quantity by causing more births. Their belief is framed in the broader category of the individual liberty and absolute "reproductive freedom". One view on how to resolve the dispute is simply to accept the terms each group uses for itself. Frequently, this approach is adopted by news organizations as applied to abortion advocacy groups, but rarely as applied to abortion opponents. The Oxford English Dictionary lists the usage of "pro-choice" at least as early as 1975, around the time when the question of the legality of abortion became increasingly discussed after Roe v. Wade (the term "choice" is used to describe options towards abortion in the case as well). Within the term pro-choice exists a spectrum of political opinion, ranging from the view that all abortions should be legal, to the view that abortions should only be legal until a certain date in the progression of the pregnancy (such as the third trimester, which is the approximate gestational age at which a fetus can survive outside of the mother's body). In its 1973 landmark case of Roe v. Wade, the US Supreme Court held that abortions were permissible during the first and second trimesters of a woman's pregnancy, but that they could be restricted during the third trimester unless the woman's life or health were at risk. People who believe the opposite often refer to themselves as pro-life. Within that term also exists a spectrum of political opinion, ranging from the view that all abortions should be illegal, to the view that abortion should only be legal in certain rare circumstances, such as pregnancy by rape or incest, or when there are fetal deformities or medical complications to pregnancy. Planned Parenthood and NARAL Pro-Choice America are the leading pro-choice advocacy and lobbying groups in the United States, though most of the major feminist organizations are involved in the issue on the pro-choice side as well. In the United States, the Democratic Party tends to be more pro-choice than the Republican Party on the issue of abortion rights. Category:Abortion

Abortion

An abortion is the termination of a pregnancy associated with the death of an embryo or a fetus. In medicine, the following terms are used to define an abortion:
- Spontaneous abortion: An abortion due to accidental trauma or natural causes, this is commonly termed a miscarriage.
- Induced abortion: Induced abortions are further subcategorized into therapeutic abortions and elective abortions.
- Therapeutic abortion: An abortion performed because the pregnancy poses physical or mental health risk to the pregnant woman.
- Elective abortion: An abortion performed for any other reason. In common parlance, the term "abortion" is synonymous with induced abortion. A pregnancy that terminates early, but where the fetus survives to become a live infant, is instead termed a premature birth. A pregnancy that ends with an infant dead upon birth, due to causes such as spontaneous abortion or complications during delivery, is termed a stillbirth. Certain forms of birth control are used to prevent implantation before the pregnancy occurs. These acts of emergency contraception are not classified as abortion by medicine. The ethics and morality of induced abortion have become the subject of an intense debate in the past 50 years in various areas of the world, particularly in the United States of America, but also to a lesser extent in Canada and a number of countries in Europe. Any female mammal can experience abortion, however this article focuses exclusively on abortion in women.

Spontaneous abortion

Spontaneous abortions, generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes. A miscarriage is spontaneous loss of the embryo or fetus before the 20th week of development. Spontaneous abortions after the 20th week are generally considered preterm deliveries. Up to 78% of all conceptions may fail, in most cases even before pregnancy is confirmed. 15% of all confirmed pregnancies end in a miscarriage. Most miscarriages occur very early in a pregnancy. Early embryonic development is an error prone process, and the body may spontaneously abort if a fetus is not viable (i.e., due to genetic deformities, such as most cases of trisomy), or when the womb is unable to support the development of the fetus. Other causes can be infection (of either the mother or the fetus), immune responses, or serious systemic diseases of the mother. The risk for spontaneous abortion is greater in women over age 35, those with a history of more than three previous (known) spontaneous abortions, and those with systemic diseases. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered an induced abortion. Some states have laws increasing the criminal liability of a person who causes a miscarriage during an assault or other violent crime.

Induced abortions

The term "abortion" is usually used by lay people to refer to induced abortion. Women from 27 nations reported the following reasons for seeking an induced abortion:
- 25.5% – Want to postpone childbearing
- 21.3% – Cannot afford a baby
- 14.1% – Has relationship problem or partner does not want pregnancy
- 12.2% – Too young; parent(s) or other(s) object to pregnancy
- 10.8% – Having a child will disrupt education or job
-   7.9% – Want no (more) children
-   3.3% – Risk to fetal health
-   2.8% – Risk to mother's health
-   2.1% – Rape, incest, other In many areas of the world, especially the developing nations or where induced abortions are illegal, many women choose or are pushed to perform abortions on themselves. These self-induced abortions are commonly unsafe abortions as described by the World Health Organization. Furthermore, some abortions are induced because of societal pressures, such as stigma of disabled persons and similar eugenic ideals, societal and religious disapproval of single motherhood, insufficient economic support for families, or laws such as under China's one-child policy. These policies and societal pressures can lead to sex-selective abortion and infanticide, which is illegal in most countries, but difficult to stop.

Methods of inducing abortion

Depending on the gestational age of the embryo or fetus, different methods of abortion can be performed to remove the embryo or fetus from the womb.

Medical Abortion

Effective in the first trimester of pregnancy, medical, or non-surgical abortions comprise 10% of all abortions in the United States and Europe. The process begins with the administration of either methotrexate or mifepristone, followed by misoprostol. While misoprostol may also be used alone to induce abortion, the need for surgical intervention is slightly elevated to about 10%, compared to the 8% when medications are combined. When surgical intervention is necessary, primarily vacuum uterine aspiration is used.

Surgical abortion

In the first fifteen weeks, suction-aspiration or vacuum abortion are the most common methods, replacing the more risky dilation and curettage (D & C). Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses suction produced by an electric pump to remove the fetus or embryo. From the fifteenth week up until around the eighteenth week, a surgical dilation and evacuation (D & E) is used. D & E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. Dilation and suction curettage consists of emptying the uterus by suction using a different apparatus. Curettage refers to the cleaning of the walls of the uterus with a curette. Dilation and curettage (D & C) is a standard gynaecological procedure performed for a variety of reasons, such as examination. As the fetus grows, other techniques must be used to induce abortion in the third trimester. Premature delivery of the human fetus can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. Very late abortions can be brought about by the controversial intact dilation and extraction (intact D & X) which requires the surgical decompression of the fetus's head before evacuation and is controversially termed "partial-birth abortion". A hysterotomy abortion, similar to a caesarian section but resulting in a terminated fetus, can also be used at late stages of pregnancy. Hysterotomy abortion can be performed vaginally, with an incision just above the cervix, in the late mid-trimester. An attempted abortion which results in the expulsion of a live infant (known medically as a neonate) is termed a failed abortion. A failed abortion is more likely to occur later in pregnancy. Some doctors who have induced a failed abortion have faced the prospect of having to kill the neonate, but are voicing concerns that doing so may be unethical and possibly subject them to criminal sanctions. As a result, recent investigations have been launched in England by the Confidential Enquiry into Maternal and Child Health (CEMACH) and the Royal College of Obstetricians and Gynaecologists in order to determine how widespread the problem is and an ethical response on how to treat the neonate.

Other means of abortion

A number of herbs are effective abortifacients. Using herbs in this way can cause serious side effects, including multiple organ failure and other serious injury, and are not recommended by physicians. Physical trauma to a pregnant woman's womb can cause an abortion. The severity of the impact required to cause an abortion carries high risk of injury, without necessarily inducing a miscarriage. Both accidental and deliberate abortions of this kind carry criminal liability in many countries.

Health effects

As with most surgical procedures, the most common surgical abortion methods carry the risk of potentially serious complications. These risks include: a perforated uterus, perforated bowel or bladder, septic shock, sterility, and death. It is difficult to accurately assess the risks of induced abortion due to a number of factors. These factors include wide variation in the quality of abortion services in different societies and among different socio-economic groups, a lack of uniform definitions of terms, and difficulties in patient follow-up and after-care. Use of other methods (e.g., overdose of various drugs, insertion of various objects into uterus) for abortion is very dangerous, carrying a significantly elevated risk for permanent injury or death compared to abortions done by physicians.

Physical health

Each phase of the abortion carries separate risks, and practitioners are not in agreement as to the best methods of mitigating those risks. The degree of risk depends upon the skill and experience of the practitioner; maternal age, health, and parity; gestational age; pre-existing conditions; methods and instruments used; medications used; the skill and experience of those assisting the practitioner; and the quality of recovery and follow-up care. A highly-skilled practitioner, operating under ideal conditions, will tend to have a very low rate of complications; an inexperienced practitioner in an ill-equipped and ill-staffed facility, on the other hand, will often have a higher incidence of complications. Some practitioners advocate using the minimal possible anesthesia, so that patient pain can alert the practitioner to possible complications. Others recommend general anesthesia in order to prevent patient movement which might cause a perforation. General anesthesia carries its own risks and most public health officials recommend against its routine use in abortion due to an increased risk of death. Dilation of the cervix carries the risk of cervical tears or perforations, including small tears that might not be apparent and might cause cervical incompetence in future pregnancies. Most practitioners recommend using the smallest possible dilators, and using osmotic rather than mechanical dilators after the first trimester of pregnancy. Instruments are placed within the uterus to remove the fetus. These can, on rare occassions, cause perforation or laceration of the uterus, and damage to structures surrounding the uterus. Laceration or perforation of the uterus or cervix can, again on rare occassions, lead to even more serious complications. Incomplete emptying of the uterus can cause hemorrhage, and infection. Use of ultrasound verification of the location and duration of the pregnancy prior to abortion, with immediate follow-up of patients reporting continuing pregnancy symptoms after the procedure, will virtually eliminate this risk. In rare cases, the abortion will be unsuccessful and the pregnancy will continue. Most practitioners recommend a second procedure to terminate the pregnancy due to the possibility that the abortion attempt had caused injury to the fetus. The sooner a complication is noted and properly treated, the lower the risk of permanent injury or death. A specific and undisputed complication that can arise, especially with repeated abortions by a dilatation and curettage, is the development of Asherman syndrome.

Suggested effects

There is controversy over a number of proposed risks and effects of abortion. Evidence, whether in support of or against such claims, might in part be influenced by the political and religious affiliations of the parties behind it.

Breast cancer

The controversial abortion-breast cancer (ABC) hypothesis posits an association between having an abortion and a higher risk of developing breast cancer. The proposed mechanism is based on the increased estrogen levels found during early pregnancy, which initiate cellular differentiation (growth) in the breast in preparation for lactation. The ABC hypothesis states that if the pregnancy is aborted before full differentiation in the third trimester, then more "vulnerable" undifferentiated cells would be left than prior to the pregnancy, resulting in an elevated risk of breast cancer. The majority of interview-based studies have indicated a link, and some have been demonstrated to be statistically significant, but there remains debate as to their reliability because of possible response bias. According to the National Cancer Institute (NCI), it is "well established" that "induced abortion is not associated with an increase in breast cancer risk." Those findings have been disputed by Dr. Joel Brind, a leading scientific advocate of the ABC hypothesis. Nevertheless, gaps and inconsistencies remain in the research as the "ABC link" continues to be a politicized issue.

Fetal pain

The experience of the fetus during abortion is a matter of consideration among scientists and political activists. Evidence is conflicting, with some authorities claiming that the fetus is capable of feeling pain from the first trimester, while others hold that the neuro-anatomical requirements for such experience do not exist until the second or third trimester. Pain receptors begin to appear in the seventh week of pregnancy. The thalamus, the part of the brain which receives signals from the nervous system and then relays them to the cerebral cortex, starts to form in the fifth week. However, other anatomical structures involved in the nociceptic process are not present until much later in gestation. Links between the thalamus and cerebral cortex aren't forged until around the 23rd week. [http://www.parliament.uk/post/pn094.pdf]. Myelin, an insulation on nerve fibres whichs aids in the conduction of electrical impulses, does not begin to develop until the sixth month. [http://www.pediatrics.emory.edu/neonatology/dpc/brain.htm] Researchers have observed changes in the heart rates and hormonal levels of neonates after circumcision, blood tests, and surgery — effects which were alleviated with the administration of anaesthesia. [http://www.cirp.org/library/pain/anand/#n99] Others suggest that the human experience of pain, being more than just physiological, cannot be measured in such reflexive responses.

Mental health

It is indisputable that some women will experience negative feelings as a result of elective abortion. However, whether this phenomenon is significant enough to warrant a general diagnosis, or even classification as an independent syndrome (see abortion trauma syndrome), is a subject that is debated among members of the medical community. Data on the incidence of clinical depression, mental illness, post-traumatic stress disorder, and suicide in association with abortion remain inconclusive. [http://bmj.bmjjournals.com/cgi/content/abstract/bmj.38623.532384.55v1] A comparative analysis of the suicide rates among postpartum and post-abortive women in Finland found a raw statistical correlation between abortion and suicide. [http://bmj.bmjjournals.com/cgi/content/full/313/7070/1431] Other studies have suggested a link between the elective termination of an unwanted pregnancy and an improvement in reported mental well-being. The majority of evidence would seem to indicate that adverse emotional reactions to the procedure are most strongly influenced by pre-existing psychological conditions and other negative factors. [http://www.apa.org/ppo/issues/womenabortfacts.html] Elective abortion may reduce the occurrence of depression in cases of unwanted pregnancy, as compared to cases in which the pregnancy has been carried to completion, but it is also sometimes reported as an additional stressor. Spontaneous abortion, or miscarriage, presents an increased risk of depression in women. [http://www.medicinenet.com/script/main/art.asp?articlekey=619]

History of abortion

depression The practice of induced abortion, according to some anthropologists, can be traced to ancient times. There is evidence to suggest that, historically, pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. Soranus, a 2nd century Greek physician, suggested in his work Gynaecology that women wishing to abort their pregnancies should engage in violent exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a number of recipes for herbal bathes, pessaries, and bloodletting, but advised against the use of sharp instruments to induce miscarriage due to the risk of organ perforation. [http://www.stoa.org/diotima/anthology/wlgr/wlgr-medicine355.shtml] It is also known that the ancient Greeks relied upon the herb silphium as both a contraceptive and an abortifacient. The plant, as the chief export of Cyrene, was driven to extinction, but it is suggested that it might have possessed the same abortive properties as some of its closest extant relatives in the Apiaceae family. Such folk remedies, however, varied in effectiveness and were not without risk. Tansy and pennyroyal, for example, are two poisonous herbs with serious side effects that have at times been used to terminate pregnancy. 19th-century medicine saw advances in the fields of surgery, anaesthesia, and sanitation, in the same era that doctors with the American Medical Association lobbied for bans on abortion in The United States and the British Parliament passed the Offences Against the Person Act. Demand for the procedure continued, however, as the disguised, but nonetheless open, advertisement of abortion services in Victorian times would seem to suggest. [http://users.telerama.com/~jdehullu/abortion/abhist.htm]

The abortion debate

Throughout the history of abortion, induced abortions have been a source of considerable debate and controversy regarding the morality and legality of this practice. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues have a strong relationship with that individual's value system. A person's position on abortion may be best described as a combination of their personal beliefs on the morality of induced abortion, and that person's beliefs on the ethical scope and responsibility of legitimate governmental and legal authority. Another factor for many individuals is religious doctrine. See religion and abortion for more. Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. Most often those in favor of legal prohibition of abortion describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Both are used to indicate the central principles in arguments for and against abortion: "Is the fetus a human being with a fundamental right to life?" for pro-life advocates, and, for those who are pro-choice, "Should the state or the individual have choice on the matter of abortion?" In both public and private debate, arguments presented in favour of or against abortion focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand.

Public opinion

Political sides have largely been divided into absolutes. The abortion debate, as such, tends to centre around individuals who hold strong positions. However, public opinion varies from poll to poll, country to country, and region to region:
- Australia: In a February 2005 AC Nielsen poll, as reported in the The Age, 56% thought the current abortion laws were "about right," 16% want changes in law to make abortion "more accessible," and 17% want changes to make it "less accessible." [http://www.theage.com.au/news/National/Poll-backs-abortion-laws/2005/02/15/1108230007300.html] A 1998 poll, conducted by Roy Morgan Research, asked, "Do you approve of the termination of unwanted pregnancies through surgical abortion?" 65% of the Australians polled stated that they approved of surgical abortion and 25% stated that they disapproved of it. [http://oldwww.roymorgan.com/polls/1998/3058]
- Ireland: A 1997 Irish Times/MRBI poll of the Republic of Ireland's electorate found that 18% believe that abortion should never be permitted, 35% that one should be allowed in the event that the mother's life is threatened, 18% if her health is at risk, 28% that "an abortion should be provided to those who need it," and 5% were undecided. [http://www.ireland.com/newspaper/front/1997/1211/archive.97121100003.html]
- Canada: A recent poll of Canadians, conducted in April 2005 by Gallup, found that 52% of those polled want abortion laws to "remain the same," 20% want the laws to be "less strict," and 24% would prefer that the laws become "more strict." An earlier Gallup poll, from December 2001, asked, "Do you think abortions should be legal under any circumstances, legal only under certain circumstances or illegal in all circumstances and in what circumstances?" 32% of Canadians responded that they believe abortion should be legal in all circumstance, 52% that it should be legal in certain circumstances, and 14% that it should be legal in no circumstances. See Abortion in Canada.
- The United Kingdom: An online YouGov/Daily Telegraph poll in August 2005 found that 30% of Britons would back a measure to reduce the legal limit for abortion to 20 weeks, 19% support a limit of 12 weeks, 9% support a limit of less than 12 weeks, and 25% support maintaining the current limit of 24 weeks. 6% responded that abortion should never be allowed while 2% said it should be permitted throughout the entirety of pregnancy. [http://www.yougov.com/archives/pdf/TEL050101042_1.pdf]
- The United States: A CNN/USA Today/Gallup poll conducted in November 2005 revealed that 39% believe that abortion should be legal only in "a few circumstances" and another 16% think that it should be legal under "no circumstances", whereas 26% believe it should remain legal in "all circumstances" (the current law under Roe v. Wade) and 16% said it should be legal under "most circumstances". [http://www.cnn.com/2005/US/11/27/abortion.poll] Additional recent U.S. polling data can be found [http://www.pollingreport.com/abortion.htm here.] [http://www.pollingreport.com/abortion.htm]

Abortion law

Roe v. Wade The Soviet Union (1920) and Iceland (1935) were some of the first countries to generally allow abortion. The second half of the twentieth century saw the liberalization of abortion laws in many other countries. In 1973, the U.S. Supreme Court struck down state laws banning abortion, controversially ruling that such laws violated an inferred right to privacy in the U.S. Constitution. The Supreme Court of Canada, similarly, discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under in the Canadian Charter of Rights and Freedoms. Ireland, on the other hand, added an amendment to its Constitution in 1983 by popular referendum, recognizing "the right to life of the unborn." (see Abortion in Ireland). Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. The right to life, the right to liberty, and the right to security of person are major issues of human rights that are sometimes used as justification for the existence or the absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a trimester-based system to regulate the window in which abortion is still legal to perform:
- In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.
- In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially necessitated before it can be performed. Other countries, in which abortion is illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A handful of nations ban abortion entirely, such as Chile, El Salvador, and Malta.

Sources

# Bankole, Akinrinola; Singh, Susheela; Haas, Taylor. "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries." International Family Planning Perspectives, 1998 # Moreau, C. et al, [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15777440&query_hl=8 "Previous induced abortions and the risk of very preterm delivery"], BJOG. 2005; 112(4):430-7 #[http://www.timesonline.co.uk/article/0,,2087-1892696,00.html The Sunday Times (Britain)] November 27, 2005 # [http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/05/15/nabort15.xml http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/05/15/nabort15.xml] # Beral V, Bull D, Doll R, Peto R, Reeves G; Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries. Lancet. 2004 Mar 27;363(9414):1007-16. PMID 15051280 # Ciganda C, Laborde A., [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12807304&query_hl=9 "Herbal infusions used for induced abortion"], J Toxicol Clin Toxicol. 2003; 41(3):235-9 # [http://www.efc.org.uk/Foryoungpeople/Factsaboutabortion/Unsafeabortion Education For Choice] – Unsafe abortion

External links

- [http://www.johnstonsarchive.net/policy/abortion Abortion Statistics and Other Data]
- [http://annualreview.law.harvard.edu/population/abortion/abortionlaws.htm Abortion Laws of the World]
- [http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review] The following links may be biased:
- [http://www.abortion.com/ Abortion.com]
- [http://agi-usa.org/ The Alan Guttmacher Institute]
- [http://www.all.org/ American Life League]
- [http://www.care-net.org/ CareNet]
- [http://justfacts.com/abortion.htm Just Facts: Abortion]
- [http://www.plannedparenthood.com Planned Parenthood] Category:Abortion Category:Abortion by country Category:Obstetrics Category:Issue in the Culture Wars ja:妊娠中絶 simple:Abortion

Medicine

Medicine is a branch of health science concerned with maintaining human health and restoring it by treating disease and injury; it is both an area of knowledge, a science of body systems and diseases and their treatment, and the applied practice of that knowledge. The practice of medical care is shared between the medical profession—physicians or doctors—and other groups of professionals, such as nurses or pharmacists (sometimes called allied health professions). Historically, only members of the medical profession proper have been considered to actually practice medicine in the strictest sense, in contrast to the allied fields of health care professionals. Clinicians can be physicians, nurses, or physician assistants -- those who provide health care or otherwise tend to their patients. The medical profession is the social and occupational structure of the group of people formally trained and authorized to apply medical knowledge. Many countries and legal jurisdictions have legal limitations on who may practice medicine or the allied medical fields. Medicine is typically seen as composed of various specialized sub-branches, such as pediatrics, gynecology, neurology, dealing with particular body systems, diseases, or areas of health. Systems of medical and healthcare practices have existed among human societies since at least the dawn of recorded history. These systems have developed in various ways in different cultures and regions. Medicine as understood in the modern period has historically been considered to be the mainstream tradition which developed in the Western world since the early modern age. Many other traditions of medicine and healthcare are still widely practiced throughout the world, most of which are still considered to be separate and distinct from Western medicine, also called biomedicine or the Hippocratic tradition. The most highly developed systems of medicine outside the Western system are the Ayurvedic tradition of India and traditional Chinese medicine. Various non-mainstream traditions of health care have also developed in the Western world distinct from mainstream medicine. The various other systems practiced among various cultures are sometimes practiced alongside or in cooperation with Western medicine, while sometimes being seen as competing traditions. Medicine is also often used amongst medical professionals as shorthand for Internal Medicine. Veterinary medicine is the practice of health care specialized for other animal species.

History of medicine

Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late 18th and early 19th century in Germany (Rudolf Virchow) and France (Jean-Martin Charcot, Claude Bernard and others). The new, "scientific" medicine replaced earlier Western traditions of medicine, mostly based on the "four humours" and other pre-modern theories. The focal points of development of clinical medicine shifted to the United Kingdom and the USA by the early 1900s (Sir William Osler, Harvey Cushing). Evidence-based medicine is the recent movement to link the practice and the science of medicine more closely through the use of the scientific method and modern information science. Genomics and knowledge of human genetics is already having a large influence on medicine, as the causative genes of most monogenic genetic disorders have now identified, and the development of techniques in molecular biology and genetics are influencing medical practice and decision-making.

Practice of medicine

The practice of medicine combines both science and art. Science and technology are the evidence base for many clinical problems for the general population at large. The art of medicine is the application of this medical knowledge in combination with intuition and clinical judgment to determine the proper diagnoses and treatment plan for this unique patient and to treat the patient accordingly. Central to medicine is the patient-doctor relationship established when a person with a health concern or problem seeks the help of a physician (i.e. the medical encounter). Other health professionals similarly establish a relationship with a patient and may perform interventions from their perspective, e.g. nurses, radiographers and therapists. As part of the medical encounter, the doctor needs to:
- develop a relationship with the patient
- gather data (medical history and physical examination combined with laboratory or imaging studies)
- analyze and synthesize that data (assessment and/or differential diagnosis), and then
- develop a treatment plan (further testing, therapy, watchful observation, referral and follow-up)
- treat the patient accordingly
- assess the progress of treatment and alter the plan as necessary. The medical encounter is documented in a medical record, which is a legal document in many jurisdictions. One method that is used is called the problem-oriented medical record (POMR), which includes a problem list of diagnoses and a "SOAP" method of documentation for each visit:
- S - Subjective, the medical history of the problem from the point-of-view of the patient.
- O - Objective, the physical examination and any laboratory or imaging studies.
- A - Assessment, is the medical decision-making process including the differential diagnoses and most probable diagnoses.
- P - Plan, the way resolve the problem and monitor progress

Medical systems

Medicine is practiced within the medical system of a particular culture or government. Leaving aside tribal cultures, the most significant divide in developed countries is that between universal health care and the market based health care (such as practiced in the U.S.).

Patient-doctor relationship

The doctor-patient relationship and interaction is a central process in the practice of medicine. There are many perspectives from which to understand and describe it. An idealized physician's perspective, such as is taught in medical school, sees the core aspects of the process as the physician learning from the patient his symptoms, concerns and values; in response the physician examines the patient, interprets the symptoms, and formulates a diagnosis to explain the symptoms and their cause to the patient and to propose a treatment. In more detail, the patient presents a set of complaints or concerns about his health to the doctor, who then obtains further information about the patient's symptoms, previous state of health, living conditions, and so forth, and then formulates a diagnosis and enlists the patient's agreement to a treatment plan. Importantly, during this process the doctor educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health. This teaching relationship is the basis of calling the physician doctor, which originally meant "teacher" in Latin. The patient-doctor relationship is additionally complicated by the patient's suffering (patient derives from the Latin patiens, "suffering") and limited ability to relieve it on his own. The doctor's expertise comes from his knowledge about, or experience with, other people who have suffered similar symptoms, and his presumed ability to relieve it with medicines or other therapies about which the patient may initially have little knowledge. The doctor-patient relationship can be analyzed from the perspective of ethical concerns, in terms of how well the goals of non-maleficence, beneficence, autonomy, and justice are achieved. Many other values and ethical issues can be added to these. In different societies, periods, and cultures, different values may be assigned different priorities. For example, in the last 30 years medical care in the Western World has increasingly emphasized patient autonomy in decision making. The relationship and process can also be analyzed in terms of social power relationships (e.g., by Michel Foucault), or economic transactions. Physicians have been accorded gradually higher status and respect over the last century, and they have been entrusted with control of access to prescription medicines as a public health measure. This represents a concentration of power and carries both advantages and disadvantages to particular kinds of patients with particular kinds of conditions. A further twist has occurred in the last 25 years as costs of medical care have risen, and a third party (an insurance company or government agency) now often insists upon a share of decision-making power for a variety of reasons, reducing freedom of choice of both doctors and patients in many ways. The quality of the patient-doctor relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. In some settings, e.g. the hospital ward, the patient-doctor relationship is much more complex, and many other people are involved when somebody is ill: relatives, neighbors, rescue specialists, nurses, technical personnel, social workers and others.

Clinical skills

Main articles: Medical history, Physical examination. A complete medical evaluation includes a medical history, a physical examination, appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain diagnoses, and treatment plan. The components of the medical history are:
- Chief complaint (CC) - the reason for the current medical visit.
- History of present illness (HPI) - the chronological order of events of symptoms. A mnemonic PQRST is sometimes helpful in obtaining the history:
- Provocative-palliative factors - what makes a symptom worse or better.
- Quality - description of the symptom
- Region - which part of the body is affected
- Severity - what is the intensity of the symptom; using a scale of 0-10 (10 worst)
- Timing - what is the course of the symptom
- Current activity - occupation, hobbies, what the patient actually does.
- Medications - what drugs including OTCs, and home remedies, as well as herbal remedies such as St. John's Wort. Allergies are recorded.
- Past medical history (PMH/PMHx) - other medical diagnoses, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
- Review of systems (ROS) - an outline of additional symptoms to ask which may be missed on HPI, generally following the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc).
- Social history (SH) - birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
- Family history (FH) - listing of diseases in the family that may impact the patient. A family tree is sometimes used. The physical examination is the examination of the patient looking for signs of disease. The doctor uses his senses of sight, hearing, touch, and sometimes smell (taste has been made redundant by the availability of modern lab tests). Four chief methods are used: inspection, palpation, percussion, and auscultation; smelling may be useful (e.g. infection, uremia, diabetic ketoacidosis). The clinical examination involves study of:
- Vital signs include height, weight, body temperature, blood pressure, pulse, respiration rate, hemoglobin oxygen saturation
- General appearance of the patient
- Skin
- Head, eye, ear, nose, and throat (HEENT)
- Cardiovascular - heart and blood vessels
- Respiratory - lungs
- Abdomen and rectosigmoid
- Genitalia
- Spine and extremities - musculoskeletal
- Neurological and psychiatric Laboratory and imaging studies results may be obtained, if ncessary. The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem. The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with multi-system problems, with involvement by several specialists. On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

Settings where medical care is delivered

See also clinic, hospital, and hospice Medicine is a diverse field and the provision of medical care is therefore provided in a variety of locations. Primary care medical services are provided by physicians or other health professionals who has first contact with a patient seeking medical treatment or care. These occur in physician's office, clinics, nursing homes, schools, home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sex. Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting. Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc. Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.

Branches of medicine

Working together as an interdisciplinary team, many highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Some examples include: nurses, laboratory scientists, pharmacists, physiotherapists, speech therapists, occupational therapists, dietitians and bioengineers. The scope and sciences underpinning human medicine overlap many other fields. Dentistry and psychology, while separate disciplines from medicine, are sometimes also considered medical fields. Physician assistants, nurse practitioners and midwives treat patients and prescribe medication in many legal jurisdictions. Veterinary medicine applies similar techniques to the care of animals. Medical doctors have many specializations and subspecializations which are listed below.

Basic sciences

- Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures.
- Biochemistry is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
- Biostatistics is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to epidemiology and evidence-based medicine.
- Cytology is the microscopic study of individual cells.
- Embryology is the study of the early development of organisms.
- Epidemiology is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
- Genetics is the study of genes, and their role in biological inheritance.
- Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and immunohistochemistry.
- Immunology is the study of the immune system, which includes the innate and adaptive immune system in human, for example.
- Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
- Neuroscience is a comprehensive term for those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain.
- Nutrition is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for diabetes, cardiovascular diseases, weight and eating disorders, allergies, malnutrition and neoplastic diseases.
- Pathology is the study of disease - the causes, course, progression and resolution thereof.
- Pharmacology is the study of drugs and their actions.
- Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
- Toxicology is the study of hazardous effects of drugs and poisons.

Diagnostic specialties

- Clinical laboratory sciences are the clinical diagnostic services which apply laboratory techniques to diagnosis and management of patients. In the United States these services are supervised by a Pathologist. The personnel that work in these medical laboratory departments are technically trained staff, each of whom usually hold a medical technology degree, who actually perform the tests, assays, and procedures needed for providing the specific services.
- Transfusion medicine is concerned with the transfusion of blood and blood component, including the maintenance of a "blood bank".
- Cellular pathology is concerned with diagnosis using samples from patients taken as tissues and cells using histology and cytology.
- Clinical chemistry is concerned with diagnosis by making biochemical analysis of blood, body fluids and tissues.
- Hematology is concerned with diagnosis by looking at changes in the cellular composition of the blood and bone marrow as well as the coagulation system in the blood.
- Clinical microbiology is concerned with the in vitro diagnosis of diseases caused by bacteria, viruses, fungi, and parasites.
- Clinical immunology is concerned with disorders of the immune system and related body defenses. It also deals with diagnosis of allergy.
- Radiology is concerned with imaging of the human body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography.
- Interventional radiology is concerned with using imaging of the human body, usually from CT, ultrasound, or fluoroscopy, to do biopsies, place certain tubes, and perform intravascular procedures.
- Nuclear Medicine uses radioactive substances for in vivo and in vitro diagnosis using either imaging of the location of radioactive substances placed into a patient, or using in vitro diagnostic tests utilizing radioactive substances.

Clinical disciplines

- Anesthesiology (AE), Anaesthesia (BE), is the clinical discipline concerned with providing anesthesia. Pain medicine is often practiced by specialised anesthesiologists.
- Dermatology is concerned with the skin and its diseases.
- Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
- General practice, Family practice, family medicine or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family doctors are usually able to treat over 90% of all complaints without referring to specialists.
- Hospital medicine is the general medical care of hospitalized patients. Doctors whose primary professional focus is hospital medicine are called hospitalists.
- Internal medicine is concerned with systemic diseases of adults, i.e. those diseases that affect the body as a whole , (restrictive ,current meaning) or with all adult non-operative somatic medicine (traditional , inclusive meaning) , thus excluding pediatrics , surgery , gynaecology & obstetrics and psychiatry. There are several subdisciplines of internal medicine:
- Cardiology is concerned with the heart and cardiovascular system and their diseases.
- Critical care medicine is concerned with the therapy of patients with serious and life-threatening disease or injury. Intensive care medicine employs invasive diagnostic techniques and (temporary) replacement of organ functions by technical means. Also known as Intensive care medicine. This field is often associated with Pulmonology.
- Endocrinology is concerned with the endocrine system, i.e. endocrine glands and hormones, usually Diabetes or Thyroid diseases.
- Gastroenterology is concerned with the alimentary tract.
- Geriatrics is concerned with medical care of the elderly.
- Hematology (or haematology) is concerned with the blood and its diseases.
- Hepatology is concerned with the liver and biliary tract, and is usually a part of Gastroenterology
- Infectious diseases is concerned with the study, diagnosis and treatment of diseases caused by biological agents.
- Nephrology is concerned with diseases of the kidneys.
- Oncology is devoted to the study, diagnosis and treatment of cancer and other malignant diseases, and is often grouped with Hematology.
- Pulmonology (or chest medicine, respiratory medicine or lung medicine) is concerned with diseases of the lungs and the respiratory system.
- Rheumatology is devoted to the diagnosis and treatment of inflammatory diseases of the joints and other organ systems, such as arthritis.
- Neurology is concerned with the diagnosis and treatment of nervous system diseases.
- Obstetrics and Gynecology (often abbreviated as Ob/Gyn) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists.
- Palliative care is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal diseases (cancer, heart failure).
- Pediatrics (or paediatrics) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialities for specific age ranges, organ systems, disease classes and sites of care delivery. Most subspecialities of adult medicine have a pediatric equivalent such as pediatric cardiology, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, and pediatric oncology, pediatric ophthalmology, and neonatology.
- Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital abnormality.
- Preventive medicine is the branch of medicine concerned with preventing disease.
- Community health care or public health is an aspect of health services concerned with threats to the overall health of a community based on population health analysis.
- Occupational medicines principal role is the provision of health advice to organisations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained.
- Psychiatry is a branch of medicine that studies and treats mental disorders. Related non-medical fields are psychotherapy and clinical psychology. There are several subdisciplines of Psychiatry:
- Child & adolescent psychiatry focuses on the care of children and adolescents with mental/emotional/learning problems (i.e., ADHD, Autism, family conflicts).
- Geriatric psychiatry focuses on the care of elderly people with mental illnesses (i.e., dementias, post stroke cognitive changes, depression).
- Addiction psychiatry focuses on substance abuse and its treatment.
- Forensic psychiatry focuses on the interface of psychiatry and the Law.
- Radiation therapy is concerned with the therapeutic use of ionizing radiation and high energy elementary particle beams in patient treatment.
- Surgical specialties - there are many medical disciplines that employ operative treatment. Some of these are highly specialized and are often not considered subdisciplines of surgery, although their naming might suggest so.
- General surgery is traditionally defined as the specialty of surgery of the skin, endocrine glands, and abdomen (and, sometimes, the mammary glands). In some countries, it is still deemed a pre-requisite training prior to progression to training in certain sub-specialties, but lately has evolved into its own sub-specialty.
- Cardiovascular surgery is the surgical specialty that is concerned with the heart and major blood vessels of the chest.
- Neurosurgery is concerned with the operative treatment of diseases of the nervous system.
- Maxillofacial surgery (technically a subspeciality of dentistry)
- Ophthalmology deals with the diseases of the eyes and their treatment.
- Orthopedic surgery consists on surgery of the locomotor system.
- Otolaryngology (or otorhinolaryngology or ENT/ear-nose-throat) is concerned with treatment of ear, nose and throat disorders. The term head and neck surgery defines a closely related specialty which is concerned mainly with the surgical management of cancer of the same anatomical structures.
- Pediatric surgery treats a wide variety of thoracic and abdominal (and sometimes urologic) diseases of childhood.
- Plastic surgery includes aesthetic surgery (operations that are done for other than medical purposes) as well as reconstructive surgery (operations to restore function and/or appearance after traumatic or operative mutilation).
- Surgical oncology is concerned with curative and palliative surgical approaches to cancer treatment.
- Urology focuses on the urinary tracts of males and females, and on the male reproductive system. It is often practiced together with andrology ("men's health").
- Vascular surgery is surgery of "peripheral" blood vessels, i.e. those outside of the chest (usually operated on by cardiovascular surgeons) and of the central nervous system (treated by neurosurgery).
- Urgent Care focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department.
Interdisciplinary fields
Interdisciplinary sub-specialties of medicine are:
- Aerospace medicine deals with medical problems related to flying and space travel.
- Bioethics is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology.
- Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
- Conservation medicine studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine, environmental medicine, or medical geology.
- Diving medicine (or hyperbaric medicine) is the prevention and treatment of diving-related problems.
- Evolutionary medicine is a perspective on medicine derived through applying evolutionary theory.
- Forensic medicine deals with medical questions in legal context, such as determination of the time and cause of death.
- Medical humanities includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.
- Medical informatics and medical computer science are relatively recent fields that deal with the application of computers and information technology to medicine.
- Nosology is the classification of diseases for various purposes.
- Sports medicine deals with the treatment and preventive care of athletics, amateur and professional. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.
- Therapeutics is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health [http://2.1911encyclopedia.org/T/TH/THERAPEUTICS.htm] [http://www.britannica.com/eb/article-9106176?query=Therapeutics&ct=].
- Travel medicine or emporiatrics deals with health problems of international travelers or travelers across highly different evironments.
Medical education
See also Medical doctor (BE), Physician (AE), and Medical school. Medical training involves several years of university study followed by several more years of residential practice at a hospital. Entry to a medical degree in some countries (such as the United States) requires the completion of another degree first, while in other countries (such as the United Kingdom, Australia and New Zealand) medical training can be commenced as an undergraduate degree immediately after secondary education. The name of the medical degree gained at the end varies: some countries (e.g. the US) call it "Doctor of Medicine" (abbreviated 'M.D.'), while other countries (mostly following the British Oxbridge system) call it "Medicinæ Baccalaureus & Baccalaureus Chirurgiæ" (Latin for "Bachelor of Medicine/Bachelor of Surgery", Old English: "Chirurgie"); this is technically a double degree, frequently abbreviated 'MB BChir', 'MB ChB', 'MB BS' (or variations thereof), dependent on the medical school. In either case, graduates of a medical degree may call themselves physician. In the US and some other countries there is a parallel system of medicine which is equal in all aspects of education, legality, and practice to M.D.'s. It is called osteopathic medicine (generic term: "osteopathy") which awards the degree of "Doctor of Osteopathic Medicine" (abbreviated 'D.O.'). In many countries, a doctorate of medicine does not involve original research as does, in distinction, a Ph.D.. Once graduated from medical school most physicians (both M.D.'s and D.O.'s) begin their residency/house post training, where skills in a speciality of medicine are learned, supervised by more experienced doctors. The first year of residency is known as the "intern" year (USA) or "junior/pre-registration house officer" year (UK). The duration of residency training depends on the speciality. A medical graduate can then enter general practice and become a general practitioner (or primary care internist in the USA); training for these is generally shorter, while specialist training is typically longer. Medical education is a never ending endeavor. In addition to continually reading relevant medical journals, physicians require a number of continuing medical education (CME)credits annually to be recertified. These can be acquired by attending conferences, lectures, online, and through other sources.
Medical devices
See also the main articles: implant, artificial limbs, corrective lenses, cochlear implants, ocular prosthetics, facial prosthetics, somato prosthetics, surgical prosthetics, maxillo-facial prosthetics and dental implants Medical devices are devices used by health professionals as tools in diagnosis, treatment, or other aspects of patient care.
Legal restrictions
In most countries, it is a legal requirement for medical doctors to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to doctors that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against charlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health and healing, such as alternative medicine or faith healing.
Criticism
Criticism of medicine has a long history. In the Middle Ages, it was not considered a profession suitable for Christians, as disease was considered Godsent, and interfering with the process a form of blasphemy. Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as a speciality of medicine, rather than an accessory field. Through the course of the twentieth century, doctors focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. The ensuing development of a more mechanistic, detached practice, with the perception of an attendent loss of patient-focused care led to further criticisms. This issue started to reach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980s and 1990s. Perhaps the most devastating criticism of modern medicine came from Ivan Illich, in his 1976 work Medical Nemesis. In his view, modern medicine only medicalises disease, causing loss of health and wellness, while generally failing to restore health by eliminating disease. The human being thus becomes a lifelong patient. Other less radical philosophers have voiced similar views, but none were as virulent as Illich. (Another example can be found in Technopoly: The Surrender of Culture to Technology by Neil Postman, 1992, which criticises overreliance on technological means in medicine.) Criticism of modern medicine has led to some improvements in the curricula of medical schools, which now teach students systematically on medical ethics, holistic approaches to medicine, the biopsychosocial model and similar concepts. The inability of modern medicine to properly address many common complaints continues to prompt many people to seek support from alternative medicine. Although most alternative approaches lack scientific validation, some report improvement of symptoms after obtaining alternative therapies. The bioscience medical paradigm and the alternative / complementary healthcare paradigms may differ to such an extent that what constitutes scientific evidence is contested. Many medical doctors also practice alternative medicine alongside the orthodox. Medical errors are also the focus of many complaints and negative coverage. Practitioners of human factors engineering believe that there is much that medicine may usefully gain by emulating concepts in aviation safety, where it was long ago realized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make errors. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. Radical critics of certain medical traditions may hold that whole fields or traditions of medicine are intrinsically harmful or ineffective. They would reject any use or support of practices belonging to that tradition. However, generally, there is spectrum of efficacy on which all traditions lie; some are more effective, some are less effective, but nearly all contain some harmful practices and some effective ones. Naturally, though, most individuals or groups seeking a healthcare practice to improve their own health would seek a tradition with the maximum degree of efficacy.
See also

- Academic conference
- Big killers
- Complementary and alternative medicine
- Health profession
- Healthcare system
- Iatrogenesis (ill health caused by medical treatment)
- List of diseases
- List of medical abbreviations
- List of medical schools
- Important publications in medicine
- Medical equipment
- Rare diseases
External links

- [http://home.planet.nl/~hend2438/MOTW/index.htm Medicine on the Web]
- [http://www.nlm.nih.gov NLM] (National Library of Medicine, contains resources for patients and healthcare professionals)
- [http://www.vh.org Virtual Hospital] (digital health sciences library by the University of Iowa)
- [http://cancerweb.ncl.ac.uk/omd/index.html Online Medical Information]- medical news, links and resources.
- [http://www.medmark.org Online Medical Directory]
- [http://www.wikimd.org/index.php?title=Free_Medical_Resources Collection of links to free medical resources] fiu-vro:Arstitiidüs als:Medizin zh-min-nan:I-ha̍k ko:의학 ja:医学 simple:Medicine th:แพทยศาสตร์

Loaded term

: Loaded language

Pejorative

A word or phrase is a pejorative (occasionally misspelled perjorative) if it expresses contempt or disapproval. The adjective pejorative is synonymous with derogatory and dyslogistic (noun: dyslogism) (antonyms: meliorative, eulogistic, noun eulogism). Dyslogisms such as "pea-brain" and "bottom-feeder" are words and phrases essentially pejorative by their nature. Although pejorative (adj.) means much the same thing as disparaging, the latter term may be applied to a look or gesture as well as to spoken language— in the evocative languages of gesture, it is not easy to distinguish a disparaging gesture from a dismissive or merely skeptical one, however. Pejorative expressions that are not dyslogisms may also be used in a non-pejorative way, however, and determining the intent of the speaker is problematic— as with any implied meaning. Conversely, a common rhetorical ploy is to apply "pejorative" to a factual descriptor— as "toxic" might be applied to poison— and then decry it as "pejorative" to suit the agenda of those defending the substance as harmless. Not every breath of criticism is pejorative: a "petty distinction" is indeed a petty distinction: in that case, the defender must demonstrate the authenticity and seriousness of the distinction, which may then be simply recognized as dismissive rather than pejorative. Sometimes a term may begin as a pejorative word and eventually be adopted in a non-pejorative sense. This happened with the terms Quaker, Yankee and Ham radio operator, which were originally slang insults which came to be worn with pride. In other cases, some groups have attempted to reclaim formerly offensive words applied against them, with limited success: when usage of a term like nigger, redneck, "white cracker", dyke, queer, faggot, tranny, pervert, Kraut, geek, chav or cripple by someone outside the group is still considered offensive, that is a sign this process of neutralization is incomplete. British English also incorporates many British regional slurs Conversely, a neutral (non-pejorative) term may grow to become pejorative: the term retard, to refer to a person whose mental capacity is permanently held back from development, was originally used as a euphemism, as had been moron before, itself a euphemism for idiot, in order to avoid true dyslogisms like feebleminded, and half-witted. But it quickly grew to have a pejorative sense of its own. Another example is the use of the word cripple being replaced by handicapped. Both of these are considered pejorative with the term "physically challenged" as the current euphemism. This same progression, from neutral to pejorative, may be happening with the words challenged and special, used in the same sense, today. Language writer Steven Pinker has called this process "the euphemism treadmill." Since meanings change over time, an up-to-date dictionary should be consulted for information on specific words.

Etymology

Unrelated to perjury, pejorative comes from the Latin pejoratus, "made worse," and made a surprisingly late entry in written English, 1882, probably deriving from a contemporary French usage, péjoratif. [http://www.etymonline.com/index.php?l=p&p=8]. It is so frequently misspelled as perjorative that the Oxford English Dictionary [http://www.askoxford.com/ website] contains a FAQ [http://www.askoxford.com/asktheexperts/faq/aboutspelling/perjorative entry] about this misspelling.

Oxford English Dictionary

The Oxford English Dictionary (OED) is a comprehensive dictionary published by the Oxford University Press (OUP). Often regarded as the definitive dictionary of the English language, it includes about 301,100 main entries, as of November 30, 2005, comprising over 350 million printed characters. In addition to the headwords of main entries, the OED contains 157,000 combinations and derivatives in bold type, and 169,000 phrases and combinations in bold italic type, making a total of 616,500 word-forms. There are 137,000 pronunciations, 249,300 etymologies, 577,000 cross-references, and 2,412,400 illustrative quotations. The policy of OED is to attempt to record all known uses and variants of a word in all varieties of English, worldwide, past and present. To quote the 1933 Preface: :The aim of this Dictionary is to present in alphabetical series the words that have formed the English vocabulary from the time of the earliest records down to the present day, with all the relevant facts concerning their form, sense-history, pronunciation, and etymology. It embraces not only the standard language of literature and conversation, whether current at the moment, or obsolete, or archaic, but also the main technical vocabulary, and a large measure of dialectal usage and slang. The OED is the starting point for much scholarly work regarding words in English. Its choice of the order in which to list variant spellings of headwords is influential on written English in many countries.

Origins

The dictionary had no university connection originally; it was conceived in London as a project of the Philological Society, when Richard Chenevix Trench, Herbert Coleridge, and Frederick Furnivall had become dissatisfied with the available dictionaries of English. In June 1857 they formed an "Unregistered Words Committee" with the goal of finding words not listed and defined in existing dictionaries. But the report that Trench presented that November was not a simple list of unregistered words; it was a study On Some Deficiencies in our English Dictionaries. These, he said, were sevenfold:
- Incomplete coverage of obsolete words
- Inconsistent coverage of families of related words
- Incorrect dates for earliest use of words
- History of obsolete senses of words often omitted
- Inadequate distinction between synonyms
- Insufficient use of good illustrative quotations
- Space wasted on inappropriate or redundant content Trench suggested that nothing short of a new and truly comprehensive dictionary would do: one that would be based on contributions from a large number of volunteer readers, who would read books, copy out passages illustrating various actual uses of words onto quotation slips, and mail them to the editor. In 1858 the Society agreed in principle to the project: A New English Dictionary on Historical Principles (NED).

The first editors

Trench played a key role in the first months of the project, but his ecclesiastical career meant that he could not give the dictionary the continued attention that it needed over a period that, it was realized, might easily be as long as ten years. So Trench withdrew, and it was Herbert Coleridge who became the dictionary's first editor. On May 12, 1860, Coleridge's plan for the work was published, and the research was set in motion. His home became the first editorial office; he ordered a grid of 54 pigeon-holes in which could eventually be arrayed 100,000 quotation slips. In April 1861, the first sample pages of the dictionary were published... and then Coleridge, aged just 31, died of tuberculosis. The editorship then fell to Furnivall, who had great enthusiasm and knowledge, but definitely lacked the temperament for such a long-term project. His energetic start saw many assistants recruited and two tons of readers' slips and other materials delivered to his house, and in many cases passed on to these assistants. But as months and years passed, the project languished. Furnivall began to lose track of his assistants, some of whom assumed that the project was abandoned; others died and their slips were not returned. The entire set of quotation slips for words starting with H was later found in Tuscany; others were assumed to be waste paper and burned as tinder. In the 1870s Furnivall approached Henry Sweet and Henry Nicol to succeed him, but neither one accepted the post. But then, at a Society meeting in 1876, James Murray declared his willingness to try.

The Oxford editors

At the same time the Society had become concerned about the publication of what it was now clear would have to be an immensely large book. Various publishers had been approached over the years, either to produce sample pages or for the possible publication of the whole, but no agreements had been reached. These had included both the Cambridge and the Oxford University Press (OUP). Finally in 1879, after two years of negotiations involving Sweet and Furnivall as well as Murray, the Oxford University Press agreed not only to publish the dictionary, but also to pay Murray (who by this time was also president of the Philological Society) a salary as editor. They hoped that the work would now be completed in another ten years. It was Murray who really got the project off the ground and was able to tackle its true scale. Because he had many children, he chose not to use his house (in the London suburb of Mill Hill) itself as a workplace; a kit-form iron outbuilding, lined with deal, which he called the "Scriptorium", was erected for him and his assistants. It was provided with 1,029 pigeon-holes and many bookshelves. Murray now tracked down and regathered the slips already collected by Furnivall, but he found them inadequate because readers had focused on rare and interesting words: he had ten times more quotations for abusion than for abuse. He therefore issued a new appeal for readers, which was widely published in newspapers and distributed in bookstores and libraries. This time readers were specifically asked to report "as many quotations as you can for ordinary words" as well as all of those that seemed "rare, obsolete, old-fashioned, new, peculiar or used in a peculiar way." Murray arranged for the Pennsylvanian philologist, Francis March, to manage the process in North America. Soon 1,000 slips per day were arriving at the Scriptorium, and by 1882 there were 3,500,000 of them. It was February 1, 1884, 23 years after Coleridge's sample pages, when the first portion, or fascicle, of the actual dictionary was finally published. The full title had now become A New English Dictionary on Historical Principles; Founded Mainly on the Materials Collected by The Philological Society, and the 352 pages, covering words from A to Ant, were priced at 12s.6d. in Britain (today this fraction of a pound would be written 62.5p) or $3.25 US. The total sales were a disappointing 4,000 copies. It was now clear to OUP that it would take much too long to complete the work if the editorial arrangements were not revised. Accordingly they supplied additional funding for assistants, but made two new demands on Murray in return. The first was that he move from Mill Hill to Oxford, which he did in 1885. Again he had a Scriptorium built on his property (to appease a neighbour, this one had to be half-buried in the ground), and the Oxford post office paid his work the compliment of installing a new pillar box (mailbox) directly in front of his house. Murray was more resistant to the second requirement: that if he could not mee

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