This article presents evidence supporting the claim that ethical reasoning is a skill that can be taught and assessed. We propose a working definition of ethical reasoning as 1) the ability to identify, analyze, and weigh moral aspects of a particular situation, and 2) to make decisions that are informed and warranted by the moral investigation. The evidence consists of a description of an ethical reasoning education program—Ethical Reasoning in Action —designed to increase ethical reasoning skills in a variety of (...) situations and areas of life. ERiA is housed at a public, major comprehensive U.S. university—James Madison University—and assessment of the program focuses on interventions delivered prior to and during orientation for incoming first-year students. Findings indicate that the interventions measurably enhance the ability of undergraduate students to reason ethically. ERiA’s competency-targeted program and positive student learning outcomes offers a promising model for higher education ethics programs seeking to connect classroom learning in ethics to decision-making in everyday life. (shrink)

From the stance of cognitive developmental theories, claims that general g is an entity of the mind are compatible with notions about domain-general development and age-invariant individual differences. Whether executive function is equated with general g or fluid g, research into the mechanisms by which development occurs is essential to elucidate the kinds of environmental inputs that engender effective intervention. (Published Online April 5 2006).

Early intervention aims to identify children or families at risk of poor health, and take preventative measures at an early stage, when intervention is more likely to succeed. EI is concerned with the just distribution of “life chances,” so that all children are given fair opportunity to realize their potential and lead a good life; EI policy design, therefore, invokes ethical questions about the balance of responsibilities between the state, society, and individuals in addressing inequalities. We (...) analyze a corpus of EI policy guidance to investigate explicit and implicit ethical arguments about who should be held morally responsible for safeguarding child health and well-being. We examine the implications of these claims and explore what it would mean to put the proposed policies into practice. We conclude with some remarks about the useful role that philosophical analysis can play in EI policy development. (shrink)

ZusammenfassungIn der Medizinethik sind der Respekt vor der Patientenselbstbestimmung, das Nichtschadensgebot, das Handeln zum Wohl des Kranken und das Gerechtigkeitsgebot praxisrelevante Prinzipien. Anhand des Beispiels der Frühintervention und Akutbehandlung schizophrener Störungen wird aufgezeigt, dass es in der psychiatrischen Praxis zu einer Kollision dieser Prinzipien kommen kann. Der frühe Krankheitsbeginn und der häufig chronische Verlauf schizophrener Störungen führen zu großem Leid der Betroffenen und ihrer Angehörigen sowie zur ökonomischen Belastung der Solidargemeinschaft. Die negativen Folgen einer verzögerten Intervention stehen den Risiken (...) der Stigmatisierung sowie den möglichen Nebenwirkungen durch die psychotherapeutische oder psychopharmakologische Behandlung gegenüber. Es wird für eine an der konkreten Situation orientierte, lebensnahe und dynamische Ethik plädiert, die vom konkreten Fall aus diskutiert und verschiedene Perspektiven berücksichtigt – mit dem Ziel von einer Arztethik und Patientenethik zu einer Verantwortungspartnerschaft zu gelangen. (shrink)

Over the last century, Alzheimer’s disease has proven a highly malleable concept. Initially an obscure diagnosis pertaining to rare cases of young onset dementia, by the latter half of the 20th cen...

In his stimulating article on this topic Mr. Christopher Ehrhardt sought to show that there is no good reason to believe in any intervention by Philip of Macedon in Thessaly earlier than his campaign of 353. The second half of his paper is devoted to the date of Philip's capture of Pagasae, which Diodorus appears to put in the Athenian archon year 354/3 after the fall of Methone, a date adopted by most modern interpreters accepting the emendation for the (...) unidentifiable in the text of Diodorus. Ehrhardt shows well the difficulties of believing in any capture of Pagasae, the port of Pherae, earlier than the capture of Pherae itself, and concludes that the emendation is to be rejected. In this I think he is right, and I am joining him in dating the capture of Pagasae in 352 after Pherae itself had fallen. The first half of his paper, however, rejecting all the evidence suggesting other interventions by Philip in Thessaly earlier than 353, is much harder to accept, for two reasons. (shrink)

Alzheimer’s disease (AD) in its most common form results in cognitive changes in memory function leading to dementia due to underlying neurodegenerative disease. Recent research advancements in AD...

Early intervention comes in-between the lives of children, families and teachers. This article uses part of a report written by an educational psychologist about a little girl to question the nature of intervention through Rancière’s writings. As children and parents are seen as put into the position of inadequacy, they require such intervention, which in turn makes them more inadequate. The article goes on to highlight the numerous ‘givings’ involved in early intervention, through Derrida’s (...) writing. However, such giving is questioned as creating expectations that receivers of the gift must fulfil, thus nullifying the gift. The conclusion suggests that starting from a perspective of equality and acknowledging the aporia involved could help the people in this scenario to take a different approach. (shrink)

Early intervention is developed following different types of service organization, which in turn require different professional and family roles. The aim of this study was to compare the perceived satisfaction and family quality of life amongst families receiving early intervention developed at centers in comparison to those receiving the routines-based early intervention in families’ homes, that is a family centered intervention in ecological environments. Under a transformative paradigm, a mixed methods design was used, (...) using the Consumer Report Effectiveness Scale (CRES-4) and the Beach Center Family Quality of Life Scale (FQOLS) and two focus groups as data collection instruments. The sample comprised 166 parents in the quantitative phase and 16 parents in the qualitative phase. Results showed that families receiving routines-based early intervention had greater satisfaction with the service although both groups showed similar scores for family quality of life in most of the analyzed domains. Three dimensions were identified throughout the qualitative phase: problem solving, professional team and service organization. Both the models analyzed have an impact on family quality of life and parents are in general satisfied. Strengths and weaknesses were found related to the problem-solving process, the role of the professional team, family empowerment and the service’s organization. The areas requiring further development are the effective training of professionals focused on family practices, the exchange of information with the family and a more participatory organization that takes parent’s perspectives into consideration. The value given to a combined model is another aspect highlighted in this study, as well as the need for a more agile assessment period to avoid unnecessary delays. (shrink)

The growth of autistic self-advocacy and the neurodiversity movement has brought about new ethical, theoretical and ideological debates within autism theory, research and practice. These debates have had genuine impact within some areas of autism research but their influence is less evident within early intervention research. In this paper, we argue that all autism intervention stakeholders need to understand and actively engage with the views of autistic people and with neurodiversity as a concept and movement. In so (...) doing, intervention researchers and practitioners are required to move away from a normative agenda and pay diligence to environmental goodness-of-fit, autistic developmental trajectories, internal drivers and experiences, and autistic prioritized intervention targets. Autism intervention researchers must respond to these debates by reframing effectiveness, developing tools to measure autistic prioritized outcomes, and forming partnerships with autistic people. There is a pressing need for increased reflection and articulation around how intervention practices align with a neurodiversity framework and greater emphasis within intervention programmes on natural developmental processes, coping strategies, autonomy, and well-being. (shrink)

Research on individuals at clinical high risk for psychological and physical disorders has grown exponentially in recent years, with a variety of new screening tools and early intervention techniques being implemented. One recent example is Attenuated Psychosis Syndrome, a diagnosis for individuals who are at clinical high risk for psychosis, which was recently included in Section III of the Diagnostic and Statistical Manual of Mental Disorders. Given the focus on prevention at early stages, at-risk individuals will continue (...) to be a topic of significance not only in psychosis research but also in other illnesses. This document provides a comprehensive summary of the ethical dilemmas that clinicians or researchers may encounter in this domain, and possible actions consistent with the current Canadian Code of Ethics for Psychologists. We use clinical high risk for psychosis and the Canadian Code of Ethics for Psychologists as a way to illuminate these ethical issues; however, application to other jurisdictions and disciplines, as well as other high-risk populations, is also of relevance. (shrink)

Researchers have found that philosophy’s gender gap gradually increases as students progress from first year, to majoring and into graduate school. By analysing enrolments in philosophy units at Australian universities from 2005 to 2017, I argue that early interventions are likely to be more effective than typically assumed. My findings are consistent with previous data, but improve on previous analyses in a few ways. First, this paper quantifies women’s risk of leaving philosophy relative to men at each point throughout (...) their studies, and confirms women’s relative risk of leaving philosophy is much higher than men’s throughout all of their undergraduate studies. Second, this paper shows there is a large pool of women who leave philosophy after taking only one unit, and argues studies or interventions which focus on students closer to graduating may miss this group of women. Third, this paper argues interventions aimed at this group of women could be more effective at reducing our discipline’s gender gap than later interventions, because a much lower rate of uptake is needed. Trials aimed at identifying effective interventions may also be easier to conduct than we typically assume. I also identify four kinds of interventions that are worth trying, based on evidence from studies on gender gaps in STEM fields. These include having more role models for female students, exposing girls to philosophy from a younger age, boosting female students’ sense of belonging, and expanding the scope of careers that we market to students as possible with a philosophy major. (shrink)

Constructions of normality and abnormality in discussions of young people changed considerably in the early to mid-twentieth century in many parts of the world, including Australia. The perennial trope of youth as a threat assumed a distinctly new form in this era, as the troubled and troublesome child, the incipient and confirmed delinquent, was reconfigured through emerging knowledges of the human sciences. Exploring the effects of new concerns with the ‘normal’, this article begins by examining the construct of normalcy (...) and its interdependency with notions of the ‘abnormal’, particularly juvenile delinquency, as the antithesis of personal and social adjustment. Yet the discursive strategies that saw delinquency, at one level, recognized as a complex and multi-causal problem also construed it as amenable to clinical solutions, notably psychological intervention. The article explores how emergent ideas of the importance of early intervention created divisions between three groups of youthful populations: the ‘normal child’ deemed well adjusted, the ‘problem child’ thought to be responsive to adjustive measures, and the ‘confirmed delinquent’, whose behaviour was considered intractable and was thus unlikely to attain the socially desired status of normalcy. (shrink)

Background: The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. Method: Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP. Results: The median DUP (...) across the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015). Conclusion: These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services. (shrink)

The aim of the research is to investigate the effect of eye movement desensitization and reprocessing therapy on post-traumatic stress disorder levels of individuals who can be defined as high-risk groups during the pandemic. Therefore, the online EMDR R-TEP Protocol was applied to a total of 154 individuals working with coronavirus patients, frontline professionals, relatives of coronavirus patients, coronavirus patients, and relatives of someone who died from coronavirus and the PTSD symptom level before, after, and 1 month after therapy was (...) measured and examined. A personal information form and impact of events scale were used to collect data. Analyses showed that EMDR therapy was effective in reducing the PTSD level in all groups. The PTSD levels of frontline professionals continued to decrease until the follow-up test but remained the same in the other groups. (shrink)

Background. In some organisations, traumatic events via direct or indirect exposure are routine experiences. A NICE review (2005; updated in December 2018) of Post-Traumatic Stress Disorder (PTSD) management in primary and secondary care did not address early interventions for trauma in emergency response organisations. Aims. This scoping review was designed to identify previous research which evaluated the use of early interventions following exposure to primary or secondary trauma, to report on the effectiveness of early interventions models. Method. (...) A scoping review was conducted to examine early interventions for trauma with staff in roles potentially exposed to trauma including: emergency response, military and humanitarian aid. Relevant data was extracted from included studies and outcomes were assessed using meta-ethnography. Results. Fifty studies of mixed quality met the inclusion criteria for this review. Synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they: are delivered in a manner that respects distinct organisational culture; are supported by organisations and senior management, and; harness existing social cohesion and peer support systems within teams. Conclusions. This review demonstrates that early interventions support emergency responders following exposure to trauma when: tailored to the needs of the population, are supported by the host organisation, and harness existing social cohesion and peer support processes within a team or unit. We identify a number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organisations. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its (...) purpose. Intervention participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Many scholars view Confucianism as relatively open to war, as a legitimate tool for maintaining order and rescuing oppressed peoples. Indeed, it is not uncommon for statements such as the following to be presented as though they were straightforward matters of fact: “Confucians would approve the use of force by one state against another state for the protection against abusive rule in the latter if properly carried out”.1 Such claims find support in the work of Daniel A. Bell, Tongdong Bai, (...) and Yan Xuetong. Both Bell and Bai are explicit in their view that Confucians ought to support some humanitarian interventions. Bai writes, “When it is humane and strong, a state... (shrink)

The possibility of early diagnosis and intervention is radically changed by the advent of genetic testing. The recent report of the Nuffield Council on Bioethics is timely and helpful. I have suggested, that not only the severity of the disability indicated by genetic information, and the accuracy of the data, ought to govern the approach to the implementation of screening for genetic disorders. In addition, assessment of the value of the information to those involved should be considered. The (...) efficacy of the available therapeutic measures, combined with the prognostic data are important indices of the value of the information. These measures fall into three categories and thus indicate that three different courses of intervention may be appropriate. Three approaches to diagnosis and intervention are then outlined, drawing on the experience of various clinical initiatives. (shrink)

Early adversity and trauma can have profound effects on children’s affective development and mental health outcomes. Interventions that improve mental health and socioemotional development are essential to mitigate these effects. We conducted a pilot study examining whether a reading-based program improves emotion recognition and mental health through socialization in Syrian refugee and Jordanian non-refugee children aged 7–12 years old living in Jordan. To measure emotion recognition, children classified the expression in faces morphed between two emotions, while mental health was (...) assessed using survey measures of optimism, depression, anxiety, distress, and insecurity. Prior to the intervention, both groups of children were significantly biased to interpret ambiguous facial expressions as sad, while there was no clear bias on the fear–anger spectrum. Following the intervention, we found changes in Syrian refugee children’s bias in emotion recognition away from sad facial expressions, although this returned to pre-intervention levels 2 months after the end of the program. This shift in the bias away from sad facial expressions was not associated with changes in self-reported mental health symptoms. These results suggest a potential positive role of the reading intervention on affective development, but further research is required to determine the longer-term impacts of the program. (shrink)

BackgroundIndividuals with early phase cognitive impairment are frequently affected by existential distress, social avoidance and associated health issues. The demand for efficient psychological support is crucial from both an individual and a societal perspective. We have developed a novel psychological intervention manual for providing a non-medical path to enhanced psychological health in the cognitively impaired population. The current article provides specific information on the randomized controlled trial -design and methods. The main hypothesis is that participants receiving PIPCI will (...) increase their psychological flexibility compared to participants in the active control group and the waiting list control group. The secondary hypotheses are that participants receiving PIPCI will improve psychological health compared to participants in the active control group and the waiting list control group.Materials and MethodsThis three-arm RCT will recruit participants from the cognitive centers at Karolinska University Hospital in Stockholm and randomize approximately 120 individuals in the early phase of cognitive impairment to either an experimental group, an active control group or a waiting list control group. Intervention outcome will be evaluated with self-report questionnaires on physical and psychological aspects of health, cognitive assessment, biological markers and health care costs. Assessments will be performed at pre- and post-intervention, as well as at a 6-month follow-up.DiscussionThe development of a potentially feasible and effective psychological intervention tailored for early phase cognitive impairment has the potential to advance the non-pharmacological intervention field. This is especially important given the extensive burden for many affected individuals and their families and the current lack of effective treatments. If the psychological intervention discussed here shows feasibility and efficacy, there is potential for far-reaching healthcare implications for patients with early cognitive impairment at risk of developing dementia.Clinical Trial RegistrationClinicalTrials.gov: NCT04356924. Date of registration: April 22, 2020. URL: https://clinicaltrials.gov/ct2/show/NCT04356924. (shrink)

Caring for unrepresented patients encompasses legal, ethical, and moral challenges regarding decision-making, consent, the patient’s values, wishes, best interest, and the healthcare team’s professional integrity and autonomy. In this article, I consider the impact of the aging population and the effects of the social determinants of health and suggest that without preventive intervention, the number of unrepresented patients will continue to increase. The health, social, and legal risk factors for becoming unrepresented require a multidisciplinary response. Medical-Legal Partnerships (MLPs) bring (...) healthcare and legal professionals together to address risk factors and health-harming legal needs. The article discusses the role of MLPs in identifying at-risk individuals, providing preventive interventions, and providing support. I make recommendations and conclude that proactive MLPs offer a sustainable approach to the ethical challenges in caring for unrepresented patients by providing interventions to prevent individuals from becoming unrepresented. (shrink)

After the end of the Cold War, many in the West viewed Africa as a testing ground for the solidarist argument that sovereignty was no longer an absolute principle and that the international community could intervene to protect individual from human rights violations. This argument seems particularly challenging in the African context, given the continental leadership’s historic commitment to territorial integrity and non-intervention. However, as the author shows, African leaders from 1945 to 1990 were largely upholding the pluralist international (...) norms of the time. In other words, the case for humanitarian intervention – and the problems posed by the practice – are not region-specific. The early 1990s, during which the United Nations intervened in Somalia, seemed to confirm the solidarist position. However, the failure to intervene in Rwanda in 1994, and the more recent experience of interventions in Sierra Leone, present a more mixed picture. Humanitarian intervention remains a controversial practice because of its coercive means, and its tendency to attribute blame or responsibility in what are often very complex civil conflicts. (shrink)