Once common, therapeutic privilege—the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient—is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population. There are no data in this work.

Previous research has established that the success of strikes, and social movements more broadly, depends on their ability to garner support from the public. However, there is scant published research investigating the response of the public to strike action by healthcare workers. In this study, we address this gap through a study of public responses to UK nursing strikes in 2022–2023, using a data set drawn from Twitter of more than 2300 publicly available tweets. We focus on negative tweets, investigating (...) which societal discourses social media users draw on to oppose strike action by nurses. Using a combination of corpus‐based approaches and discourse analysis, we identified five categories of opposition: (i) discourse discrediting nurses; (ii) discourse discrediting strikes by nurses; (iii) discourse on the National Health System; (iv) discourse about the fairness of strikers' demands and (v) discourse about potential harmful impact. Our findings show how social media users operationalise wider societal discourses about the nursing profession (e.g., associations with care, gender, vocation and sacrifice) as well as recent crises such as the Covid‐19 pandemic to justify their opposition. The results also provide valuable insights into misconceptions about nursing, strike action and patient harm, which can inform strategies for public communication. (shrink)

This paper focuses on Confucian formulations of personhood and the implications they may have for bioethics and medical practice. We discuss how an appreciation of the Confucian concept of personhood can provide insights into the practice of informed consent and, in particular, the role of family members and physicians in medical decision-making in societies influenced by Confucian culture. We suggest that Western notions of informed consent appear ethically misguided when viewed from a Confucian perspective.

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 1-2, Page 164-188, June 2022.

: The main contribution of this paper to current philosophical and sociological studies on modeling is to analyze modeling as an object-oriented interdisciplinary activity and thus to bring new insights into the wide, heterogeneous discourse on tools, forms and organization of interdisciplinary research. A detailed analysis of interdisciplinarity in the making of models is presented, focusing on long-standing interdisciplinary collaboration between specialists in infectious diseases, mathematicians and computer scientists. The analysis introduces a novel way of studying the elements of the (...) models as carriers of interdisciplinarity. These elements, being functionally interdependent building blocks, evolve during the modeling work and carry the disciplinary tensions in the process. This shows how the long and challenging process of defining and reformulating the object of research is crucial for understanding the dynamics of interdisciplinarity in the making. (shrink)

A discussion of the intersections between Aristotle's works: Ethics and Metaphysics. It debates the ways in which - and even the extent to which - the two texts illuminate one another, examine Aristotle's methods and intellectualism and analyse issues of matter, form, potency and art.

Existing whistle-blowing models rely on “cold” economic calculations and cost-benefit analyses to explain the judgments and actions of potential whistle-blowers. I argue that “hot” cognitions – value conflict and emotions – should be added to these models. I propose a model of the whistle-blowing decision process that highlights the reciprocal influence of “hot” and “cold” cognitions and advocate research that explores how value conflict and emotions inform reporting decisions. I draw on the cognitive appraisal approach to emotions and on the (...) social-functional value pluralism model to generate propositions. (shrink)

This paper is going to explore the adverse effects of exposure to combat death on medics’ holistic well-being, which, if ignored could decrease individual readiness and negatively impact the mission. We rely on the experience of United States Air Force Special Operation Surgical Teams (AF SOST) whose exposure to mass casualty scenarios in austere environments could serve as approximations of conditions of future battlefields. Over the past two decades, the ability to deliver advanced medical care on and off the battlefield (...) along with a rapid casualty evacuation platform has allowed for unprecedented survival rates exceeding 90%. While laudable, these medical achievements have also set up a casualty management paradigm in which medical decision-making singularly focuses on life-saving care. Confronting peer-peer adversaries in large scale combat operations (LSCO) on a multi-domain battlefield will make casualty management frighteningly more complex by introducing major infrastructural, personnel, and resource constraints. When considering the high number of casualties expected in LSCO alongside enormous limitations in medical resource and resupply capability, the current casualty management paradigm will not be sustainable. The resource constrained environment in LSCO will shift medical decision-making away from a singular focus on life-saving care to triage, which hinges on the ability to determine futile medical interventions—a skill that has been lost in the past two generation of combat medics. As such, a broad ethical challenge that arises in preparation for LSCO is the need to set new expectations concerning dying and death. However, medical decision-making focused on death and dying has not been explicitly addressed in military medical training, research, or policy. Relying on a body of literature known as terror management theory (TMT) and ethnographic data from our study with AF SOST medics, we are going to argue that it is important to expose medics to death in mass casualty and triage training. (shrink)

Research on religion can advance understanding of social cognition by building connections to sociology, a field in which much cognitively oriented work has been done. Among the schools of sociological thought that address religious cognition are: structural functionalism, symbolic interactionism, conflict theory, phenomenology, and, most recently, exchange theory. The gulf between sociology and cognitive science is an unfortunate historical accident.

An absolute decline in US life expectancy in low education whites has alarmed policy makers and attracted media attention. Depending on which studies are correct, low education white women have lost between 3 and 5 years of lifespan; men, between 6 months and 3 years. Although absolute declines in life expectancy are relatively rare, some commentators see the public alarm as reflecting a racist concern for white lives over black ones. How ought we ethically to evaluate this lifespan contraction in (...) low education whites? Should we care, or is it racist to care? Does it constitute an injustice or reflect justice being done? I argue that the lifespan contraction in low education whites violates key normative criteria used to make determinations of health justice, and that these judgments do not vitiate concerns about racism. I conclude with reflections on US population health policy and building an inclusive health equity movement. (shrink)

The increasing concern about ethics and integrity in research communities has brought attention to how students and junior academics can be trained on this regard. Moreover, it is known that ethical behaviour and integrity not only involve individual but also group norms and considerations. Thus, through action research and participant observation, this research investigates the learning processes through which 64 students collaboratively develop research ethics and integrity competencies. The aim was to understand how bachelor, master and PhD students approach ethical (...) dilemma cases through a collaborative process. The data consisted of recorded group work on ethics cases, student group reports, and post-training questionnaires. Later, the analyses considered groups as the unit of analysis. These data were analysed through content analysis utilizing the SOLO taxonomy to identify levels of understanding and assess evolvement of ethical sensitivity during a case-based training session. The results show that all groups reached the level of understanding where the groups demonstrated that concepts had been understood appropriately, but occasionally struggled to make connections between them. Students perceived working collaboratively as beneficial. The results help teachers of research ethics and integrity to make pedagogically justified choices in their teaching. Drawing on the results of this study, we propose a tool for the formative assessment of student learning of research ethics and integrity. (shrink)

The focus of this article is university teachers’ and students’ views of plagiarism, plagiarism detection, and the use of plagiarism detection software as learning support. The data were collected from teachers and students who participated in a pilot project to test plagiarism detection software at a major university in Finland. The data were analysed through factor analysis, T-tests and inductive content analysis. Three distinct reasons for plagiarism were identified: intentional, unintentional and contextual. The teachers did not utilise plagiarism detection to (...) support student learning to any great extent. We discuss the pedagogical implications and suggest that the contextual reasons for plagiarism require focus primarily on study strategies, whereas the intentional reasons require profound discussion about attitudes and conceptions of good learning and university-level study habits. (shrink)

The study focused on university students' understanding and conceptions of ethical issues in research. Domain-specific and domain-transcending measures were developed to gauge the students' awareness of ethical issues. Responses were obtained from 269 undergraduate and graduate students at a U.S. regional university. Participant withdrawal, the debriefing of research participants, the dissemination of findings, and giving credit to co-contributors were the most challenging ethical issues for the students. Ethical awareness was predicted by professional and organizational socialization, and perspective taking. Contextualization greatly (...) improved the students' ability to recognize ethical issues. Simulations and role-taking are suggested as the means with which to teach students about the ethical issues perceived as challenging. (shrink)

Este ensayo propone una lectura de la VIII de las Tesis sobre la historia, de Benjamin que la “emplea”, en el sentido en que el propio Benjamin sostenía que una exposición materialista de la historia debía emplear los fragmentos del pasado para interrogar radicalmente el presente y resistir a las opresiones. Se pone en relación esta tesis con las palabras de las mujeres zapatistas, pronunciadas con motivo de la inauguración del Segundo encuentro internacional de mujeres que luchan, para argumentar que (...) el “estado de excepción” que Benjamin había advertido era en verdad la regla, lo sigue siendo hoy específicamente (aunque no únicamente) para las mujeres y otros cuerpos, individuales y colectivos, feminizados. Se argumenta también que la tradición de lucha de las mujeres indígenas producida por una colonialidad capitalista que sigue en curso es la que hoy nos muestra la normalidad del “estado de excepción” contemporáneo. Finalmente se propone que las luchas de las mujeres son, también, ejercicios críticos y prácticas de resistencia e invención, para una justicia por-venir. (shrink)

The COVID-19 pandemic’s disproportionate harm to racialized communities and increased public attention to the deaths of Black people at the hands of police (Elijah McClain, Breonna Taylor, George F...

Abstract:Many scientists argue that the world is becoming increasingly dominated by human activity, much to the detriment of the natural world. In what scholars have dubbed the Anthropocene, the current geological epoch during which time human activity has been the dominating force over climate and the environment, many questions of environmental ethics have arisen. Who does the earth belong to? What is the relationship between humans and the environment? What is the moral standing of non-human life? Locke and Rousseau provide (...) varying answers to these questions, which are central to discussions of environmental ethics. In many ways, Locke and Rousseau's answers are opposed to each other, suggesting a differing world view when it comes to environmental ethics. Locke's understanding of environmental ethics seems to dominate, and perhaps even cause, the onset of the Anthropocene, but Rousseau's response, and a potential turn toward his understanding of environmental ethics marks an ideological shift in the way that humans understand their relationship with the world around them. This paper argues that the writings of Locke and Rousseau correspond to different stages of the Anthropocene with significant effects on both environmental ethics and environmental governance and policy. (shrink)

Scientific models are used to predict and understand the target phenomena in the reality. The kind of epistemic relationship between the model and the reality is always regarded by most of the philosophers as a representational one. I argue that, complementary to this representational role, some of the scientific models have a constructive role to play in altering and reconstructing the reality in a physical way. I hold that the idealized model assumptions and elements bestow the constructive force of a (...) model on the reality. By recognizing the physical constructive force of some scientific models, the merit of these models could be judged by how successful they are in the reality construction, rather than by the traditional criterion of model-world representation. (shrink)

El objetivo del estudio es evaluar el desempleo juvenil universitario en mujeres de 18 a 30 años, como consecuencia de los efectos de la pandemia en la salud pública. La metodología responde a un estudio de campo con una muestra de 239 casos analizados a través de una encuesta cerrada, basada en 26 ítem, mediante una escala Likert para contrastar las situaciones profesionales y humanas de las encuestadas relacionado a conciliación, igualdad y desarrollo profesional. Los resultados evidenciaron brechas en mujeres, (...) sobre lo cual se requiere fortalecer la participación de la mujer en espacios laborales. (shrink)

Current advances in assisted reproductive technologies aim to promote the health and well-being of future children. They offer the possibility to select embryos with the greatest potential of being born healthy (eg, preimplantation genetic testing) and may someday correct faulty genes responsible for heritable diseases in the embryo (eg, human germline genome modification (HGGM)). Most laws and policy statements surrounding HGGM refer to the notion of ‘serious’ as a core criterion in determining what genetic diseases should be targeted by these (...) technologies. Yet, this notion remains vague and poorly defined, rendering its application challenging and decision making subjective and arbitrary. By way of background, we begin by briefly presenting two conceptual approaches to ‘health’ and ‘disease’: objectivism (ie, based on biological facts) and constructivism (ie, based on human values). The basic challenge under both is sorting out whether and to what extent social and environmental factors have a role in helping to define what qualifies as a ‘serious’ disease beyond the medical criteria. We then focus on how a human rights framework (eg, right to science and right to the highest attainable health) could integrate the concepts of objectivism and constructivism so as to provide guidance for a more actionable consideration of ‘serious’. Ultimately, it could be argued that a human rights framework, by way of its legally binding nature and its globally accepted norms and values, provides a more universal foundation for discussions of the ethical, legal and social implications of emerging or disruptive technologies. (shrink)

Separation-based accounts of privacy define privacy as being left alone and unaccessed. Pyrrho et al. propose a more control-based account where privacy is about having the age...

Women and men are biologically and reproductively dissimilar. This sexual distinctiveness gives rise to a “sexual asymmetry”—the fundamental reality that the potential consequences of sexual intercourse are far more immediate and serious for women than for men. Advocates of contraception and abortion sought to cure sexual asymmetry by decoupling sex from procreation, relieving women from the consequences of sex, and thus equalizing the sexual experiences of men and women. But efforts to suppress or reject biological difference have not relieved women (...) of the consequences of sex and the vulnerabilities of pregnancy, even as they have further relieved men. Although secular feminist responses to biological difference have served to exacerbate sexual asymmetry, Catholic teaching on abortion, sex, and marriage—even contraception—provides an authentically pro-woman cultural response. (shrink)

Patients with amyotrophic lateral sclerosis (ALS) face many difficult, timing-sensitive decisions over the course of their illness, weighing present versus future harms and benefits. Supplemented by interviews with people with ALS, we argue for a relational approach to understanding these decisions and their effects on identity. We highlight two critical aspects of the patient–caregiver relationship: (1) the extent to which each may rely on the other leaves their wellbeing intimately intertwined and (2) patients often require others to help with the (...) imaginative task of considering possible futures for each therapeutic option. We show why family involvement in decisionmaking practices can be so critical, and shed light on the ways intimate others help preserve and protect people’s identities amidst the destabilizing uncertainty illness and treatment can bring. (shrink)

Through qualitative surveys, a team of law students, law professors, physicians, and residents explored the perceptions of neurology residents towards referral to appropriate legal resources in an academic training program. Respondents reported feeling uncomfortable screening their patients for health-harming legal needs, which many attributed to a lack of training in this area. These findings indicate that neurology residents would benefit from training on screening for social factors that may be impacting their patients’ health.

Our aim was to identify the ethical issues faced by students in the behavioral and natural sciences during their doctoral programmes. The participants were 28 PhD students who were interviewed about their doctoral study and supervision experiences. We identified a total of 102 ethical issues compromising the principles of nonmaleficence, beneficence, autonomy, justice, or fidelity. There were some differences in emphases, with the students in the behavioral sciences displaying a broader range of ethical compromises than the students in the natural (...) sciences. Ethical problems emerged in the individual supervisor–student relationships, but often problems involving the scholarly community appeared in the background. (shrink)

This article describes research-based role-play on academic integrity. In the role-play, doctoral students negotiated the revision of an institutional integrity policy representing different groups of academics and students. On the one hand, role-play as a teaching method and learning activity demonstrated the difficulty of accommodating different perspectives; on the other, it showed the power and necessity of negotiation in matters that involve value judgments. The role-play is described in detail along with its underlying pedagogical foundations and its contextualisation in a (...) doctoral summer school where it took place. The purpose of the article is to describe how academic integrity was approached through role-play and to discuss theoretical and pedagogical foundations of role-play in teaching academic integrity. Although the article does not describe empirical research on role-play as a teaching method, it demonstrates how role-play in teaching academic integrity was developed based on prior research on the topic. (shrink)

Consequentialism is a moral philosophy that maintains that the moral worth of an action is determined by the consequences it has for the welfare of a society. Consequences of model design are a part of the model lifecycle that is often neglected. This paper investigates the issue using system dynamics modeling as an example. Since a system dynamics model is a product of the modeler’s design decisions, the modeler should consider the life cycle consequences of using the model. Seen from (...) a consequentialist perspective, the consequences of policies developed from system dynamics models determine the model’s moral value. This concept is explored by discussing model uncertainty from an engineering perspective. In this perspective, the ethical considerations shift from the behavior of the modeler to the model itself and the model’s inherent uncertainty. When the ethical considerations are taken away from the modeler and directed to what the model does, the ethical boundaries extend beyond the proximity of the model. This discussion renews the ethics conversation in system dynamics by considering this shift in philosophical perspective, and investigates how consequentialist moral philosophy applies to the modeling process and in communicating with decision-makers. A model of social assistance in Norway in the context of immigration pressures illustrates some possibilities for addressing these ethical concerns. This paper argues for an ethical framework, or at the very least, an ethical conversation within the field of system dynamics.Article first published online: 25 FEB 2017. (shrink)

In this chapter I will present, in a general way, Millikan's biosemantic theory of the phenomenon of intentionality. For this purpose, the text will take the following path. First, I will present the problem of intentionality and an overview of the dominant theories of intentional content during the twentieth century and part of the twenty-first century. Then, I will present a general version of Millikan's biosemantic theory, appearing in 1984, which will allow us to see what the relevance and originality (...) of his proposal consists in. Finally, in keeping with one of the central purposes of Las filósofas que nos formaron, I will share a brief interview that Millikan very kindly agreed to give for this publication, in which she tells us some non-theoretical aspects of her history as a philosopher. (shrink)

The aim of this study was to investigate the consequences of the use of text-matching software on teachers’ and students’ conceptions of plagiarism and problems in academic writing. An electronic questionnaire included scale items, structured questions, and open-ended questions. The respondents were 85 teachers and 506 students in a large Finnish university. Methods of analysis included exploratory factor analysis, t-test, and inductive content analysis. Both teachers and students reported increased awareness of plagiarism and improvements in writing habits, as well as (...) concerns and limitations related to the system. The results suggest that teachers are inclined to think of plagiarism as part of a learning process rather an issue of morality, which may have consequences for how they understand the role of text matching. The introduction of text-matching software has supported teachers’ work, but at the same time teachers emphasized their own responsibility in detecting problems in student writing. The survey provides a limited sample of “Case Finland,” where implementation of text-matching software nationwide has been remarkably rapid; it offers a glimpse into one institution’s implementation of a newly introduced policy for mandatory plagiarism detection. (shrink)

The United States Court of Appeals for the Second Circuit recently upheld United States District Court for the Eastern District of New York Judge's denial of petitioner's application for a writ of habeas corpus. The Court held that it was not objectively unreasonable for the Appellate Division to conclude, in light of clearly established federal law as expressed by the Supreme Court of the United States, that a New York statute providing for the recommitment of specific defendants who plead not (...) responsible by reason of mental disease or defect under a mere “preponderance of the evidence” standard does not violate either due process or the equal protection clause of the Fourteenth Amendment. (shrink)

In Philosophy, it is well known that of the total faculty population, the proportion of women is significantly lower than men. This disproportion is odd for a discipline within the humanities; these numbers seem more compatible with what is found in STEM (Science, Technology, Engineering, Mathematics) careers. These proportions are in turn a product of the low female presence that exists from the previous levels of academic training in philosophy. What happens in the case of the philosophy student body? For (...) example, the report presented by BeeBee and Saul (2011), on women in philosophy in the United Kingdom, in the period 2008 and 2009, points out that in the first degrees of academic training, in the bachelor's degree, women occupy 45% of the student population, in the master's degree 38% and in the doctorate 35%. Thus, "it is notable that there is a reduction in the proportion of women from the bachelor's degree to the doctorate [...]. This has as a consequence that at the professional level women holding positions as professors represent only 19%" (BeeBee & Saul, 2011, p. 11). Recently, Torres González (2018), based on European Union studies, points out that in Spain, with respect to gender disparity in students, "the data yield as a result masculinized studies, where, contrary to what happens in the branch of the humanities to which it [philosophy] belongs, males outnumber females by 28 percentage points" (2018, p. 328). This disparity is reflected in philosophy at the professional level, "the indicators of vertical segregation show a reinforced glass ceiling, which presents one of the worst data of hierarchical discrimination in the university: the percentage of female professors in philosophy is 12% compared to 21% of female professors in higher education" (Idem). Although it is a fact that there are fewer women than men studying philosophy and, therefore, fewer women than men working professionally in this discipline, we do not yet have possible explanations for this phenomenon of gender disparity in the student body in philosophy. In some cases, even if the number of women entering the philosophy degree program is already low, the number of women graduating is even lower, which indicates that there is attrition along the way; the initial numbers of women entering the program tend to decrease by the time they graduate. Thus we come to the question that is the subject of this paper: What causes female students to drop out of the philosophy program? In this article we answer this question from the philosophy of science and supported by local empirical data, so we do not give a complete or even less exhaustive answer. We review two explanatory models that purport to answer the question of why there are fewer women in philosophy, both formatively and professionally. These are the Different Voices Model (DVM) and the Perfect Storm Model (PSM); we opt for the latter and give reasons for it. Regarding the empirical aspect of our research, our source of statistical data belongs to the undergraduate program in philosophy at the Facultad de Estudios Superiores Acatlán-UNAM, Mexico (FES Acatlán), obtained in the framework of the SWIP-Analytic Mexico workshops. Our analysis of these data shows that even when female students have better GPAs than male students and take fewer subjects while enrolled, female students graduate less than male students in the FES Acatlan degree program. (shrink)

This study focuses on the intersection of research ethics and academic writing, i.e. the use of sources, assignment of credit to the contributors in the research, and the dissemination of research findings. The study utilized a set of semi-structured and open-ended questions. The sample consisted of 269 undergraduate (BA) and graduate (MA) students at a U.S. university department of psychology including major and non-major students. The data showed that although an overwhelming number of the students’ examples related to ethical issues (...) in citation dealt with plagiarism, a broad range of examples of other types of issues were also provided. Understandably, students tended to view the questions about both the assignment of credit to those involved in conducting the research and the dissemination of research findings from the research participant’s perspective, which is more familiar to them than the researcher perspective. In order to help the students to expand their notions beyond the immediate own experience to a broader understanding for the ethical principles that ought to guide a researcher in his or her work, it is desirable that students be provided with opportunities to participate in authentic research projects. With a deeper understanding of the students’ conceptions of ethics in research and academic writing, we can become more attuned to the common limitations and misconceptions that students harbor, and thus better equipped to support students in their learning process. (shrink)

Intraspecific niche variation can differentially impact community processes and can represent the initial stages of adaptive radiation. Here we test for intraspecific differences in niche use in a keystone species, the alewife (Alosa pseudoharengus). To test whether feedbacks between predator foraging traits and prey communities have led to differences in niche use, we compare the diet composition and trophic position of anadromous and landlocked alewife populations. These populations differ in phenotypic traits related to foraging (gill raker spacing, gape width, and (...) prey selectivity). Trait differences appear to have resulted from eco-evolutionary feedbacks between alewives and their zooplankton prey, and suggest that these two life history forms are exploiting different niches. Direct diets show that anadromous alewives consume a greater biomass of predatory copepods than do landlocked alewives. Anadromous alewives also consume more ostracods—a littoral prey item—as the growing season progresses. These diet differences do not translate into a significant difference in trophic position, as estimated from stable isotopes. However, stable-isotope estimates of diet source show that during early fall, anadromous alewives obtain significantly more of their dietary carbon from the littoral food web. This increased reliance on littoral prey is likely a result of a diet switch that occurs in response to the alewife-driven exhaustion of large-bodied prey items available in the pelagic zone, i.e., alewife niche construction. These findings show the existence of important intraspecific niche differences in the alewife and support the role of eco-evolutionary feedbacks in shaping these niche differences. The initiation of alewife divergence is the result of dam building by humans. Therefore, alewife niche differentiation can be considered to be an eco-evolutionary byproduct of human cultural niche construction. (shrink)

Despite apparent political concern and action—often fuelled by high-profile cases and campaigns—legislative and institutional responses to image-based sexual abuse in the UK have been ad hoc, piecemeal and inconsistent. In practice, victim-survivors are being consistently failed: by the law, by the police and criminal justice system, by traditional and social media, website operators, and by their employers, universities and schools. Drawing on data from the first multi-jurisdictional study of the nature and harms of, and legal/policy responses to, image-based sexual abuse, (...) this article argues for a new joined-up approach that supports victim-survivors of image-based sexual abuse to ‘reclaim control’. It argues for a comprehensive, multi-layered, multi-institutional and multi-agency response, led by a government- and industry-funded online or e-safety organisation, which not only recognises the diversity of victim-survivor experiences and the intersection of image-based sexual abuse with other forms of sexual and gender-based violence and discrimination, but which also enables victim-survivors to reclaim control within and beyond the criminal justice system. (shrink)

In this study we intend to investigate the ancient city as the state unable to guarantee the protection and enforcement of justice between individuals and the birth of the Republic undemocratic libel resultant of the failure and the decay of the old city. Plato tries to convince men that it is life in a community that makes it possible to happiness in our short roaming in the world. The ontology of the property falls here as a strategy of persuasion on (...) the insistence of preserving the unity of the city as institutional correlate the individual's fully integrated itself. (shrink)