How should clinical ethicists be trained? Scholars have stated that clinical ethics fellowships create well-trained, competent ethicists. While this appears intuitive, few features of fellowship programs have been publicly discussed, let alone debated. In this paper, we examine how fellowships can foster effective mentoring relationships. These relationships provide the foundation for the fellow’s transition from novice to competent professional. In this essay, we begin by discussing our pedagogical commitments. Next, we describe the structures our program has created to assist our (...) fellows in becoming competent ethicists. We then outline the kinds of knowledge, skills, and professional attributes mentors should possess. Following this, we focus on the knowledge, skills, and professional attributes that fellows develop as they co-create effective mentoring relationships. We will not prescribe a single approach to fellowship training; instead, our perspective will, we hope, become a catalyst for further conversation on training and mentoring clinical ethics fellows. (shrink)

Somatic or inherited mutations in the adenomatous polyposis coli (APC) gene are a frequent cause of colorectal cancer in humans. APC protein has an important tumor suppression function to reduce cellular levels of the signaling protein β‐catenin and, thereby, inhibit β‐catenin and T‐cell‐factor‐mediated gene expression. In addition, APC protein binds to microtubules in vertebrate cells and localizes to actin‐rich adherens junctions in epithelial cells of the fruit fly Drosophila (Fig. 1). Very little is known, however, about the function of these (...) cytoskeletal associations. Recently, Hamada and Bienz have described a potential role for Drosophila E‐APC in cellular adhesion,1 which offers new clues to APC function in embryonic development, and potentially colorectal adenoma formation and tumor progression in humans. BioEssays 24:771–774, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

The purpose of this study was to examine the impact of parenting and adolescent fearfulness on adolescents’ pro‐social values and pro‐social and antisocial behaviour. A total of 134 adolescents (M age = 16.22, 72 girls, 62 boys) responded to questions regarding their own fearfulness, pro‐social values and pro‐social and antisocial behaviour, as well as their perceptions of maternal attachment and maternal appropriateness. Results revealed few main‐effect findings, most notably a negative relation between attachment and antisocial behaviour. However, findings pointed to (...) several multiplicative relations as a function of parenting, adolescent fearfulness, and child gender, including: (1) maternal appropriateness was more important for boys than for girls, (2) maternal attachment was related to greater importance of pro‐social values and higher pro‐social behaviour for boys low on fear and (3) maternal appropriateness was related to lower antisocial behaviour for boys low on fear. The discussion focuses on the importance of examining the multiplicative relations between parenting and adolescent temperament and the implications of this for both educators and parents. (shrink)

Clinical populations sometimes demonstrate difficulties forgetting stimuli related to their trauma-related disorder, perhaps because their intense personal connection to these stimuli produce deficits in the inhibitory control abilities necessary for forgetting. The present work examined this possibility for people who have high levels of traits implicated in borderline personality disorder (BPD). In two well-powered studies, we found no evidence for deficits in forgetting specific to BPD traits, even for people with clinically significant levels of the traits, contrary to previous studies. (...) The present experiments updated the designs from earlier experiments to employ the most contemporary methods to examine directed forgetting recommended by recent reviews. With these improved methods, Study 1 found that participants showed significant directed forgetting for BPD-related words independent of their level of BPD traits, perhaps because the BPD-related words were so strongly associated with one another. Study 2 found that when we removed the strong relatedness between the stimuli, forgetting of BPD-relevant words was significant and did not interact with BPD symptomology. We concluded that in contrast to people with PTSD who show specific inhibitory deficits for trauma-related works, people with BPD show normal, intact inhibitory control even for words that they should find threatening. (shrink)

Neuroimaging offers great potential to clinicians and researchers for a host of mental and physical conditions. The use of imaging has been trumpeted for forensic psychiatric and psychological evaluations to allow greater insight into the relationship between the brain and behavior. The results of imaging certainly can be used to inform clinical diagnoses; however, there continue to be limitations in using neuroimaging for insanity cases due to limited scientific backing for how neuroimaging can inform retrospective evaluations of mental state. In (...) making this case, this paper reviews the history of the insanity defense and explains how the use of neuroimaging is not an effective way of improving the reliability of insanity defense evaluations. (shrink)

Video news releases (VNRs) have been criticized when they are used within a newscast without source disclosure because they violate ethical codes related to transparency and consumers' “right to be informed” by whom they are being persuaded. In an experiment, we show how increased persuasion knowledge about VNRs is positively related to beliefs in news commercialization, beliefs in VNR inappropriateness without disclosure, and support for disclosure of VNR material. We suggest that increased knowledge about VNRs without source disclosure measures might (...) harm messages that are not employing the tactic (“false positives”) and lead to a general distrust of all media. (shrink)

What if human joy went on endlessly? Suppose, for example, that each human generation were followed by another, or that the Western religions are right when they teach that each human being lives eternally after death. If any such possibility is true in the actual world, then an agent might sometimes be so situated that more than one course of action would produce an infinite amount of utility. Deciding whether to have a child born this year rather than next is (...) a situation wherein an agent may face several alternatives whose effects could well ramify endlessly on such suppositions, for the child born this year would be a different person—one who preferred different things, performed different actions, and had different descendants—from a child born next year. It has recently been suggested that traditional utilitarianism stumbles on such cases of infinite utility. Specifically, utilitarianism seems to require, for its application, that all experience of pleasure and pain cease at some time in the future or asymptotically approach zero.2 If neither of these conditions holds, then the utility produced by each of two alternative actions may turn out to be infinite, and utilitarianism thus loses its ability to discriminate morally between them. (shrink)

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

A critical review of Sabina Lovibond's book Ethical Formation (2004).

The paper aims to put certain basic mathematical elements and operations into an empirical perspective, evaluate the empirical status of various analytic operations widely used within psychology and suggest alternatives to procedures criticized as inadequate. Experimentation shows the "manyness" of items to be a perceptual quality for both young children and animals and that natural operations are performed by naive children analogous to those performed by persons tutored in arithmetic. Number, counting, arithmetic operations therefore can make distinctions that are not (...) inevitably arbitrary, and conceptual operations can obviously have a status as natural events with psychology. If the elements and conceptual operations involved in mathematical systems were not inherent in physiological process, various primitive discriminations could not be possible. Also, since some calculi have a natural status in a given empirical circumstance, the axioms of others can not be satisfied. Therefore the psychologist when acting as an empirical scientist seeks a calculus having a structure whose elements are isomorphic with natural units of stimulus and response and whose operations are isomorphic with whatever natural processes are involved. Measurement poses a special problem for the empirical scientist. It concerns but a single class of natural qualities and this only in a limited way. The concept of quantity has a natural counterpart but quantity and measurement are not wholly analogous. Measurement is defined, as H. S. Leonard suggests, as a theoretical activity. Measurement theory has a formal structure but empirical end. Measurement hypothesizes about the position of a particular quality within a definite range of qualities. It therefore is beholden to definite empirical restrictions. Some hypotheses-making systems use terms and relations per se as the context and starting point for dealing with discriminable events. Such procedures are 'transcendent." In empirical science, questions are part of problem-solving activity and their reference is naturally restricted. In providing description and explanation, psychological researchers frequently use calculi in a transcendent way. This results in theories that are only quasi-empirical and "half" true. The roles measurement plays in psychology are discussed. Of particular concern are those cases in which the results of measuring or a theory of measurement are used to define the "real" units, or the "real" relations involved in problematic psychological events, and thence to describe and explain behaviors of interest. Metaphysical or ontological usages of measurement sometimes occur. The implication of these arguments with regard to a view of empirical science is discussed. (shrink)

At the time of this writing, a widely publicized, waived-consent trial is underway. Sponsored by Northfield Laboratories, Inc. (Evanston, IL) the trial is intended to evaluate the emergency use of PolyHeme®, an oxygen-carrying resuscitative fluid that might prevent deaths from uncontrolled bleeding. The protocol allows patients in hemorrhagic shock to be randomized between PolyHeme® and saline in the field and, still without consent, randomized between PolyHeme® and blood after arrival at an emergency department. The Federal regulations that govern the waiver (...) of consent restrict its applicability to circumstances where proven, satisfactory treatments are unavailable. Blood - the standard treatment for hemorrhagic shock - is not available in ambulances but is available in hospitals. The authors argue that the in-hospital stage of the study fails to meet ethical and regulatory standards. (shrink)

The ability of adolescents to access safe and effective new products for HIV prevention and treatment is optimised by adolescent licensure at the same time these products are approved and marketed for adults. Many adolescent product development programmes for HIV prevention or treatment products may proceed simultaneously with adult phase III development programmes. Appropriately implemented, this strategy is not expected to delay licensure as information regarding product efficacy can often be extrapolated from adults to adolescents, and pharmacokinetic properties of drugs (...) in adolescents are expected to be similar to those in adults. Finally, adolescents enrolled in therapeutic HIV prevention and treatment research can be considered adults, based on US Food and Drug Administration regulations and the appropriate application of state law. The FDA permits local jurisdictions to apply state and local HIV/sexually transmitted infection minor treatment laws so that adolescents who are HIV-positive or at risk of contracting HIV may be enrolled in therapeutic or prevention trials without obtaining parental permission. (shrink)

A paediatric clinical trial conducted in a developing country is likely to encounter conditions or illnesses in participants unrelated to the study. Since local healthcare resources may be inadequate to meet these needs, research clinicians may face the dilemma of deciding when to provide ancillary care and to what extent. The authors propose a model for identifying ancillary care obligations that draws on assessments of urgency, the capacity of the local healthcare infrastructure and the capacity of the research infrastructure. The (...) model lends itself to a decision tree that can be adapted to the local context and resources so as to provide procedural guidance. This approach can help in planning and establishing organisational policies that govern the provision of ancillary care. (shrink)

The Oregon Basic Health Services Act of 1989 seeks to establish universal access to basic medical care for all currently uninsured Oregon residents. To control the increasing cost of medical care, the Oregon plan will restrict funding according to a priority list of medical interventions. The basic level of medical care provided to residents with incomes below the federal poverty line will vary according to the funds made available by the Oregon legislature. A rationing plan such as Oregon's which potentially (...) excludes medically necessary procedures from the basic level of health care may be just, for the right to publically-sponsored medical care is restricted by opposing rights of private property. However, the moral acceptability of the Oregon plan cannot be determined in the absence of knowing the level of resources to be provided. Finally, Oregon to date has failed to include the individuals being rationed in discussions as to how the scarce resources are to be distributed. (shrink)

Spatial skills predict important life outcomes, such as mathematical achievement or entrance into Science, Technology, Engineering, and Mathematics disciplines. Children significantly vary in their spatial performance even before they enter formal schooling. One correlate of children's spatial performance is the spatial language they produce and hear from others, such as their parents. Because the emphasis has been on spatial language, less is known about the role of hand gestures in children's spatial development. Some children are more likely to fall behind (...) in their spatial skills than others. Children born premature constitute such a risk group. Here, we compared performance of term and preterm-born children on two non-verbal spatial tasks—mental transformation and block design. We also examined relations of children's performance on these tasks to parental spatial language and gesture input and their own production of spatial language and gesture during an independent puzzle play interaction. We found that while term and preterm-born children as a group did not differ in the mental transformation or block design performance, children varied widely in their performance within each group. The variability in mental transformation scores was predicted by both a subset of spatial words and all spatial gestures children produced. Children's spatial language and gesture were in turn related to their parents' spatial language and gesture. Parental spatial language and gesture had an indirect relation on children's mental transformation, but not block design, scores via children's spatial language, and gesture use. Overall, results highlight the unique contributions of speech and gesture in communicating spatial information and predicting children's spatial performance. (shrink)