In preparation for the development of a rapid tissue donation programme, we surveyed healthcare providers in our institution about knowledge and attitudes related to RTD with lung cancer patients. A 31-item web based survey was developed collecting data on demographics, knowledge and attitudes about RTD. The survey contained three items measuring participants’ knowledge about RTD, five items assessing attitudes towards RTD recruitment and six items assessing HCPs’ level of agreement with factors influencing decisions to discuss RTD. Response options were presented (...) on a 5-point Likert scale. Ninety-one HCPs participated in the study. 66% indicated they had never heard of RTD prior to the survey, 78% rated knowledge of RTD as none or limited and 95.6% reported not having ethical or religious concerns about discussing RTD with patients. The majority were either not comfortable or not sure if they felt comfortable discussing RTD with cancer patients . 56.1% indicated their knowledge of RTD would play an integral role in their decision to discuss RTD with patients. 71.4% reported concerns with RTD discussion and the emotional state of the patient. Physicians and nurses play an important role in initiating conversations about recruitment and donation to research that can ultimately influence uptake. Increasing HCP knowledge about RTD is a necessary step towards building an RTD programme. Our study provides important information about characteristics associated with low levels of knowledge and practice related to RTD where additional education and training may be warranted. (shrink)

Given the long-standing controversy about whether the brain-dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. In this article, we consider the kind of policy that should be adopted to manage a family's insistence that their brain-dead loved one continues to receive supportive care. We argue that while it would be ethically (...) inappropriate to continue to devote scarce acute care resources to such patients in a hospital setting, it may not be ethically inappropriate for patients to receive these resources in certain other settings. Thus, if a family insists on continuing to care for their brain-dead loved at their home, we should not, from a policy perspective, interfere with the family's wishes. We also argue that healthcare professionals should make some effort to facilitate the transfer of brain-dead patients to these other settings when families insist on continued treatment despite being informed about the lack of any potential for recovery of consciousness. Our arguments are strengthened by the fact that patients in a persistent vegetative state, who, when correctly diagnosed, also have no potential for recovery of consciousness, are routinely transferred from hospitals to nursing homes or long-term care facilities where they continue to be ventilated, tube fed and to receive other supportive care. We also briefly explore the question of who should be responsible for the costs of such treatment at the long-term care facility. (shrink)

Given the long‐standing controversy about whether the brain‐dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. In this article, we consider the kind of policy that should be adopted to manage a family's insistence that their brain‐dead loved one continues to receive supportive care. We argue that while it would be ethically (...) inappropriate to continue to devote scarce acute care resources to such patients in a hospital setting, it may not be ethically inappropriate for patients to receive these resources in certain other settings. Thus, if a family insists on continuing to care for their brain‐dead loved at their home, we should not, from a policy perspective, interfere with the family's wishes. We also argue that healthcare professionals should make some effort to facilitate the transfer of brain‐dead patients to these other settings when families insist on continued treatment despite being informed about the lack of any potential for recovery of consciousness. Our arguments are strengthened by the fact that patients in a persistent vegetative state, who, when correctly diagnosed, also have no potential for recovery of consciousness, are routinely transferred from hospitals to nursing homes or long‐term care facilities where they continue to be ventilated, tube fed and to receive other supportive care. We also briefly explore the question of who should be responsible for the costs of such treatment at the long‐term care facility. (shrink)

The existing EELS literature has usefully identified the scope of ethical issues posed by pharmacogenetic and pharmacogenomic research. The time has come for in-depth examination of particular ethical issues. The involvement of racial and ethnic communities in pharmacogenetic and pharmacogenomic research is contentious precisely because it touches upon the science and politics of studying racial and ethnic difference. To date, the ethics literature has not seriously taken account of the fact that such research impinges upon the interests of communities, and (...) that taking such interests seriously requires that we both protect and empower communities in research. We propose a framework that rests upon the recognition that communities are heterogeneous human associations and differing policies are appropriate for differing communities. Community consent and consultation and community consultation alone are neither appropriate nor required for all pharmacogenetic and pharmacogenomic research. Rather, application of these policy protections must take into account particulars of both planned research and the communities involved. (shrink)

In this paper we describe the objectives of teaching medical ethics to undergraduates and the teaching methods used. We describe a workshop used in the University of Liverpool Department of Psychiatry, designed to enhance ethical sensitivity in psychiatry. The workshop reviews significant historical and current errors in the ethical practice of psychiatry and doctors' defence mechanisms against accepting responsibility for deficiencies in ethical practice. The workshop explores the student doctors' own group ethos in response to ethical dilemmas, and demonstrates how (...) the individual contributes to and is responsible for the group ethos through participation and also through nonparticipation. The student feedback about the workshop is reviewed. The Toronto Ethical Sensitivity Instrument was used to assess whether or not the workshop altered sensitivity. Compared to a control group the attenders' sensitivity was significantly increased (on Student's t-test p equals or is less than 0.002). (shrink)

As the single most important experience in the lives of all people, the process and event of death must be handled carefully by the medical community. Twentieth-century advances in life-sustaining technology impose new areas of concern on those who are responsible for dying persons. Physicians and surrogates alike must be ready and willing to decide not to intervene in the dying process, indeed to hasten it, when they see the autonomy and dignity of patients threatened. In addition, the very ways (...) we talk about death and dying need to come under scrutiny, and it is likely that our technical advances should be parallelled by equally arduous advances in the semantic and rhetorical approaches we take to death. (shrink)

The COVID-19 pandemic has presented a global threat to physical and mental health worldwide. Research has highlighted adverse impacts of COVID-19 on wellbeing but has yet to offer insights as to how wellbeing may be protected. Inspired by developments in wellbeing science and guided by our own theoretical framework, we examined the role of various potentially protective factors in a sample of 138 participants from the United Kingdom. Protective factors included physical activity, tragic optimism, gratitude, social support, and nature connectedness. (...) Initial analysis involved the application of one-sample t-tests, which confirmed that wellbeing in the current sample was significantly lower compared to previous samples. Protective factors were observed to account for up to 50% of variance in wellbeing in a hierarchical linear regression that controlled for a range of sociostructural factors including age, gender, and subjective social status, which impact on wellbeing but lie beyond individual control. Gratitude and tragic optimism emerged as significant contributors to the model. Our results identify key psychological attributes that may be harnessed through various positive psychology strategies to mitigate the adverse impacts of hardship and suffering, consistent with an existential positive psychology of suffering. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Virtual GalleryJessica Evett-Miller (bio) Click for larger view View full resolutionImage 1. Click for larger view View full resolutionImage 2. Click for larger view View full resolutionImage 3. Click for larger view View full resolutionImage 4. Click for larger view View full resolutionImage 5. Click for larger view View full resolutionImage 6. Click for larger view View full resolutionImage 7. Click for larger view View full resolutionImage 8. Click (...) for larger view View full resolutionImage 9. Click for larger view View full resolutionImage 10. Click for larger view View full resolutionImage 11. Click for larger view View full resolutionImage 12. Click for larger view View full resolutionImage 13. Click for larger view View full resolutionImage 14. Click for larger view View full resolutionImage 15. Click for larger view View full resolutionImage 16.Jessica Evett-Miller Jessica Evett-Miller took these photographs during a trip to Italy and Sicily and assembled them for her senior project at the Alternative Community School in Ithaca’ New York. Now a freshman at Cornell University, she is planning to design an independent major in visual studies. She would like to dedicate thesephotographs toherfather, John Miller, and to thank him for his inspiration.She paired the front and back cover images (the first and the last) to create an interplay between the two. They function together rather than separately.Copyright © 1996 The Johns Hopkins University Press... (shrink)

“Hypertension in Blacks is a salt disease,” Dr. Anderson1 explained. “Too much salt overloads their renin-angiotensin system and their kidneys can’t handle it. It’s just the way their bodies work....

Organizational deviance represents a costly behavior to many organizations. While some precursors to deviance have been identified, we hope to add to our predictive capabilities. Utilizing social cognitive theory and psychological contract theory as explanatory concepts, we explore the role of moral disengagement and turnover intentions, testing our hypotheses using two samples: a sample of 44 nurses from a hospital system in the Southwestern United States (Study 1), and a sample of 52 working adults collected from an online survey system (...) (Study 2). Results strongly supported our hypotheses in both samples, indicating that the self-regulatory deactivation inherent in moral disengagement led to increased organizational deviance; effects that were much more pronounced when turnover intentions were high. Our findings support the increased role of cognition in determining behavior when environmental pressures stemming from the psychological contract have been altered, leading to a number of theoretical and practical implications, particularly in industries with high turnover rates. (shrink)

ABSTRACT Defining a nonpaternalistic yet achievable form of trust in medicine in an era of simultaneous patient empowerment and institutional control has been and remains an important task of bioethics. The ‘crisis of trust’ in medicine has been viewed mainly as the problem of getting patients to trust their health care providers, especially physicians. However, since paradigmatic cases of trust are mutual, bioethicists must pay more attention to physician trust in patients. A physician’s view of the reasonableness of trust in (...) a particular patient is affected not just by his or her relationship with that patient, but also by what is going on institutionally, professionally, legally, and politically with regard to a given treatment or intervention. Since general moral principles are insufficient in determining the moral value and reasonableness of trust in particular instances, I discuss in detail the role of trust and distrust in the specific case of treating patients with medications implicated in drug abuse. I conclude that it is important to become aware, first, of the clinical significance of physician trust and distrust in patients, and second, of the many factors which inform both of these moral attitudes. These two claims together suggest that a central, but overlooked, virtue of medical practice is reflective, context‐responsive trust in patients. (shrink)

Death and morality connect in interesting ways in Disney movies. In some Disney films, heroes are defined partly by their willingness to take risks that might result in death, as long as these risks are to protect or obtain good things that make human life worth living. A related ethical issue that Disney films address with regard to death is appropriate grief. Disney films, on balance, show an awareness and respect for the cycle of human life. Perhaps that is why (...) Disney reserves some of its worst deaths for evil characters who refuse to accept the fact of their own mortality. In all of the examples, Disney illustrates the connection many philosophers maintain between courage, cowardice, and death. Disney and Pixar films are so rich and popular that people should use them to engage in difficult conversations about death and other subjects. (shrink)

Principles of Philosophy was written in Latin by Rene Descartes. Published in 1644, it was intended to replace Aristotle's philosophy and traditional Scholastic Philosophy. This volume contains a letter of the author to the French translator of the Principles of Philosophy serving for a Preface and a letter to the most serene princess, Elizabeth, eldest daughter of Frederick, King of Bohemia, Count Palatine, and Elector of the Sacred Roman Empire. Principes de philosophie, by Claude Picot, under the supervision of Descartes, (...) appeared in 1647 with a letter-preface to Queen Christina of Sweden. (shrink)

Recent literature on trust commonly contains the claim that the trust which characterizes intimate relationships is a different phenomenon altogether from the trust that characterizes professional and other sorts of non-intimate relationships. In this paper I argue that while there are important differences among kinds of trust, an invidious distinction between trust in strangers and trust infriends is not only unwarranted but it obscures the fundamentally affective and relational base of all forms of interpersonal trust. In this essay I construct (...) an account of interpersonal trust, which recognizes the similarities that pervade its different forms. Without such a complex approach, we lose theoretical sight not only of key features of trust, but of the relationship of trust to significant dimensions of human existence. (shrink)

This paper explores the ways in which trust and distrust, especially among relative strangers, are connected to social identities and locations. It begins by sketching an account of interpersonal trust, emphasizing the role that socially salient identities, based in part upon cultural figurations, play in their development. It then contends that these cultural figurations both foster and result from distrust of specific social groups, including African Americans, the poor, and (some) women. Treating social roles and relations as central to moral (...) analysis enables an understanding of the injustice of some forms of social distrust which does not imply that one individual’s distrust of another is culpable in a straightforward way. The paper then develops the claim that one’s social location can affect the moral desirability of trust and distrust, concluding that social distrust can sometimes function as a kind of dissident attitude, a political stance with emancipatory potential. (shrink)

Robert Baker (2005) has urged that bioethicists develop a code of ethics on several related but distinct grounds: that, based on his analysis of the history of development of other professions, the...

In the early 2000s, several states legalized marijuana for medicinal uses. Since then, more and more states have either decriminalized or legalized marijuana use for medical or recreational purposes. Federal law has remained unchanged. The state-level decriminalization of marijuana and the concomitant de-stigmatizing and mainstreaming is likely to lead to greater use among the general population, including among nursing mothers. Marijuana is already one of the most widely used illicit substances among lactating women. There exist few studies demonstrating the effects (...) of marijuana in breast milk on nursing babies. In the present context of a changing legal landscape, shifting cultural beliefs, and the absence of clear professional guidelines, healthcare professionals are faced with ethical questions around how best to support nursing mothers and their babies when marijuana use is a factor. This paper first presents an overview of the law, science, and professional guidelines as they relate to marijuana and breastfeeding. Then, I offer an assessment of the relevant ethical issues providers and their patients may need to navigate. (shrink)

Ever since the constitutional revolution of the 1930s, constitutional law and theory have been dominated by questions of civil rights. The expansion of rights under the Warren Court constituted a deep-seated shift in judicial attitudes that has proved remarkably stable over time. Despite protests in some quarters that the Burger Court and the current Rehnquist Court have undermined civil rights recognized during the Warren Court era, the fact is that the changes have been surprisingly marginal. Even precedents that were widely (...) believed to be endangered species a decade ago – such as Miranda and Roe v. Wade – continue in force, although they have indeed been pruned back. Despite their importance, however, these high-profile cases do not go to the core of the Supreme Court's agenda. The core is epitomized by Brown v. Board of Education on the one hand, representing an aggressive and interventionist attitude toward government discrimination against discrete minorities, and footnote four of the Carotene Products case, on the other hand, representing an extraordinarily deference to the political process with respect to economic regulation. The Rehnquist Court's commitment to this core agenda is not dramatically different than that of its predecessors, at least not when the broad sweep of constitutional law is taken into account. (shrink)

Debriefing is a standard ethical requirement for human research involving the use of deception. Little systematic attention, however, has been devoted to explaining the ethical significance of debriefing and the specific ethical functions that it serves. In this article, we develop an account of debriefing as a tool of moral accountability for the prima facie wrong of deception. Specifically, we contend that debriefing should include a responsibility to promote transparency by explaining the deception and its rationale, to provide an apology (...) to subjects for infringing the principle of respect for persons, and to offer subjects an opportunity to withdraw their data. We also present recommendations concerning the discussion of deception in scientific articles reporting the results of research using deception. (shrink)

Asking people to discover the identity of a recognition test probe immediately before making a recognition judgment increases the probability of an old judgment. To inform theories of this “revelation effect,” event-related potentials were recorded for revealed and intact test items across two experiments. In Experiment 1, we used a revelation effect paradigm where half of the test probes were presented as anagrams and the other items were presented intact. The pattern of ERP results from this experiment suggested that revealing (...) an item decreases initial familiarity levels and caused the revealed items to elicit similar levels of activity. In Experiment 2, half of the probes were preceded by an addition task . The pattern of ERP effects in this study were distinct from those observed in Experiment 1. More specifically, revealed item ERPs were more negative than intact ERPs at frontal electrodes and more positive at parietal electrodes early in the interval. Later in the epoch, revealed item ERPs were more negative than intact items. These data suggest that related tasks decrease familiarity and alter the signal-to-noise ratio of old and new items, whereas unrelated tasks affect processing in a different way that also results in the revelation effect. The implications for current theories of the revelation effect are discussed. (shrink)

ABSTRACTWe investigated the impact of emotions on learning vocabulary in an unfamiliar language to better understand affective influences in foreign language acquisition. Seventy native English speakers learned new vocabulary in either a negative or a neutral emotional state. Participants also completed two sets of working memory tasks to examine the potential mediating role of working memory. Results revealed that participants exposed to negative stimuli exhibited difficulty in retrieving and correctly pairing English words with Indonesian words, as reflected in a lower (...) performance on the prompted recall tests and the free recall measure. Emotional induction did not change working memory scores from pre to post manipulation. This suggests working memory could not explain the reduced vocabulary learning in the negative group. We argue that negative mood can adversely affect language learning by suppressing aspects of native-language processing and impeding form-meaning mapping with second language words. (shrink)

Non-suicidal self-injury has consistently been associated with self-reported difficulties in emotion reactivity and the regulation of negative emotions; however, less is known about the accuracy of these self-reports or the reactivity and regulation of positive emotions. The present study sought to investigate differences between women with and without a history of NSSI on: self-reported general tendencies of negative and positive emotion reactivity, self-reported general tendencies of negative and positive emotion regulation, and emotion regulation reported in response to a positive and (...) negative mood induction. The sample consisted of 36 women with a recent history of NSSI within the last 2 years and a comparison group with no history of NSSI. Participants completed self-report measures of negative and positive emotion reactivity and regulation. In a separate session, participants underwent both a negative and positive mood induction using a counterbalanced design and reported their experienced emotions. Results from two-way MANOVAs and ANOVAs revealed those with a history of NSSI reported significantly greater difficulties in negative emotion reactivity and regulation than the no-NSSI comparison group; however, no group differences emerged in self-reported reactivity or regulation of positive emotions. In contrast, repeated measures ANOVAs on data from the mood induction task found no group differences in reactivity or regulation for either negative or positive emotions. These findings highlight the possibility that although individuals with a history of NSSI evaluate their ability to manage negative emotions as significantly worse than individuals with no history of self-injury, this may not reflect their actual emotion regulatory processes. (shrink)

The tropomyosins are a family of actin filament binding proteins. In multicellular animals, they exhibit extensive cell type specific isoform diversity. In this essay we discuss the genetic mechanisms by which this diversity is generated and its possible significance to cellular function.

The white sclera is important in facilitating gaze perception in humans. Iris color may likewise influence gaze perception but no previous studies have directly assessed its effect. We therefore examined how the interaction between sclera and iris color influences human gaze perception. We recorded the eye movements of human participants as they performed a visual search task with human faces exhibiting directed or averted gaze. The faces either exhibited light or dark irises. In addition, the faces had sclera that were (...) depigmented or pigmented. We found that participants were quick and accurate in evaluating gaze regardless of iris color in faces with depigmented sclera. When the sclera were pigmented, participants were slower to evaluate the gaze of faces with both light and dark irises but these effects were most pronounced in the faces with dark irises. Furthermore, participants were generally less accurate in assessing faces with pigmented sclera when the irises were dark rather than light. Our results suggest that depigmented sclera are especially important for gaze perception in faces with dark irises. Because depigmented sclera likely evolved at a time when ancestral humans exhibited dark irises, the depigmented sclera may have been crucial for efficient and accurate gaze perception in ancestral humans. (shrink)

This paper explores the ways in which trust and distrust, especially among relative strangers, are connected to social identities and locations. It begins by sketching an account of interpersonal trust, emphasizing the role that socially salient identities, based in part upon cultural figurations, play in their development. It then contends that these cultural figurations both foster and result from distrust of specific social groups, including African Americans, the poor, and (some) women. Treating social roles and relations as central to moral (...) analysis enables an understanding of the injustice of some forms of social distrust which does not imply that one individual’s distrust of another is culpable in a straightforward way. The paper then develops the claim that one’s social location can affect the moral desirability of trust and distrust, concluding that social distrust can sometimes function as a kind of dissident attitude, a political stance with emancipatory potential. (shrink)

Modern medical technology has made it possible for babies to survive with conditions that would have ended their lives only half a century ago. But complex health care interventions and regimens are not enough. These children require support, caregiving, and constant vigilance from their families, especially their parents. Sometimes referred to as children with "special needs," their dependency and vulnerability may stem from genetic disorders, premature births, serious accidents, or illness. This includes conditions such as severe autism spectrum disorder, Down (...) syndrome, hypoxic ischemic encephalopathy, Trisomy 13, Trisomy 18, Fragile X Syndrome, spina bifida, and brain damage... (shrink)

Objectives: Neuroplastic changes that drive recovery of shoulder/elbow function after stroke have been poorly understood. The purpose of this study was to determine the relationship between neuroplastic brain changes related to shoulder/elbow movement control in response to treatment and recovery of arm motor function in chronic stroke survivors.Methods: Twenty-three chronic stroke survivors were treated with 12 weeks of arm rehabilitation. Outcome measures included functional Magnetic Resonance Imaging (fMRI) for the shoulder/elbow components of reach and a skilled motor function test (Arm (...) Motor Abilities Test, AMAT), collected before and after treatment.Results: We observed two patterns of neuroplastic changes that were associated with gains in motor function: decreased or increased task-related brain activation. Those with significantly better motor function at baseline exhibited a decrease in brain activation in response to treatment, evident in the ipsilesional primary motor and contralesional supplementary motor regions; in contrast, those with greater baseline motor impairment, exhibited increased brain activation in response to treatment. There was a linear relationship between greater functional gain (AMAT) and increased activation in bilateral primary motor, contralesional primary and secondary sensory regions, and contralesional lateral premotor area, after adjusting for baseline AMAT, age, and time since stroke.Conclusions: Recovery of functional reach involves recruitment of several contralesional and bilateral primary motor regions. In response to intensive therapy, the direction of functional brain change (i.e., increase or decrease in task-related brain recruitment) for shoulder/elbow reach components depends on baseline level of motor function and may represent either different phases of recovery or different patterns of neuroplasticity that drive functional recovery. (shrink)