This investigation is intended to explore the effect of the digital environment as well as perfectionism during the COVID-19 pandemic on anxiety and depression. The study used a mixed-methods design; a mixed research methodology was used regarding explanatory design by using a qualitative sub-sample from quantitative sample data. The researcher conducted the study on a sample of 980 students and non-students smartphone and internet users using both qualitative and quantitative approach. Three different questionnaires were used: The Multidimensional Perfectionism Scale, Beck (...) Depression, and Beck Anxiety Inventory. On the other hand, the researcher designed a self-reported interview for the qualitative part that included 5 major questions and 10 sub-questions. The gathered data were investigated using SPSS version 22 to analyze the collected data for this study, and simple descriptive statistics and coding were used. The results denote that the digital environment is significantly correlated with multidimensional perfectionism in a low positive manner for students. However, the correlation effects for non-students are significantly high as evidenced by a significant positive correlation. Another finding suggests that there is a positive significant association between perfectionism and being depressed and anxious. (shrink)

This paper will discuss why and how social network sites ought to be used in surrogate decision making (SDM), with focus on a context like Singapore in which substituted judgment is incorporated as part of best interest assessment for SDM, as guided by the Code of Practice for making decisions for those lacking mental capacity under the Mental Capacity Act (2008). Specifically, the paper will argue that the Code of Practice already supports an ethical obligation, as part of a patient-centred (...) care approach, to look for and appraise social network site (SNS) as a source of information for best interest decision making. As an important preliminary, the paper will draw on Berg’s arguments to support the use of SNS information as a resource for SDM. It will also supplement her account for how SNS information ought to be weighed against or considered alongside other evidence of patient preference or wishes, such as advance directives and anecdotal accounts by relatives. (shrink)

Respect for autonomy is a key concept in contemporary bioethics and in ethics at the end of life in particular. An individualistic interpretation of autonomy may not incorporate the aspects of consideration that patients may have for their wider construct of personhood, which includes their love and consideration for their families. This anonymous case describes the intricacies of a patient’s decision making at the end of life, the choices she made, and how her decisions changed as her situation evolved. The (...) tension this produced within the medical team is unpacked using a lens of compassionate care in the intensive care unit. (shrink)

Brain death certification can be a clinically and ethically challenging affair. Healthcare workers are expected to refer patients for brain death certification to identify potential organ donors, but family members may be ill-prepared for this turn of events. Already distraught families may not appreciate delays in brain death certification, but such delays are common because of the need to manage the patient’s altered physiological state to allow testing. Opportunities for donation are sometimes lost because of the unnecessary delay. With focus (...) on an opt-out organ donation law, we discuss causes of delays in brain death certification, and the ethical issues faced by clinicians in using tests to certify patients. To resolve the issues, we argue for the use of supplementary confirmatory tests as part of a more protocol-driven approach to brain death certification to avoid delays. Such tests should be regarded as part of the donation process funded by the state. (shrink)

What is the responsibility of the physician when a capacitated patient assigns decision-making authority to a surrogate who does not act in the patient’s best interest?

In the case described here, an often recurring and unresolved scenario is presented where communication issues are underpinned by pre-existing perceptions of mistrust between the caregivers and the surrogate family members in the intensive care unit. Racial factors play into this mistrust, when a family feel that their loved one is “yet again” not being treated in the best way possible. The perspectives of all stakeholders are considered in the discussion and relevant literature is cited.

Background The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. Research Objectives The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. Research Design This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual interviews (...) that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. Results Four key themes described the threats to women’s dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. Conclusion The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth. (shrink)

Objective: We hypothesized that the reasons behind this tension are complex and can be understood better by applying social psychology theory.Design: A qualitative methodology was drawn on for data collection and thematic analysis, with focus group discussions adopted for interviews with patient families and ICU physicians. Additionally, we used a social psychology theory, the reasoned action approach (RAA) framework, to understand these tensions.Setting: Two 15-bedded ICUs of an academic university–affiliated teaching hospital in Singapore.Subjects: A total of 72 physicians and family (...) members of older ICU patients (>70 years old).Measurements and Main Results: The primary analysis revealed five areas of tension around prognostication in the ICU. These dealt with issues of divergent views, different role expectations, conflicting emotional responses, and issues of communication and trust. Further analysis helped to identify underlying factors leading to tensions and behaviors. Differences in prognostication and in expectation of outcomes between clinicians and family members were the main cause of tensions. When the RAA framework was applied, these tensions could be predicted early on and understood more clearly.Conclusions: Tensions revolve around losing control of the patient’s care, differences between hopeful expectations and clinical prognostication, perceived biases of physicians, and underlying mistrust between families and physicians. (shrink)

Apart from the stylistic and cognitive studies which have already been done separately on Miller’sThe Crucible, this paper provides a new insight into the play and its system of characterization by integrating these approaches. To this end, the paper draws on Jonathan Culpeper’s cognitive stylistic theory of top-down and bottom-up processes in literary text comprehension and characterization. Based on this holistic framework, the paper takes advantage of such stylistic tools as speech acts, the Cooperative Principle and politeness theory to examine (...) features of the language used by the characters Proctor and Danforth. In this regard, the article assimilates those linguistic elements with the embedded schemata within the play. Consequently, the study reveals that Proctor’s complex characterization does not coincide with the readers’ schema and thus they form their impression of his character based on piecemeal integration. On the other hand, Danforth’s character reinforces the readers’ schema about a representative of the church discourse and thus they comprehend his character on the basis of confirmatory categorization. The paper concludes that while Proctor and Danforth have a passive existence in the text or in people’s minds, it is only in the interaction between their language and the readers’ minds that they come into existence. (shrink)