Academic dishonesty, including cheating and plagiarism, is on the rise in colleges, particularly among engineering students. While students decide to engage in these behaviors for many different reasons, academic integrity training can help improve their understanding of ethical decision making. The two studies outlined in this paper assess the effectiveness of an online module in increasing academic integrity among first semester engineering students. Study 1 tested the effectiveness of an academic honesty tutorial by using a between groups design with a (...) Time 1- and Time 2-test. An academic honesty quiz assessed participants’ knowledge at both time points. Study 2, which incorporated an improved version of the module and quiz, utilized a between groups design with three assessment time points. The additional Time 3-test allowed researchers to test for retention of information. Results were analyzed using ANCOVA and t tests. In Study 1, the experimental group exhibited significant improvement on the plagiarism items, but not the total score. However, at Time 2 there was no significant difference between groups after controlling for Time 1 scores. In Study 2, between- and within-group analyses suggest there was a significant improvement in total scores, but not plagiarism scores, after exposure to the tutorial. Overall, the academic integrity module impacted participants as evidenced by changes in total score and on specific plagiarism items. Although future implementation of the tutorial and quiz would benefit from modifications to reduce ceiling effects and improve assessment of knowledge, the results suggest such tutorial may be one valuable element in a systems approach to improving the academic integrity of engineering students. (shrink)

In Psychoanalysis as a Subversive Phenomenon, Amber M. Trotter explores processes of social change, highlights the role of ethics, and illuminates ways in which analytic theory and practice can disrupt contemporary American culture.

This arts- based project creatively introduces residents to photography, self-portraiture and narratives to document the longitudinal journey of becoming a family physician. Visual arts and writing can foster reflection: an important skill to cultivate in developing physicians. Unfortunately, arts based programs are lacking in many residency programs. Tools and venues that nourish physician well being and resilience may be important in today’s changing healthcare environment and epidemic of physician burnout. Residents created self-portraits with accompanying narratives throughout their three-year training. Analysis (...) of the portraits and accompanying narratives completed the assessment. Residents created a body of work that includes 182 creative and deeply personal portraits and narratives. The five most frequent themes of portraits included “Residency is Difficult,” “Hobbies,” “Family,” “Growing as a Doctor,” and “Coping Mechanisms.” Self-portrait photography and reflection gives insight into the journey of becoming a family medicine physician at a deeply personal and professional level. Further partnerships between residency programs and the arts should be explored to promote reflection. (shrink)

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice—the capacity to benefit, personal responsibility, and need—to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women (...) who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice. (shrink)

We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to “need” and “the capacity to benefit”. Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and (...) Wagstaff offers a visual and conceptual aid. Of the eight principles we illustrate, only two treat as relevant both a person’s initial health state and a person’s CTB per resource unit expended: allocate resources so as to most closely equalize final health states and allocate resources so as to equally restore health states to population norms. These allocative principles ought to be preferred to the alternatives if one deems relevant both a person’s initial health state and a person’s CTB per resource unit expended. Finally, we examine some possibilities for conceptualizing benefits as relative to how badly off someone is, extending Parfit’s thought on Prioritarianism. Questions arise as to how much intervention effects accruing to the worse off count for more and how this changes with improving health. We explicate some recent efforts to answer these questions, including in Dutch and British government circles. These efforts can be viewed as efforts to operationalize need as an allocative principle. Each effort seeks to maximize in the aggregate quanta of effect that are differentially valued in favor of the worst off. In this respect, each effort constitutes one type of Prioritarianism, which Parfit failed to differentiate from other types. (shrink)

New agrifood technologies are often difficult to grasp for the public, which may lead to resistance or even rejection. Insight into which technology features determine public acceptability of the technology could offer guidelines for responsible technology development. This paper systematically assesses the relative importance of specific technology features for consumer response in the agrifood domain in two consecutive studies. Prominent technology features were selected from expert judgment and literature. The effects of these features on consumer evaluation were tested in a (...) consumer study. Fictitious technologies were used to avoid any uncontrollable contextual influences that existing new technologies may evoke. Results show that technologies that were seen as more natural and newer were perceived less risky, more beneficial, and were evaluated more positively. Technologies applied to food were judged to be more beneficial, but also more risky than those applied to non-food. Technologies used in the production process were perceived to be less risky and evaluated more positively than those used in the product. Technologies owned by the market leader were perceived to be more beneficial, and evaluated more positively than those that were freely available. In a next study, effects of the technology features on consumer response were tested for existing new agrifood technologies. This study replicated the results for perceived naturalness, perceived newness, and place in the production process where the technology is applied. However, in contrast to the first study, we did not find an effect of application area and technology ownership. (shrink)

We explored the relationship between qualities of victims in hypothetical scenarios and the appearance of framing effects. In past studies, participants’ feelings about the victims have been demonstrated to affect whether framing effects appear, but this relationship has not been directly examined. In the present study, we examined the relationship between caring about the people at risk, the perceived interdependence of the people at risk, and frame. Scenarios were presented that differed in the degree to which participants could be expected (...) to care about the group and the extent to which the group could be construed as interdependent. A framing effect was found only for the scenario describing the victims as the participants’ friends who did not know each other (high caring/low interdependence), and this went in the opposite direction from typical framing effects. Finally, perceived interdependence and caring affected choice both within and across scenarios, with more risky choices made by participants with high interdependence ratings and high caring ratings. (shrink)

Concern about the integrity of empirical research has arisen in recent years in the light of studies showing the vast majority of publications in academic journals report positive results, many of these results are false and cannot be replicated, and many positive results are the product of data dredging and the application of flexible data analysis practices coupled with selective reporting. While a number of potential solutions have been proposed, the effects of these are poorly understood and empirical evaluation of (...) each would take many years. We propose that methods from the systems sciences be used to assess the effects, both positive and negative, of proposed solutions to the problem of declining research integrity such as study registration, Registered Reports, and open access to methods and data. In order to illustrate the potential application of systems science methods to the study of research integrity, we describe three broad types of models: one built on the characteristics of specific academic disciplines; one a diffusion of research norms model conceptualizing researchers as susceptible, “infected” and recovered; and one conceptualizing publications as a product produced by an industry comprised of academics who respond to incentives and disincentives. (shrink)

In their analyses of the neural correlates of discrete emotionality, Lindquist et al. do not consider the numerous drawbacks to inferring psychological processes based on currently available cognitive neurometric technology. The authors also disproportionately emphasize the relevance of neuronal activation over deactivation, which, in our opinion, limits the scope and utility of their conclusions.

Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

Infants are sensitive to statistical regularities (i.e., transitional probabilities, or TPs) relevant to segmenting words in fluent speech. However, there is debate about whether tracking TPs results in representations of possible words. Infants show preferential learning of sequences with high TPs (HTPs) as object labels relative to those with low TPs (LTPs). Such findings could mean that only the HTP sequences have a word‐like status, and they are more readily mapped to a referent for that reason. But these findings could (...) also suggest that HTP sequences are easier to encode, just like any other predictable sequence. Here we aimed to distinguish between these explanations. To do so, we built on findings that infants become resistant to learning labels that are not typical of their native language as they approach 2 years of age and add words to their lexicons. If tracking TPs in speech results in identifying candidate words, at this age TPs may have reduced power to confer lexical status when they yield a unit that is very dissimilar to word forms that are typical of infants’ native language. Indeed, we found that at 20 months, English‐learning infants with relatively small vocabularies learned HTP Italian words (but not LTP words) as object labels, while infants with larger vocabularies resisted learning HTP Italian words. These findings suggest that the HTP sequences may be represented as candidate words, and more broadly, that TP statistics are relevant to word learning. (shrink)

The increasing demand for transparency in AI has recently come under scrutiny. The question is often posted in terms of “epistemic double standards”, and whether the standards for transparency in AI ought to be higher than, or equivalent to, our standards for ordinary human reasoners. I agree that the push for increased transparency in AI deserves closer examination, and that comparing these standards to our standards of transparency for other opaque systems is an appropriate starting point. I suggest that a (...) more fruitful exploration of this question will involve a different comparison class. We routinely treat judgments made by highly trained experts in specialized fields as fair or well-grounded even though—by the nature of expert/layperson division of epistemic labor—an expert will not be able to provide an explanation of the reasoning behind these judgments that makes sense to most other people. Regardless, laypeople are thought to be acting reasonably—and ethically—in deferring to the judgments of experts that concern their areas of specialization. I suggest that we reframe our question regarding the appropriate standards of transparency in AI as one that asks when, why, and to what degree it would be ethical to accept opacity in AI. I argue that our epistemic relation to certain opaque AI technology may be relevantly similar to the layperson’s epistemic relation to the expert in certain respects, such that the successful expert/layperson division of epistemic labor can serve as a blueprint for the ethical use of opaque AI. (shrink)

It is commonly maintained that neuroplastic mechanisms in the brain provide empirical support for the hypothesis of multiple realizability. We show in various case studies that neuroplasticity stems from preexisting mechanisms and processes inherent in the neural structure of the brain. We argue that not only does neuroplasticity fail to provide empirical evidence of multiple realization, its inability to do so strengthens the mind-body identity theory. Finally, we argue that a recently proposed identity theory called Flat Physicalism can be enlisted (...) to explain the current state of the mind-body problem more adequately. (shrink)

This article proposes potential strategies to address gun violence in communities of color while identifying the harms associated with a policing-centered, criminal legal approach. In addition to highlighting the dangers associated with the United States' current criminal legal tactics to reduce gun violence in these communities, the authors advocate for community-endorsed strategies that give those impacted by this issue the resources to take on gun violence in their own communities. Specifically, they identify, describe, and endorse a series of violence prevention (...) programs that rely on community relations to detect and prevent incidents of gun violence and that view gun violence as a public health rather than criminal legal issue. (shrink)

Microbiome science asserts humans are made up of more microbial cells and genes than human ones, and that each person harbors their own unique microbial population. Human microbiome studies gesture toward the post-racial aspirations of personalized medicine—characterizing states of human health and illness microbially. By viewing humans as “supraorganisms” made up of millions of microbial partners, some microbiome science seems to disrupt binding historical categories often grounded in racist biology, allowing interspeciality to supersede race. But inevitably, unexamined categories of race (...) and ethnicity surface in a myriad of studies on microbiota. This paper approaches race as a ghost variable across microbiome research and asks, what is race doing in studies of the microbiome? Why is it there, and how is it functioning? I examine this research to argue that social scientists must work with biological scientists to help put microbial differences into perspective—to investigate how microbiomes and race are entangled embodiments of the social, environmental, and biological. Ultimately, transdisciplinary collaboration is required to address racial health disparities in microbiome research without reifying race as a straightforward biological or social designation. (shrink)

Moral understanding is a species of knowledge. Understanding why an action is wrong, for example, amounts to knowing why the action is wrong. The claim that moral understanding is immune to luck while moral knowledge is not does not withstand scrutiny; nor does the idea that there is something deep about understanding for there are different degrees of understanding. It is also mistaken to suppose that grasping is a distinct psychological state that accompanies understanding. To understand why something is the (...) case is to grasp or see why something is the case and grasping and seeing are ways of knowing. (shrink)

This study analyzes discussions from online language teacher education to understand how conversations between monolingual and bilingual preservice teachers (PSTs) in the US create and delimit structural constraints on teachers’ agency, (re)positioning teachers’ capacity to act in the instruction of emergent bilingual students (EBs). Employing positioning theory within a critical discursive psychology approach, findings demonstrate how bilingual PSTs pushed back on structural constraints introduced as potential barriers to achieving linguistic pluralism in monolingual teachers’ posts, asserting teachers’ agency by simultaneously positioning (...) themselves and others as capable and responsible for education of EBs. These findings inform theoretical understandings of agency as a discursive construct and offer insights for teacher educators as they conceptualize the role of discursive exchanges in developing PSTs’ understanding of structures and agentive possibilities regarding the equitable education of EBs. (shrink)

In this article I explore Mary Midgley's meta-philosophy: her view of the purpose of philosophy and its corresponding methodology. After some biographical information and historical context, I consider Midgley's answer to the question ‘why do we need philosophy?’.

ABSTRACTEffects of metaphorical framing of political issues on opinion have been studied widely by two approaches: a critical-discourse approach and a response-elicitation approach. The current article reports a systematic literature review that examines whether these approaches report converging or diverging effects. We compared CDA and REA on the metaphorical frames that were studied and their reported effects. Results show that the CDA frames are typically more negative, nonfictional, and extreme than REA frames. Reported effects in CDA and REA studies differ (...) in terms of presence, directionality, and strength, with CDA typically reporting strong effects in line with the frame, compared to REA. These differences in effects can be explained by the different frame characteristics. However, differences in the methods applied by CDA and REA could be responsible for these differences as well. In all, we conclude that the research field is fragmented on the impact of metaphors in politics. (shrink)

Recent studies of the low abundant signaling lipid, phosphatidylinositol 3,5‐bisphosphate (PI(3,5)P2), reveal an intriguingly diverse list of downstream pathways, the intertwined relationship between PI(3,5)P2 and PI5P, as well as links to neurodegenerative diseases. Derived from the structural lipid phosphatidylinositol, PI(3,5)P2 is dynamically generated on multiple cellular compartments where interactions with an increasing list of effectors regulate many cellular pathways. A complex of proteins that includes Fab1/PIKfyve, Vac14, and Fig4/Sac3 mediates the biosynthesis of PI(3,5)P2, and mutations that disrupt complex function and/or (...) formation cause profound consequences in cells. Surprisingly, mutations in this pathway are linked with neurological diseases, including Charcot‐Marie‐Tooth syndrome and amyotrophic lateral sclerosis. Future studies of PI(3,5)P2 and PI5P are likely to expand the roles of these lipids in regulation of cellular functions, as well as provide new approaches for treatment of some neurological diseases. (shrink)

We analyze the environmental implications of basic income programs through literature review, government documents, pilot studies, and interviews eliciting expert knowledge. We consider existing knowledge and then use a grounded approach to produce theory on the relationship between a basic income guarantee and environmental protection/damage. We find that very little empirical or theoretical work has been done on this relationship and that theoretical arguments can be made for both positive and negative environmental impacts. Ultimately, this implies, the environmental impact of (...) a basic income program will be dependent on program design. These insights allow us to generate a toolkit of policy proposals to assist in the development of green basic income programs via either conditions, additions, or complements. (shrink)

This collection addresses a post-WWII shift in the hierarchy of scientific explanations, where the highest goal moves from reductionism towards some ...

Noninvasive prenatal testing promises to enhance women's reproductive autonomy by providing genetic information about the fetus, especially in the detection of genetic impairments like Down syndrome. In practice, however, NIPT provides opportunities for intensified manipulation and control over women's reproductive decisions. Applying Miranda Fricker's concept of epistemic injustice to prenatal screening, this article analyzes how medical professionals impair reproductive decision-making by perpetuating testimonial injustice. They do so by discrediting positive parental testimony about what it is like to raise a child (...) with DS. We argue that this testimonial injustice constitutes a twofold harm: people with DS and their family members who claim that parenting a child with DS may be a rewarding and joyous experience are harmed when they are systematically silenced, disbelieved, and/or denied epistemic credibility by medical professionals, and pregnant women are harmed since they might make poorly informed choices without access to all relevant information. The broader implication of the analysis is that epistemic justice is a precondition of reproductive autonomy. We conclude by calling for federal oversight of the acquisition and dissemination of information that prospective parents receive following a positive diagnosis of DS to ensure that it is comprehensive and up to date. (shrink)

More than two decades after the passage of the Americans with Disabilities Act , people with disabilities continue to live at the margins of American democracy and capitalist society. This persistent exclusion poses a conundrum to political theorists committed to disability rights, multiculturalism, and social justice. Drawing from feminist insights, specifically the work of Nancy Fraser, among others, I examine the necessary conditions for meaningful inclusion to be realized within a deliberative democracy. Using Fraser's concept of “participatory parity” as a (...) proxy for inclusion, I strategize how to overcome informal barriers—economic inequality and misrecognition—that persist even after disabled people are granted the legal right to participate. The analysis concludes that a truly inclusionary and multicultural democracy requires the redistribution of wealth and a more expansive model of political deliberation, one that can recognize unconventional modes of communication through practices of translation. (shrink)

Point-of-care evidence-based medicine websites allow physicians to answer clinical queries using recent evidence at the bedside. Despite significant research into the function, usability and effectiveness of these programmes, little attention has been paid to their ethical issues. As many of these sites summarise the literature and provide recommendations, we sought to assess the role of conflicts of interest in two widely used websites: UpToDate and Dynamed. We recorded all conflicts of interest for six articles detailing treatment for the following conditions: (...) erectile dysfunction, fibromyalgia, hypogonadism, psoriasis, rheumatoid arthritis and Crohn's disease. These diseases were chosen as their medical management is either controversial, or they are treated using biological drugs which are mostly available by brand name only. Thus, we hypothesised that the role of conflict of interest would be more significant in these conditions than in an illness treated with generic medications or by strict guidelines. All articles from the UpToDate articles demonstrated a conflict of interest. At times, the editor and author would have a financial relationship with a company whose drug was mentioned within the article. This is in contrast with articles on the Dynamed website, in which no author or editor had a documented conflict. We offer recommendations regarding the role of conflict of interest disclosure in these point-of-care evidence-based medicine websites. (shrink)

Plato articulates a deep perplexity about inquiry in ?Meno's Paradox??the claim that one can inquire neither into what one knows, nor into what one does not know. Although some commentators have wrestled with the paradox itself, many suppose that the paradox of inquiry is special to Plato, arising from peculiarities of the Socratic elenchus or of Platonic epistemology. But there is nothing peculiarly Platonic in this puzzle. For it arises, too, in classical Indian philosophical discussions, where it is formulated with (...) great clarity, and analysed in a way that casts it in a new light. We present three treatments of the puzzle in Indian philosophy, as a way of refining and sharpening our understanding of the paradox, before turning to the most radical of the Indian philosophers to tackle it. The Indian philosophers who are optimistic that the paradox can be resolved appeal to the existence of prior beliefs, and to the resources embedded in language to explain how we can investigate, and so move from ignorance to knowledge. Highlighting this structural feature of inquiry, however, allows the pessimist philosopher to demonstrate that the paradox stands. The incoherence of inquiry is rooted in the very idea of aiming our desires at the unknown. Asking questions and giving answers rests on referential intentions targeting objects in a region of epistemic darkness, and so our ?inquiry sceptic? also finds structurally similar forms of incoherence in the pragmatics of interrogative discourse. (shrink)

While Kierkegaard creates characters who represent various ways of existing as lovers in the aesthetic and the ethical spheres, namely, Johannes the Seducer and Judge William, he does not have a corresponding character for love in the religious sphere. Is there truly only marginal space for romantic love in Kierkegaard’s religious sphere, or did his own personal history prevent him from being able to imagine what that might look like? This paper examines a commonly overlooked discourse, “On the Occasion of (...) a Wedding,” for Kierkegaardian insights on erotic love in the religious sphere. Against understanding erotic love as a moment (in the aesthetic sphere), or a duty (in the ethical sphere), this paper explores how “On the Occasion of a Wedding” recasts erotic love as gift. Kierkegaard stages the “imagined occasion” of a wedding as a phenomenological reduction through which love presents itself with gift‐like characteristics. Respecting the gift‐status of love transforms the lover into a grateful recipient rather than a seducer or a conqueror. This paper concludes that the proper response to love as gift would be neither to refuse it in favor of nihilistic uncertainty nor to possess it through triumphalistic objectivity, but to humbly embrace both its “already” and its “not yet” dimensions. (shrink)

Aristotle bequeathed to us a powerful metaphysical picture, of substances in which properties inhere. The picture has turned out to be highly problematic in many ways; but it is nevertheless a picture not easy to dislodge. Less obvious are the normative tones implicit in the picture and the way these permeate our system of values, especially when thinking of ourselves and our ambitions, hopes and fears. These have proved, if anything, even harder to dislodge than the metaphysical picture which supports (...) them. This paper first draws out the ethics suggested by a conception of being as individual substances, and finds both inner tensions among these values—expressed in divergent characteristics in the history of philosophy—and a neglect of a significant set of values. Substance metaphysics prefers freedom, independence and autonomy over relational and reciprocal values, which can even be regarded as existentially threatening. A prominent attempt to accommodate both sorts of values without eschewing substantialist metaphysics is briefly considered, before turning to examine an alternative metaphysics and the values it implies. A metaphysics which takes being as becoming, it is argued, supports an ethics centred on relational values, and their associated virtues of care. (shrink)

A survey was conducted on the advertising practitioners in Taiwan concerning their experiences of ethical challenges at work. Among 120 respondents, while 32.5 percent responded that ethical problems did not exist, 67.5 percent admitted that ethical problem was a commonplace at work. According to these respondents, the most frequently mentioned ethical problems area representing unethical products or services, the message of advertisements, agency-client relationship, the creditability of research, undertable rebate, and the quality of service. Suggestions for international advertising managers were (...) also provided by comparing the finding from the present study with earlier studies in the United States. However, due to its preliminary nature, the present study should be considered exploratory and descriptive rather than conclusive, with the hope to inspire more research on advertising ethics in Taiwan as well as in other countries in the world. (shrink)

Objectives The use of empathy during clinical practice is paramount to delivering quality patient care and is important for understanding patient concerns at both the cognitive and affective levels. This study sought to determine how and when physicians self-report the use of empathy when interacting with their patients. Methods A cross-sectional survey of 76 physicians working in a large urban hospital was conducted in August of 2017. Physicians were asked a series of questions with Likert scale responses as well as (...) asked to respond to open-ended questions. Results All physicians self-report that they always (69%) or usually (29.3%) use empathic statements when engaging with patients. 93.1% of physicians believe that their colleagues always (20.7%) or usually (69%) use empathic statements when communicating with patients. Nearly one-third of physicians (33%) indicated that using the words “I understand” denotes an empathic statement. Although 36% of physicians reported that they would like to receive more training or assistance about how and when to use empathy during clinical practice. Significance of Results Despite the self-reported prevalent use of empathic statements, one-third of physicians indicate a desire for more training in what empathy means and when it should be used in a clinical setting. Additionally, nearly one-third of physicians in this study reported using responses that patients may not perceive as being empathic, even when intended to be empathic. This suggests that many physicians feel uncertain about a clinical skill they believe should be used in most, if not all, encounters. (shrink)

Implantable cardioverter defibrillators (ICDs) reduce mortality in selected patients at risk for life-threatening heart arrhythmias, and their use is increasingly common. However, these devices also confer risk for delivery of unexpected painful shocks during the dying process, thus reducing the quality of palliative care at the end of life. This scenario can be avoided by ICD deactivation in appropriate circumstances but patients will remain unaware of this option if not informed about it. It is not known how often end-of-life implications (...) are discussed with patients prior to ICD implantation, when focus is primarily on the short-term potential complications of the device placement procedure itself. We conducted a retrospective chart review to determine how often end-of-life implications were discussed with patients as part of the informed consent process. We evaluated consent forms and related other chart documentation for 91 patients (ranging from age 60 to 89 years) undergoing first-time ICD placement at a mid-western academic medical center from 2006-2008. Only one chart documented any discussion of end-of-life implications, in a case where the issue was raised by a patient who noted that quality of life was their main focus. Consent was provided by a health care surrogate in only four of the 91 cases. In conclusion, patients giving consent for ICD implantation may be uninformed about the device's potential future impact on end-of-life care, the dying process, and the option for device deactivation. Truly informed consent requires that both short- and long-term potential implications be reviewed with patients. (shrink)