Volume 19, Issue 11, November 2019, Page 37-39.

Background: Little is known about what factors may contribute to the growth of a consultation service or how a practice may change or evolve across time. Methods: This study examines data collected from a busy ethics consultation service over a period of more than two decades. Results: We report a number of longitudinal findings that represent significant growth in the volume of ethics consultation requests from 19 in 1990 to 551 in 2013, as well as important changes in the patient (...) population for which ethics help is requested. The findings include (1) a steady growth in requests from primary care providers (e.g., physicians and nurses), as well as increases in ancillary services (e.g., social workers); (2) a decrease in length of stay (days) before ethics help is requested; (3) an increase in the reasons that individuals ask for help from ethics; (4) an upsurge in consults requests from areas outside the intensive care unit (ICU); (5) a decrease in patients that died during hospitalization (e.g., live discharges); and (6) growth in the numbers of patients lacking decision-making capacity. Conclusions: We believe the increases in consult requests reflect appropriate and necessary growth because recent consultations have also been associated with consultations requiring (7) additional interventions and (8) reasonably high time intensity scores. (shrink)

Influences on the perception of affordances (i.e., opportunities for actions) have been primarily studied by manipulating the functional morphology of the body. However, affordances are not just determined by the functional morphology of the perceiver, but also by the physiological state of the perceiver. States of anxiety have been shown to lead to marked changes in individuals’ physiological state and their behaviour. To assess the influence of emotional state on affordance perception, the perception of action capabilities in near space was (...) examined after participants completed an anxiety-provoking task. Anxiety was induced immediately prior to tasks that assessed participants' perceived reaching ability in Experiment 1, grasping ability in Experiment 2, and the ability to pass their hands through apertures in Experiment 3. Results indicated that those participants who experienced changes in anxiety underestimated their reaching, grasping, and passing ability compared to non-anxious participants. In other words, anxious participants were more conservative in their estimations of their action capabilities. These results suggest that anxiety influences the perception for affordances in near space and are consistent with the notion that anxiety induces withdrawal behaviours. (shrink)

Volume 19, Issue 10, October 2019, Page 68-70.

Given the extreme focus on perceived physical defects in body dysmorphic disorder (BDD), we expected that perceptual and cognitive biases related to physical appearance would be associated with BDD...

Donation after cardiac death (DCD) traditionally occurs in two patient populations: (1) those who do not meet neurological death criteria but who have suffered severe neurological damage, and (2) those who are fully alert and awake but are dependent on machines. This case highlights the unique dilemma when a patient falls between these two populations—conscious and cognitively intact, but completely paralyzed except for limited eye movement, afflicted by what the medical community refers to as locked-in syndrome. Prompted by the treatment (...) team’s discomfort, an ethics consultant examined whether the team was obligated to discuss a decision to donate with the patient, who was a registered organ donor. This article shows how, in determining whether or not to talk to the patient or family during end-of-life decision making, the weight assigned to the various ethical concerns in the case— the patient’s condition, the decision to be made, and the family’s agreement or disagreement regarding the patient’s wishes—can “swing the pendulum” of ethical analysis in different ways. The comfort of the patient must be accorded the highest priority, as well as the needs of the patient’s family. This case study highlights the nuanced contextual factors necessary to guide a treatment team’s approach to DCD for a patient with uncertain decision-making capacity. (shrink)

The lysine demethylase KDM5A collaborates with PARP1 and the histone variant macroH2A1.2 to modulate chromatin to promote DNA repair. Indeed, KDM5A engages poly(ADP‐ribose) (PAR) chains at damage sites through a previously uncharacterized coiled‐coil domain, a novel binding mode for PAR interactions. While KDM5A is a well‐known transcriptional regulator, its function in DNA repair is only now emerging. Here we review the molecular mechanisms that regulate this PARP1‐macroH2A1.2‐KDM5A axis in DNA damage and consider the potential involvement of this pathway in transcription (...) regulation and cancer. Using KDM5A as an example, we discuss how multifunctional chromatin proteins transition between several DNA‐based processes, which must be coordinated to protect the integrity of the genome and epigenome. The dysregulation of chromatin and loss of genome integrity that is prevalent in human diseases including cancer may be related and could provide opportunities to target multitasking proteins with these pathways as therapeutic strategies. (shrink)

Even though the measurement of fear of crime in criminological research commenced a few decades ago, specific populations, such as social activists, remain undocumented. This article is an attempt to address this gap. A study was conducted among 153 social activists involved in exposing corruption and irregularities that take place in the government system in India. This article explores the gap between the fear of crime and actual victimization among the specific social activists in India. The results indicate activists expressed (...) moderate fear of any one form of victimization including verbal and emotional, physical, and sexual victimization. It was also found that one-third of them have reported facing some form of abuse. The research implications are discussed. (shrink)

Affective variables have been shown to impact working memory and cognitive control. Theoretical arguments suggest that the functional impact of emotion on cognition might be mediated through shifting action dispositions related to changes in motivational orientation. The current study examined the effects of positive and negative affect on performance via direct manipulation of motivational state in tasks with high demands on cognitive control. Experiment 1 examined the effects of monetary reward on task-switching performance, while Experiment 2 examined the effects of (...) both rewards and punishments on working memory, using primary (liquid) reinforcers. In both experiments, dissociable trial-by-trial and contextual (block-related) enhancements of cognitive control during task performance were observed in relationship to motivational incentive value. Performance enhancements were equivalent in the reward and punishment conditions, but were differentially impacted by individual difference measures of trait reward and punishment sensitivity. Together, the results suggest both common and specific mechanisms by which approach and avoidance motivational states influence cognitive control, via activation of reward and punishment processing systems. (shrink)

Despite an abundance of academic conferences, clinical ethicists lacked a forum to share innovative practices with peers and to generate solutions to common challenges. Organizers of the first Clinical Ethics Un-Conference developed a working event centered on active participation and problem solving through peer learning, with the goal of improving realworld practice. Registrants included 95 individuals from 64 institutions. Attendees were surveyed immediately after the Un-Conference, and again eight months later. After eight months, 85 percent (n = 33/39) of the (...) survey respondents reported that they found the event “highly impactful” or “some-what impactful” to their clinical practice, and 23 attendees reported that they had implemented ideas or projects inspired by the event. Three sets of best practice guidelines and four white papers were published from the event. As the field of clinical ethics continues to advance and evolve, this working event format offers an innovative, disruptive alternative to a traditional conference format and may serve as a model for future efforts aimed at improving real-world clinical ethics practice. (shrink)

The medical drama and its central character, the doctor-hero have been a mainstay of popular television. House M.D. offers a new (and problematic) iteration of the doctor-hero. House eschews the generic conventions of the “television doctor” by being neither the idealized television doctor of the past, nor the more recent competent but often fallible physicians in entertainment texts. Instead, his character is a fragmented text which privileges the biomedical over the personal or emotional with the ultimate goal of scientifically uncovering (...) and resolving instances of disease. This article examines the implicit and explicit messages in House M.D. and critically analyzes both the show and its lead character in relation to the traditional medical drama genre that highlights the “doctor-hero” as the central character. While at first House seems to completely violate narrative and generic norms, ultimately the program provides a new form that reinforces the presence of the doctor-hero, but highlights House’s character as the central figure who is personally and interpersonally problematic but biomedically effective. (shrink)

ABSTRACT Dance requires optimal range-of-motion and cognitive abilities. Mental imagery is a recommended, yet under-researched, training method for enhancing both of these. This study investigated the effect of Dynamic Neuro-Cognitive Imagery (DNI™) training on developpé performance (measured by gesturing ankle height and self-reported observations) and kinematics (measured by hip and pelvic range-of-motion), as well as on dance imagery abilities. Thirty-four university-level dance students (M age = 19.70 + 1.57) were measured performing three developpé tasks (i.e., 4 repetitions, 8 consecutive seconds (...) hold, and single repetition) at three time-points (2 x pre-, 1 x post-intervention). Data were collected using three-dimensional motion capture, mental imagery questionnaires, and subjective reports. Following the DNI™ intervention, significant increases (p <.01) were detected in gesturing ankle height, as well as in hip flexion and abduction range-of-motion, without significant changes in pelvic alignment. These gains were accompanied by self-reported decrease (p <.05) in level of difficulty experienced and significant improvements in kinesthetic (p <.05) and dance (p <.01) imagery abilities. This study provides evidence for the motor and non-motor benefits of DNI™ training in university-level dance students. (shrink)

The medical drama and its central character, the doctor-hero have been a mainstay of popular television. House M.D. offers a new (and problematic) iteration of the doctor-hero. House eschews the generic conventions of the “television doctor” by being neither the idealized television doctor of the past, nor the more recent competent but often fallible physicians in entertainment texts. Instead, his character is a fragmented text which privileges the biomedical over the personal or emotional with the ultimate goal of scientifically uncovering (...) and resolving instances of disease. This article examines the implicit and explicit messages in House M.D. and critically analyzes both the show and its lead character in relation to the traditional medical drama genre that highlights the “doctor-hero” as the central character. While at first House seems to completely violate narrative and generic norms, ultimately the program provides a new form that reinforces the presence of the doctor-hero, but highlights House’s character as the central figure who is personally and interpersonally problematic but biomedically effective. (shrink)

Environmental problems often outstrip the abilities of any single scientist to understand, much less address them. As a result, collaborations within, across, and beyond the environmental sciences are an increasingly important part of the environmental science landscape. Here, we explore an insufficiently recognized and particularly challenging barrier to collaborative environmental science: value pluralism, the presence of non-trivial differences in the values that collaborators bring to bear on project decisions. We argue that resolving the obstacles posed by value pluralism to collaborative (...) environmental science requires detecting and coordinating the underlying problematic value differences. We identify five ways that a team might coordinate their problematic value differences and argue that, whichever mode is adopted, it ought to be governed by participatory virtues, pragmatic resolve, and moral concern. Relying on our experiences with the Toolbox Dialogue Initiative, as well as with other dialogical approaches that support team inquiry, we defend the claim that philosophical dialogue among collaborators can go a long way towards helping teams of environmental scientists and fellow travelers detect their problematic value differences. Where dialogical approaches fare less well is in helping teams coordinate these differences. We close by describing several principles for augmenting philosophical dialogue with other methods, and we list several of these methods in an appendix with brief descriptions and links for further learning. Overall, the article makes three main contributions to the research collaboration and values in science literatures: It deepens our understanding of problematic value pluralism in team science; It provides actionable guidance and methods for improving values-oriented philosophical dialogue interventions; and It demonstrates one way of doing engaged philosophy. (shrink)

A request that an ethics committee or consultant analyze the ethical issues in a case, delineate ethical options, or make a recommendation need not automatically but often does elicit legal information. In a recent book in which ethics consultants described cases on which they had worked, almost all cited a legal case or statute that had shaped the consultation process. During a period of just a few months, case consultation done under the auspices of one university hospital ethics committee involved (...) interpretation of statutes on living wills, durable powers of attorney, competency, confidentiality, guardianship, AIDS testing, and disability. At another hospital, 30% of ethics consultations were thought to involve legal issues. Attorneys at a third hospital estimated that virtually every case involves legal issues. The notion that ethics consultation is an “amalgam” of medicine, ethics, interpersonal skills, and law is gaining currency. Ethics consultation has become a channel through which law enters the clinical setting. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; (...) whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward. (shrink)

Human connection is universally important, particularly in the context of serious illness and at the end of life. The presence of close family and friends has many benefits when death is close. Hospital visitation restrictions during the Coronavirus pandemic therefore warrant careful consideration to ensure equity, proportionality, and the minimization of harm. The Australian and New Zealand Society for Palliative Medicine COVID-19 Special Interest Group utilized the relevant ethical and public health principles, together with the existing disease outbreak literature and (...) evolving COVID-19 knowledge, to generate a practical framework of visiting restrictions for inpatients receiving palliative and end-of-life care. Expert advice from an Infectious Diseases physician ensured relevance to community transmission dynamics. Three graded levels of visitor restrictions for inpatient settings are proposed, defining an appropriate level of minimum access. These depend upon the level of community transmission of COVID-19, the demand on health services, the potential COVID-19 status of the patient and visitors, and the imminence of the patient’s death. This framework represents a cohesive, considered, proportionate, and ethically robust approach to improve equity and consistency for inpatients receiving palliative care during the COVID-19 pandemic and may serve as a template for future disease outbreaks. (shrink)

Do cultural models facilitate particular ways of perceiving interactions in nature? We explore variability in folkecological principles of reasoning about interspecies interactions. In two studies, Indigenous Panamanian Ngöbe and U.S. participants interpreted an illustrated, wordless nonfiction book about the hunting relationship between a coyote and badger. Across both studies, the majority of Ngöbe interpreted the hunting relationship as cooperative and the majority of U.S. participants as competitive. Study 2 showed that this pattern may reflect different beliefs about, and perhaps different (...) awareness of, plausible interspecies interactions. Further probes suggest that these models of ecological interaction correlate with recognition of social agency in nonhuman animals. We interpret our results in terms of cultural models of nature and nonhuman agency. (shrink)

ABSTRACTThis study aimed to investigate the emotional impact of sarcasm. Previous research in this area has mainly required participants to answer questions based on written materials, and results have been mixed. With the aim of instead examining the emotional impact of sarcasm when used in a more conversational setting, the current study utilized animated video clips as stimuli. In each clip, one individual answered general knowledge questions while the other provided feedback that could be delivered either literally or sarcastically, and (...) either complimented or criticized the question answerer’s performance. Participants rated the feedback based on the anticipated emotional impact on the recipient, how the speaker intended the recipient to feel, and whether the speaker intended to be humorous. Results overall supported the Tinge Hypothesis, showing that sarcastic criticism was rated as less negative than literal criticism, and sarcastic compliments were rated as... (shrink)

This paper examines the drive for consensus from the perspective of the good government framework for federal advisory commissions in the United States. Specifically, the paper examines the Federal Advisory Committee Act (FACA) – the statute, its regulations, and case law. It shows that the FACA was intended to be an antidote to abuses in consensus‐making processes, including the failure to fully include competing views on commissions. The index of suspicion in the FACA scheme rises when a group work product (...) – including a consensus report – is to be the basis of recommendations to federal officials. Once FACA's requirements regarding committee composition are satisfied, the index of suspicion drops and FACA is indifferent to consensus‐making; but the conditions for informed, meaningful participation apply to members who dissent from, as well as those who participate in, consensus. In negotiated rulemaking, the push for consensus and closure creates unacceptable tension with the good government goals of openness and accountability. Proponents of consensus‐only bioethics commissions can learn from FACA‐related legislative, agency, and judicial insights that consensus‐seeking is not always desired by government officials; is rarely cost free; and that diversity and dissent enhance openness, accountability, and fairness. The burden of proof is therefore on proponents of a consensus‐only standard for bioethics commissions to demonstrate that a drive for consensus furthers sound decision‐making by government officials more than it sets back openness and accountability to a diverse public. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reply to CriticsBethany Henningplato knew that philosophy is not something we write; it is something we live. As Deweyans, we know philosophy is an ideal that emerges within experience as the highest possibility for dialogue. Insofar as a book appears as an extended monologue, it obscures the qualitative and transactive dimensions of philosophy as it is practiced. But sessions like these reveal that books are moments in a conversation, (...) "perchings" in a dialogue that is forever in media res. I am deeply grateful to Bill Myers for organizing this panel, and for the generosity of Frank Ryan, Gregory Pappas, and Jim Garrison for having taken the time to read and think about this book. Each of them has served as a model for philosophical scholarship, and I am humbled and honored to have the opportunity to engage with them directly. They have challenged me in three distinct ways and have engaged with what I have written on separate plateaus of thought, at times revealing layers of which I was not fully aware. So I will do my best to respond to their concerns and develop our shared inquiry in their light. I will also own that my reading of Dewey is selective, and it is my attempt to work through a problem that materialized, as all problems do, in the course of ordinary lived experience.At Southern Illinois University Carbondale, where I attended graduate school, we offered a course called "The American Mind." The title was a provocation, so I applied to teach it one semester. It was a fantastic challenge to try to curate a selection of texts that would serve as an encounter with an intellectual tradition that eludes me as much as it informs me—after all, prior to college, I only knew that a "philosopher" is what becomes of the loser in the board game called Life. I did not know that there was something called "American philosophy" until I applied to study at SIUC.If philosophy is the way that a culture reflects upon itself, then in this book, I have tried to invite the American mind to lie down on the couch. [End Page 95] Or, it might be more accurate to say that I have asked John Dewey, as the representative of American philosophy, how he might psychoanalyze such a mind. My hypothesis is that Dewey's theory of aesthetic experience, and the art that communicates and preserves such moments of intensified vitality, touches the deepest, but unspoken meanings that human beings encounter. This is where quality, the character of an event as a singular whole, the immediate aspect of an event that we feel rather than know, can be stabilized and communicated. If an interpretation can be made of the deep conflicts that have left philosophy at the margins of American life, I believe we would be wise to begin with our "dreams," with the creations of our imagination, the artistic products that reveal the felt dimension of our shared world.Many readers of Dewey choose to focus on his theory of inquiry, his recasting of the scientific method, and his instrumentalism as forming the core of his thought. This is an understandable approach; his work here is novel and corrects bad intellectual habits. However, for the purposes of this book, I have emphasized aesthetic experience, the role of the qualitative, and pursuit of meaning over the correction of practice in my interpretation. This is a controversial choice since it courts the irrational and the vague, but I believe that our neglect of these portions of experience prevents philosophy from reconnecting with American life.Response to Frank RyanFrank Ryan is concerned about the extent to which I have cast the organism as porous, and that I have identified aesthetic experience as unconscious. I agree with Dr. Ryan's assessment that defining aesthetic experience as wholly unconscious would be a grievous error—and I hope not to have made it. There is a misleading ambiguity in the title of the book that might predispose the reader to suspect that I am claiming an equivalence, but what I intended to argue was not that aesthetic experience itself is unconscious, but rather... (shrink)

Recent ethics literature suggests that issues involved in non-heart-beating organ procurement are both highly charged and rather urgent. Some fear that NHB is a public relations disaster waiting to happen or that it will create a backlash against organ donation. The purpose of the study described below was to assess ethics committees' current level of involvement in and readiness for addressing the difficult issues that NHB organ retrieval raises—either proactively through policy development or concurrently through ethics consultation.

Max Weber, the grandfather of organizational theory, recognized the close association between health care organizations and law. When he introduced the concept of a legallaw-saturated,rational bureaucracies, healthcare organizations have highly formalized rules and procedures. They pay a great deal of attention to legal criteria in decisionmaking, and some have entire departments devoted to legal risk management.

Volume 20, Issue 4, May 2020, Page 59-61.

Extending literature on health information to entertainment television, we analyze the prostate cancer narrative presented in the police drama, NYPD Blue. We explain how the physician-patient interaction depicted on the show followed (and sometimes did not follow) the medical dialogue model. Findings reveal that the producers of this show advocate a more dialogic model of medical interaction. Portrayals of incompetent, ineffective physicians are contrasted with the superior, effective efforts of other physicians. The audience learns that a non-dialogic approach characterizes “bad (...) doctors,” while the dialogic method typifies “good doctors.” Likewise, medical professionals can use such texts to enhance physician-patient interaction. (shrink)

We used attractiveness judgements as a proxy to visualize the ideal female and male body for male and female participants and investigated how individual differences in the internalization of cultural ideals influence these representations. In the first of two studies, male and female participants judged the attractiveness of 242 male and female computer-generated bodies which varied independently in muscle and adipose. This allowed us to map changes in attractiveness across the complete body composition space, revealing single peaks for the attractiveness (...) of both men and women. In the second study, we asked our participants to choose the most attractive male and female bodies in a method of adjustment task in which they could independently vary muscle and adipose to create the most attractive body. We asked whether individual differences in internalization of cultural ideals, drive for muscularity, eating disorder symptomatology and depressive symptoms could systematically shift the location of peak attractiveness in body composition space. We found a clear preference by both genders for a male body with high muscle and low adipose, and a toned, low adipose female body. The degree of internalization of cultural ideals predicted large individual differences in the composition of the most attractive bodies. (shrink)

The dubious relation of “subjective” experience to “objective” reality finds its correlate in the opposition we often suppose between culture and nature. Twentieth century theorists, most notably Freud, have claimed various methods for interpreting the illusions of one realm that hide the truths of the other. Ricœur has famously called the psychoanalytic method of dream interpretation a “hermeneutics of suspicion,” which he sees as a threat to the “mytho-poetic core of imagination.” John Dewey regarded the binary opposition between culture/nature as (...) particularly dubious, preferring to see them as reciprocal phases of a continuous process; if cultural life is an interpretation of the biophysical environment, that environment surely has its say. However, in the century since Freud, the tactics of suspicion have proven themselves to be indispensable for developing of critiques that reveal the subtle operations of anti-democratic ideologies, perhaps at the expense of democratic faith. This paper considers if there are less suspicious, more Deweyan possibilities for the interpreting and sharing of dreams, not for the benefit of the psychic health of the individual dreamer, but for the sake of a recovery of democratic life. (shrink)

In response to the Covid‐19 pandemic, health care systems worldwide canceled or delayed elective surgeries, outpatient procedures, and clinic appointments. Although such measures may have been necessary to preserve medical resources and to prevent potential exposures early in the pandemic, moving forward, the indirect effects of such an extensive medical shutdown must not outweigh the direct harms of Covid‐19. In this essay, we argue for the reopening of evidence‐based health care with assurance provided to patients about the safety and necessity (...) of high‐value vaccinations, screenings, therapeutics, and procedures. To ensure that virtually all non‐Covid‐related services do not come to a halt again, health care systems and physician practices must preemptively increase their capacity, secure adequate personal protective equipment to safeguard health care personnel, and develop a measured approach to reclosing such routine health care, should it become necessary in the future. (shrink)

Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we (...) outline these challenges unique to women’s healthcare in a pandemic, provide preliminary recommendations and identify areas for further exploration and refinement of policy. (shrink)

Bethany Henning argues that within the naturalistic strains of American philosophy, there is an implicit theory of the unconscious that finds its fullest expression within the work of John Dewey. Although the unconscious contributes to all experience, it plays a principal role in experiences that are emphatically aesthetic.

Anthropology of Consciousness, EarlyView.

dewey is an optimistic thinker. He fits into a vein of pragmatism known as meliorism, which holds that the condition of the world can be improved through intelligent, imaginative, human action. For this reason, it is tempting to read Dewey as permanently cheerful—particularly when we compare him with philosophers from the continental tradition who work on similar themes. However, it is important to remember that meliorism holds that improvement is possible through intelligent engagement—not that it is guaranteed. Dewey's aesthetics particularly (...) have been mischaracterized as overly sanguine, lacking solid account of the tragic. This is a misreading since Dewey's aesthetic does make ample room for human suffering on... (shrink)

In this paper, we consider ethical issues related to the treatment of posttraumatic stress disorder (PTSD) in combat zones, via exposure therapy. Exposure-oriented interventions are the most well-researched behavioral treatments for PTSD, and rigorous studies across contexts, populations, and research groups provide robust evidence that exposure therapy for PTSD is effective and can be widely disseminated. Clinical procedures for Prolonged Exposure therapy, a manualized exposure-oriented protocol for PTSD, are reviewed, and we illustrate the potential benefits, as well as the potential (...) difficulties, associated with providing this treatment in combat zones. Several ethical considerations are identified: (1) Assuming successful treatment, is it ethical to send individuals with a known risk of developing PTSD back into combat? (2) If treatment is unsuccessful in theater (perhaps due to the confounding factor of ongoing danger), could that impact treatment effectiveness for soldiers who attempt therapy again post-deployment? (3) If the military finds combat-zone treatment effective and useful in maintaining an efficient work force, will treatment become mandatory for those diagnosed with PTSD? (4) What unintended consequences might be associated with large-scale dissemination of exposure therapy in or near combat, outside of mental health care infrastructures? (5) How would genetic variations known to be associated with PTSD risk influence decisions regarding who receives treatment or returns to combat? We conclude with a review of the personal and societal costs associated with not providing evidence-based PTSD treatments wherever possible. (shrink)

Treatment of military-related posttraumatic stress disorder is a major public health care concern. Since 2001 over 2.5 million troops have been deployed to Iraq or Afghanistan, many of whom have experienced direct combat and sustained threat. Estimates of PTSD rates related to these wars range from 8% to over 20%, or 192,000 to 480,000 individuals. Already, nearly 250,000 service members of Operations Enduring Freedom, Iraqi Freedom, and New Dawn have sought VA health care services for PTSD. This recent increased need (...) for mental health services comes in addition to the ongoing needs of Vietnam-era and other veterans who continue to suffer from PTSD. PTSD is related to high co-morbidities of other mental health difficulties, poorer physical health status, and increased medical care utilization. Such high demand for services is an important contributor to the large cost associated with combat-related PTSD. Accordingly, promoting successful, cost-effective treatment strategies for PTSD is a chief public health care priority. (shrink)