Some fictions deliberately omit all fictional statements about the mental functioning of fictional agents. This presents an interpretive dilemma, as when we read fiction we ought to reconstruct the fictional minds of characters significant to the plot. Fictions that present the reader with an opaque fictional mind resist the general imaginative project prescribed by fiction-making and seem to demand a novel approach to imagining their fictional entities. Such fictional entities demand the reader commit to one of at least two different (...) ways of imagining nothing about a fictional mind, without explicitly authorizing either. One approach has already been described by H. Porter Abbott. Another can be extracted from Simone De Beauvoir, whose ethics of ambiguity is well suited to dealing with fictional entities about which nothing is fixed nor determined. (shrink)

Cell and tissue-based products, such as autologous adult stem cells, are being prescribed by physicians across the world for diseases and illnesses that they have neither been approved for or been demonstrated as safe and effective in formal clinical trials. These doctors often form part of informal transnational networks that exploit differences and similarities in the regulatory systems across geographical contexts. In this paper, we examine the regulatory infrastructure of five geographically diverse but socio-economically comparable countries with the aim of (...) identifying similarities and differences in how these products are regulated and governed within clinical contexts. We find that while there are many subtle technical differences in how these regulations are implemented, they are sufficiently similar that it is difficult to explain why these practices appear more prevalent in some countries and not in others. We conclude with suggestions for how international governance frameworks might be improved to discourage the exploitation of vulnerable patient populations while enabling innovation in the clinical application of cellular therapies. (shrink)

Umbilical cord blood banking is one of many biomedical innovations that confront pregnant women with new choices about what they should do to secure their own and their child’s best interests. Many mothers can now choose to donate their baby’s umbilical cord blood (UCB) to a public cord blood bank or pay to store it in a private cord blood bank. Donation to a public bank is widely regarded as an altruistic act of civic responsibility. Paying to store UCB may (...) be regarded as a “unique opportunity” to provide “insurance” for the child’s future. This paper reports findings from a survey of Australian women that investigated the decision to either donate or store UCB. We conclude that mothers are faced with competing discourses that force them to choose between being a “good mother” and fulfilling their role as a “good citizen.” We discuss this finding with reference to the concept of value pluralism. (shrink)

(2013). Not Your Typical Frequent Flyer: Overcoming Mythology in Caring for Sickle Cell Disease Patients. The American Journal of Bioethics: Vol. 13, No. 4, pp. 18-20. doi: 10.1080/15265161.2013.767963.

In the April number of the Quarterly Mr. Pearson discussed seversal passages of the Rhesus. On two of these I wish to offer a few observations.

Little is known about older persons’ expectancies (or anticipations) about the possible actions of home-care professionals, although such data have implications for the ethics of home care and home-care policies. From a longitudinal study of older women’s experience of home care, findings are reported concerning their expectancies of professional home-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from a series of interviews with 13 women aged 82 to (...) 96 years. Among the five key structures of experience were ‘finding that someone has the job of helping me here’ and ‘determining where the helper’s field lies’. Two subsets within a category of expectancies were differentiated: speculations about helpers’ possible actions and expectancies about outcomes of helpers’ actions. As parameters of relational ethics, clients’ speculations and expectancies are appropriate bases for dialogue about older widows’ relationships with home-care professionals and the foci of home-care policies. (shrink)

This is a fascinating book. It uses tuberculosis to look at the balance between individual liberty and the public good: the tensions created between personal liberty and social responsibility, a strong theme in all work in public health. The context is New York in the 1990s, but as Coker states, “This book uses the lens of tuberculosis control, and in particular the detention of non-infectious individuals, to examine America's response to its most vulnerable and marginalised citizens, and asks the question: (...) `is detention of non-infectious, non-compliant individuals right from ethical, legal, and public health perspectives'”. The book is divided into nine chapters. It …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:140 BOOK REVIEWS The Church: The Universal Sacrament of Salvation. By JoHANN AUER. Translated from the German by Michael Waldstein. Washington, D.C.: The Catholic University of America Press, 1993. Pp. 541. $24.95 (paper). The Church, Community of Salvation: An Ecumenical Ecclesiology. By GEORGE H. TAVARD. Collegeville, Minnesota: The Liturgical Press, 1992. Pp. 264. $18.95 (paper). These two works represent two recent and very different attempts by contemporary Catholic ecclesiologists (...) to present a comprehensive or systematic theology of the church. I shall deal with the specifics of each work separately. Johann Auer (1910-1989) was professor of dogmatics and the history of dogma at the University of Bonn when in 1983 he first published his Die Kirche: Das allgemeine Heilssakrament. This present work is an English translation of that German text which was Volume VIII in a comprehensive, nine-part, dogmatic survey, with volumes addressing the traditional dogmatic themes: God, Creation, Christ, Grace, Eucharist, Sacraments, Church and Eschatology. Joseph Ratzinger was co-editor with Auer of the original series. And while Auer authored the first eight volumes, Ratzinger authored the final volume on eschatology. We have seen this kind of dogmatic survey in English before in the comparable six-volume work of Michael Schmaus called Dogma (1968). As with Schmaus's work, this dogmatic survey is intended as a series of textbooks for theology students and thus its method is to survey each dogmatic theme focusing upon three elements, the biblical foundation for the theme, the historical development of this theme, and finally its systematic inner coherence or integral rational development. In this volume, Auer accomplishes all three tasks in exemplary fashion and with a depth of treatment Schmaus never aimed at approaching. Auer's The Church is divided into eighteen chapters organized into four thematic sections bearing the titles, " Pathways towards the Proper Understanding of the Church," " Pathways towards a Theological Concept of the Church taken from Biblical Images," "Manifestations of the Church's Being, Life and Activity in the Light of its Sacramental Structure," and "The Church's Tasks and Its Ways to Self-Realization in the World." Under these titles are treated all the traditional themes expected of a comprehensive ecclesiology: the origin and authority of the church, its mission and ministries, biblical images, organizational BOOK REVIEWS 141 models and dogmatic marks of the church, ecumenism, the place of the Blessed Virgin Mary among the People of God, relations between church and state. Auer's consideration of each of these themes is marked by his thorough knowledge of the sources and his skillful handling of these materials. Even so, Auer's work is hardly beyond criticism. For example, arguably the heart of the book is the author's 213-page treatment of the history and theology of the ministries which comprises Part III, "Manifestations of the Church's Being, Life and Activity...." I want to call this section masterful because of the vastness of the enterprise (the development of the ministries over almost two thousand years) and the wealth of careful distinctions Auer brings to his treatment of so much material. To choose among the riches here one might single out Auer's treatment of the two principles of democracy and hierarchy and the numerous collegial forms for participative governance and administration that have been created or once existed in the church and have been revived since Vatican II (pp. 157-173). This is a stimulating but balanced discussion, blending historical material with more immediate and urgent concerns. But there are also some serious weaknesses in the larger section. For example, while extended attention is given to the offices of bishop and pope (almost a hundred pages on the papal office alone), comparatively little attention is given to the role of presbyters (four pages) and the laity. As for the latter, though Auer considers "The Question of the Secular Office of the Laity," he never addresses the question of the religious office of the laity, that is, their ministry in the church and not just to the world. He broaches this theme in his section on " Vocations or Charisms, Ministries and Offices or Commissionings " (pp. 179-194), but all too quickly he concludes this section... (shrink)

Background: Electroconvulsive therapy is one of the most effective treatments for major depressive disorder. Recently, there has been increasing attention to evaluate the effect of ECT on resting-state functional magnetic resonance imaging. This study aims to compare rs-fMRI of depressive disorder patients with healthy participants, investigate whether pre-ECT dynamic functional network connectivity network estimated from patients rs-fMRI is associated with an eventual ECT outcome, and explore the effect of ECT on brain network states.Method: Resting-state functional magnetic resonance imaging data were (...) collected from 119 patients with depression or depressive disorder, and 61 healthy participants, with an age mean of 52.25 years old. The pre-ECT and post-ECT Hamilton Depression Rating Scale were 25.59 ± 6.14 and 11.48 ± 9.07, respectively. Twenty-four independent components from default mode and cognitive control network were extracted, using group-independent component analysis from pre-ECT and post-ECT rs-fMRI. Then, the sliding window approach was used to estimate the pre-and post-ECT dFNC of each subject. Next, k-means clustering was separately applied to pre-ECT dFNC and post-ECT dFNC to assess three distinct states from each participant. We calculated the amount of time each subject spends in each state, which is called “occupancy rate” or OCR. Next, we compared OCR values between HC and DEP participants. We also calculated the partial correlation between pre-ECT OCRs and HDRS change while controlling for age, gender, and site. Finally, we evaluated the effectiveness of ECT by comparing pre- and post-ECT OCR of DEP and HC participants.Results: The main findings include depressive disorder patients had significantly lower OCR values than the HC group in state 2, where connectivity between cognitive control network and default mode network was relatively higher than other states, Pre-ECT OCR of state, with more negative connectivity between CCN and DMN components, is linked with the HDRS changes. This means that those DEP patients who spent less time in this state showed more HDRS change, and The post-ECT OCR analysis suggested that ECT increased the amount of time DEP patients spent in state 2.Conclusion: Our finding suggests that dynamic functional network connectivity features, estimated from CCN and DMN, show promise as a predictive biomarker of the ECT outcome of DEP patients. Also, this study identifies a possible underlying mechanism associated with the ECT effect on DEP patients. (shrink)

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples’ ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, (...) and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being. (shrink)

ABSTRACT Objective: To describe how local research ethics committees (LRECs) consider and apply research ethics in the evaluation of biomedical research proposals. Design: A qualitative study was conducted using purposeful sampling, focus groups and a grounded theory approach to generate data and to analyse the work of the LRECs. Setting and participants: 11 LRECs of the Mexican Institute of Social Security (IMSS). Results: LRECs considered ethics to be implicit in all types of research, but that ethics reviews were only necessary (...) for projects that included the direct participation of human beings. The LRECs appeared to understand the importance of consent, as in the completion of a consent form, but did not emphasise the importance of the process of acquiring ‘informed’ consent. The committees considered their main roles or functions to be: (a) to improve the methodological quality of research and to verify – if applicable – the ethical aspects; (b) to encourage personnel to undergo research training; (c) to follow‐up research to oversee the adherence to norms and compliance with a specified research timetable. Conclusions: This study provides a valuable insight into how these LRECs understand the ethical review process. The emphasis of the committees was on rules, regulations, improving research methodology and research training, rather than a focus on efforts to protect the rights and well being of research subjects. The results encourage further normative and descriptive lines of investigation concerning education and the development of LRECs. (shrink)