The purpose of this article is to provide a critical examination of two aspects of culture and biomedicine that have helped to shape the meaning and practice of genetic testing for breast cancer. These are: the cultural construction of fear of breast cancer, which has been fuelled in part by the predominance of a ‘risk’ paradigm in contemporary biomedicine. The increasing elaboration and delineation of risk factors and risk numbers are in part intended to help women to contend with their (...) fear of breast cancer. However, because there is no known cure or foolproof prevention for breast cancer, risk designations bring with them recommendations for vigilant surveillance strategies and screening guidelines. We argue that these in effect exacerbate women’s fears of breast cancer itself. The volatile combination of discourses of fear, risk and surveillance have significant ethical and social consequences for women’s lives and well-being. Genetic testing decisions are made within this context; if nurses understand this context they can play an important role in helping women to cope with the anxiety and fear of breast cancer risk. (shrink)

The purpose of this article is to provide a critical examination of two aspects of culture and biomedicine that have helped to shape the meaning and practice of genetic testing for breast cancer. These are: (1) the cultural construction of fear of breast cancer, which has been fuelled in part by (2) the predominance of a ‘risk’ paradigm in contemporary biomedicine. The increasing elaboration and delineation of risk factors and risk numbers are in part intended to help women to contend (...) with their fear of breast cancer. However, because there is no known cure or foolproof prevention for breast cancer, risk designations bring with them recommendations for vigilant surveillance strategies and screening guidelines. We argue that these in effect exacerbate women’s fears of breast cancer itself. The volatile combination of discourses of fear, risk and surveillance have significant ethical and social consequences for women’s lives and well-being. Genetic testing decisions are made within this context; if nurses understand this context they can play an important role in helping women to cope with the anxiety and fear of breast cancer risk. (shrink)

A basic assumption in current western medicine is that good healthcare involves informed choices. Indeed, making informed choices is not only viewed as “good practice” but a right to which each individual is entitled, a perspective only recently developed in the medical field.Moreover, in the case of ethical decisions, much of the discussion on the role of the family is cast within the autonomy paradigm of contemporary bioethics; that is, family members provide emotional support but do not make decisions for (...) the competent adult patient. The family Is uniformly viewed as an Important proxy decision maker for incompetent patients; but most bioethicists would eschew any decision-making role for the family of mentally competent adult patients. Underlying the discussion of autonomy is the basic assumption in western medicine that good healthcare Involves choices by Informed individuals. (shrink)

Incidental fndings of potential medical signifcance are seen in approximately 5-8 percent of asymptomatic subjects and 16 percent of symptomatic subjects participating in large computed tomography colonography studies, with the incidence varying further by CT acquisition technique. While most CTC research programs have a well-defned plan to detect and disclose IFs, such plans are largely communicated only verbally. Written consent documents should also inform subjects of how IFs of potential medical signifcance will be detected and reported in CTC research studies.

To understand public discourse in the United States on genetic causation of behavioral disorders, we analyzed media representations of genetic research on addiction published between 1990 and 2010. We conclude first that the media simplistically represent biological bases of addiction and willpower as being mutually exclusive: behaviors are either genetically determined, or they are a choice. Second, most articles provide only cursory or no treatment of the environmental contribution. A media focus on genetics directs attention away from environmental factors. Rhetorically, (...) media neglect the complexity underlying the etiology the addiction and direct focus back toward individual causation and responsibility. (shrink)

Psychopathy is a disorder characterized by severe and frequent moral violations in multiple domains of life. Numerous studies have shown psychopathy-related limbic brain abnormalities during moral processing; however, these studies only examined negatively valenced moral stimuli. Here, we aimed to replicate prior psychopathy research on negative moral judgments and to extend this work by examining psychopathy-related abnormalities in the processing of controversial moral stimuli and positive moral processing. Incarcerated adult males (N = 245) completed a functional magnetic resonance imaging protocol (...) on a mobile imaging system stationed at the prison. Psychopathy was assessed using the Hare Psychopathy Checklist–Revised (PCL-R). Participants were then shown words describing three types of moral stimuli: wrong (e.g., stealing), not wrong (e.g., charity), and controversial (e.g., euthanasia). Participants rated each stimulus as either wrong or not wrong. PCL-R total scores were correlated with not wrong behavioral responses to wrong moral stimuli, and were inversely related to hemodynamic activity in the anterior cingulate cortex in the contrast of wrong > not wrong. In the controversial > noncontroversial comparison, psychopathy was inversely associated with activity in the temporal parietal junction and dorsolateral prefrontal cortex. These results indicate that psychopathy-related abnormalities are observed during the processing of complex, negative, and positive moral stimuli. (shrink)

In this event-related potential study a masking technique that prevents conscious perception of words and non-words through attentional distraction was used to reveal the temporal dynamics of word processing under non-conscious and conscious conditions. In the non-conscious condition, ERP responses differed between masked words and non-words from 112 to 160 ms after stimulus-onset over posterior brain areas. The early onset of the word–non-word differences was compatible with previous studies that reported non-conscious access to orthographic information within this time period. Moreover, (...) source localisations provided evidence for automatic activation of prelexical phonological information, whereas no evidence for non-conscious semantic processing was found. When subjects were informed about the masking technique, lexical differences occurred at later time intervals, suggesting conscious access to additional word related information. These results indicate that early visual word processing does not depend entirely on attentional resources, but that non-conscious processing probably is restricted to rather lower-level linguistic information. (shrink)

Health research increasingly relies on organized collections of health data and biological samples. There are many types of sample and data collections that are used for health research, though these are collected for many purposes, not all of which are health-related. These collections exist under different jurisdictional and regulatory arrangements and include: 1) Population biobanks, cohort studies, and genome databases 2) Clinical and public health data 3) Direct-to-consumer genetic testing 4) Social media 5) Fitness trackers, health apps, and biometric data (...) sensors Population biobanks, cohort studies, and genome databases Clinical and public health data Direct-to-consumer genetic testing Social media Fitness trackers, health apps, and biometric data sensors Ethical, legal, and social challenges of such collections are well recognized, but there has been limited attention to the broader societal implications of the existence of these collections. Although health research conducted using these collections is broadly recognized as beneficent, secondary uses of these data and samples may be controversial. We examine both documented and hypothetical scenarios of secondary uses of health data and samples. In particular, we focus on the use of health data for purposes of: Forensic investigations Civil lawsuits Identification of victims of mass casualty events Denial of entry for border security and immigration Making health resource rationing decisions Facilitating human rights abuses in autocratic regimes Forensic investigations Civil lawsuits Identification of victims of mass casualty events Denial of entry for border security and immigration Making health resource rationing decisions Facilitating human rights abuses in autocratic regimes Current safeguards relating to the use of health data and samples include research ethics oversight and privacy laws. These safeguards have a strong focus on informed consent and anonymization, which are aimed at the protection of the individual research subject. They are not intended to address broader societal implications of health data and sample collections. As such, existing arrangements are insufficient to protect against subversion of health databases for non-sanctioned secondary uses, or to provide guidance for reasonable but controversial secondary uses. We are concerned that existing debate in the scholarly literature and beyond has not sufficiently recognized the secondary data uses we outline in this paper. Our main purpose, therefore, is to raise awareness of the potential for unforeseen and unintended consequences, in particular negative consequences, of the increased availability and development of health data collections for research, by providing a comprehensive review of documented and hypothetical non-health research uses of such data. (shrink)

Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients’ well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA’s cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast (...) clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

"Et toutes ces belles idées sur la liberté, elles sont appliquées quelque part? - Ensemble, non. Mais par petits bouts, oui. Enfin, je crois. - Hé bien, tu n'as qu'à aller voir." C'est ainsi que je fus arraché à la torpeur de ma bibliothèque. Depuis lors, je voyage à travers le monde avec une ambition simple : étudier les thèmes de philosophie politique qui me sont chers là où ils sont mis en oeuvre. Faire apparaître derrière les concepts des histoires, (...) des visages. Pour comprendre la tolérance religieuse, j'ai parcouru le Kerala, en Inde, où les grands monothéismes coexistent depuis la nuit des temps. Pour me faire une opinion sur le libre-échange, j'ai suivi dans son quotidien le directeur de l'Organisation mondiale du commerce. Pour tester la libéralisation des drogues, j'ai côtoyé les entrepreneurs de la marijuana au Colorado. Pour mieux saisir les enjeux du revenu universel, j'ai enquêté dans les villages brésiliens où il est expérimenté. Pour apprécier la réalité du micro-crédit, j'ai sillonné les bidonvilles de Lima. Et pour m'assurer des vertus de la liberté, j'ai rencontré ceux qui en sont privés, dans les "prisons ouvertes" finlandaises. Chemin faisant, j'ai perdu certains préjugés, découvert de nouvelles idées, croisé des auteurs insoupçonnés. Et j'ai acquis une conviction : les problèmes posés par la liberté se résolvent par... davantage de liberté. G.K. (shrink)

In 2006, Two Dutch psychiatric residents and their residency training director reported on a small qualitative survey among 13 psychiatrists working in their mental health institution. The psychiatrists were interviewed about their attitude toward religion and spirituality. The interviewers were especially interested in the role religion plays according to the psychiatrists in the relationship between psychiatrists and patient (Fiselier et al. 2006). The theme is not new, and it still evokes a lot of controversy, considering the turmoil the well-known authority (...) and opinion leader in this field of inquiry Koenig recently provoked with his editorial in Psychiatric Bulletin (Koenig 2008; Correspondence 2008). .. (shrink)

Serial music was one of the most important aesthetic movements to emerge in post-war Europe, but its uncompromising music and modernist aesthetic has often been misunderstood. This book focuses on the controversial journal die Reihe, whose major contributors included Stockhausen, Eimert, Pousseur, Dieter Schnebel and G. M. Koenig, and discusses it in connection with many lesser-known sources in German musicology. It traces serialism's debt to the theories of Klee and Mondrian, and its relationship to developments in concrete art, modern (...) poetry and the information aesthetics and semiotics of Max Bense and Umberto Eco. M. J. Grant sketches an aesthetic theory of serialism as experimental music, arguing that serial theory's embrace of both rigorous intellectualism and aleatoric processes is not, as many have suggested, a paradox, but the key to serial thought and to its relevance for contemporary theory. (shrink)