The book falls into three parts each of which focuses on one author and the ways in which pluralism manifests itself in his particular genre.

Metaphor plays a unique role in cognitive development by structuring abstract concepts and leading to conceptual change. Existing work suggests early emergence of metaphorical abilities, with five-year-olds understanding and explaining metaphors that involve cross-domain comparisons (e.g., SPACE to TIME). Yet relatively little is known about the factors that explain this developmental change. This study focuses on spatial metaphors for time, and asks whether cognitive and/or verbal factors best explain developmental changes in three- to six-year-old children's comprehension and explanation of metaphors. (...) The results show that children's grasp of the time concept—but not verbal ability—predicts their metaphor comprehension. Verbal ability, on the other hand, is a predictor of metaphor explanation, even after controlling for age. The results thus suggest that cognitive and verbal factors selectively predict children's emerging metaphorical abilities. (shrink)

Until now, adult crying has received relatively little interest from investigators, whereas in the popular media there are many strong claims about crying (e.g., crying brings relief) of which the scientific basis is not clear. In this review, we provide an overview of the current state of the scientific literature with respect to crying. We identify gaps in knowledge and propose questions for future research. The following topics receive special attention: Ontogenetic development, antecedents, individual and gender differences, and the intra- (...) and interindividual effects of crying. We conclude that the study of crying may help us obtain better insight into human nature, that is, not only our emotional, but also social, and moral functioning. (shrink)

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; there are additional equity-based reasons to offer OPS to non-binary adults as a group; and the ethical defensibility (...) of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results. (shrink)

As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

Surveys are used extensively in social research and, despite a lack of conclusive evidence of their ‘representativeness,’ probability internet panel surveys are being increasingly used to make inferences about knowledge, attitude and behavior in the general population regarding a range of socially relevant issues. A large-scale survey of Australian public attitudes and behavior toward the red meat industry was undertaken. Samples were obtained using a random digit dialing telephone survey and a PIP survey to examine differences between the two samples (...) regarding attitudes and behavior relating to livestock use and welfare. There was little difference in demographics between the CATI and the PANEL surveys apart from highest level of education. However, there were differences between the two samples in both attitudes and behavior toward the red meat industry after controlling for education levels. The PANEL respondents gave generally more conservative responses than did the CATI respondents in the sense that they were more positive toward the livestock industries and animal welfare within these industries. Differences were also found between the respondents of the two samples regarding behavior that relates to the red meat industry, both community and consumer behavior. PANEL respondents were less engaged in community behaviors performed in opposition of the red meat industry when compared with the CATI sample. The majority of CATI and PANEL respondents were red meat eaters and there was no difference between respondents of the two samples in relation to red meat consumption, however, there were fewer vegetarians and vegans in the PANEL survey. Possible reasons for the observed differences are discussed, however, a definitive answer will depend on further research to identify the specific psychological factors that differ between samples derived from different survey methodologies. (shrink)

We explored the frequency with which typical adults make Theory of Mind attributions, and under what circumstances these attributions occur. We used an experience sampling method to query 30 typical adults about their everyday thoughts. Participants carried a Personal Data Assistant that prompted them to categorize their thoughts as Action, Mental State, or Miscellaneous at approximately 30 pseudo-random times during a continuous 10-h period. Additionally, participants noted the direction of their thought and degree of socializing at the time of inquiry. (...) We were interested in the relative frequency of ToM and how prominent they were in immediate social exchanges. Analyses of multiple choice answers suggest that typical adults: spend more time thinking about actions than mental states and miscellaneous things, exhibit a higher degree of own- versus other-directed thought when alone, and make mental state attributions more frequently when not interacting than while interacting with others . A significant 3-way interaction between thought type, direction of thought, and socializing emerged because action but not mental state thoughts about others occurred more frequently when participants were interacting with people versus when alone; whereas there was an increase in the frequency of both action and mental state attributions about the self when participants were alone as opposed to socializing. A secondary analysis of coded free text responses supports findings 1–3. The results of this study help to create a more naturalistic picture of ToM use in everyday life and the method shows promise for future study of typical and atypical thought processes. (shrink)

Comprehensive and practical handbook on ethical and legal issues affectingGpsand other practitioners.

In this response, the Australian Health Ethics Committee (AHEC) indicates that it shares, and has strategies in place to address, the majority of the concerns identified by Susan Dodds. AHEC believes it is too early to assess the full impact of the National Statement on Ethical Conduct in Research Involving Humans (1999) or to call for a major review of the ethics committee process. While some Human Research Ethics Committees (HRECs) are over-stretched, the system is not on the verge of (...) collapse. (shrink)

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

This mixed-methods study explores how high school students ( n=35) enrolled in a school with a high Latino/a population evaluate the trustworthiness of documents in two historical reasoning tasks: one about the Dust Bowl in the 1930s and the other about the experiences of Mexicans and Mexican Americans in the 1920s. Students indicated whether they trusted each document, provided a rationale for their trust (or distrust) of each document, and ranked the trustworthiness of the documents. We also interviewed 10 focal (...) students to explore students’ reasoning in more in-depth ways than the written responses allowed. We found that students tended to trust the secondary source documents more than the primary source documents because, as they argued, the secondary source documents contained more facts. In contrast, students were less likely to trust the primary source documents, particularly the songs, arguing that they were more opinion-based than factual. We also found that some students had an emotional response to the content of some of the documents, and in some cases, these emotional responses shaped how they viewed the documents’ trustworthiness. Additionally, students’ heritage may have played a role in some students’ trust justifications for some documents in the experiences of Mexicans and Mexican Americans task. We conclude with implications for curriculum and instruction. (shrink)

Multiteam systems are complex organizational forms comprising interdependent teams that work towards their own proximal goals within and across teams to also accomplish a shared superordinate goal. MTSs operate within high-stakes, dangerous contexts with high consequences for suboptimal performance. We answer calls for nuanced exploration and cross-context comparison of MTSs “in the wild” by leveraging the MTS action sub-phase behavioral taxonomy to determine where and how MTS failures occur. To our knowledge, this is the first study to also examine how (...) key MTS attributes influence MTS processes and performance. We conducted historiometric analysis on 40 cases of failed MTS performance across various contexts to uncover patterns of within- and between-team behaviors of failing MTSs, resulting in four themes. First, component teams of failing MTSs over-engaged in within-team alignment behaviors by enacting acting, monitoring, and recalibrating behaviors more often within than between teams. Second, failing MTSs over-focused on acting behaviors and tended to not fully enact the action sub-phase cycle. Third and fourth, boundary status and goal type exacerbated these behavioral patterns, as external and physical MTSs were less likely to enact sufficient between-team behaviors or fully enact the action sub-phase cycle compared to internal and intellectual MTSs. We propose entrainment as a mechanism for facilitating MTS performance wherein specific, cyclical behavioral patterns enacted by teams align to facilitate goal achievement via three multilevel behavioral cycles. We argue that the degree to which these cycles are aligned both between teams and with the overarching MTS goal determines whether and how an MTS fails. Our findings add nuance beyond single-context MTS studies by showing that the identified behavioral patterns hold both across contexts and almost all types of MTS action-phase behaviors. We show that these patterns vary by MTS boundary status and goal type. Our findings inform MTS training best practices, which should be structured to integrate all component teams and tailored to both MTS attributes and situation type. (shrink)

Written by specialist practitioners with vast teaching experience, this is a unique, timely and accessible text that reinforces a contemporary focus on professionalism in medical practice.

This paper reviews the ethical literature on conflicts between health professionals and parents about medical decision-making for children. We present the results of a systematic review which addressed the question ‘when health professionals and parents disagree about the appropriate course of medical treatment for a child, under what circumstances is the health professional ethically justified in overriding the parents’ wishes?’ We identified nine different ethical frameworks that were put forward by their authors as applicable across various ages and clinical scenarios. (...) Each of these frameworks centred on a different key moral concept including harm, constrained parental autonomy, best interests, medically reasonable alternatives, responsible thinking and rationality. (shrink)

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new “spaces” for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for “clinical ethics conflict coaching” can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new spaces for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for clinical ethics conflict coaching can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using a stratified (...) purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

When novice music educators abandon their expressed dedication to forward-looking ideas like equity, epistemological distinctions between belief and knowledge, or lack of such distinctions, may influence such action. Political philosopher Russell Hardin argued that it makes sense for people to hold false, conflicting, and even extreme beliefs. Drawing on his work, we consider how social influences may encourage music educators to adopt a view of knowledge as the acquisition of information that is useful rather than truthful in the sense of (...) being falsifiable and supported by evidence. First, we examine how teachers’ everyday socialization may cause them to abandon practices associated with “music for all,” an ill-defined ideal—officially adopted by the (US) National Association for Music Education—that we problematize here. Second, we consider the effects of broader polarization on socialized epistemology, including amplifying effects of technology, which may contribute to an in-group versus out-group mentality. Third, we investigate how advocacy related endeavors as well as bounded social circles in both K-12 music education and collegiate music teacher education may further solidify extreme beliefs within the profession. Finally, we consider implications for practice, including providing tools for more inclusive and open-minded advocacy efforts and some version of profession-wide “music for all” that focuses on socialization and recognition. (shrink)

Birds are not commonly admired for emotional expression, and when they are, the focus is typically on negative states; yet vocal behavior is considered a direct reflection of an individual’s emotional state. Given that over 4000 species of songbird produce learned, complex, context-specific vocalizations, we make the case that songbirds are conspicuously broadcasting distinct positive emotional states and that hearing songs can also induce positive states in other birds. Studies are reviewed that demonstrate that that the production of sexually motivated (...) song reflects an emotional state of anticipatory reward-seeking (i.e., mate-seeking), while outside the mating context song in gregarious flocks reflects a state of intrinsic reward. Studies are also reviewed that demonstrate that hearing song induces states of positive anticipation and reward. This review brings together numerous studies that highlight a potentially important role for the songbird nucleus accumbens, a region nearly synonymous with reward in mammals, in positive emotional states that underlie singing behavior and responses to song. It is proposed that the nucleus accumbens is part of an evolutionarily conserved circuitry that contributes context-dependently to positive emotional states that motivate and reward singing behavior and responses to song. Neural mechanisms that underlie basic emotions appear to be conserved and similar across vertebrates. Thus, these findings in songbirds have the potential to provide insights into interventions that can restore positive social interactions disrupted by mental health disorders in humans. (shrink)

Clinical ethics has been developing in paediatric healthcare for several decades. However, information about how paediatricians use clinical ethics case consultation services is extremely limited. In this project, we analysed a large set of case records from the clinical ethics service of one paediatric hospital in Australia. We applied a paediatric-specific typology to the case referrals, based on the triadic doctor–patient–parent relationship. We reviewed the 184 cases referred to the service in the period 2005–2014, noting features including the type of (...) case, the referring department(s) and the patient9s age at referral. The two most common types of referral involved clinician uncertainty about the appropriate care pathway for the child (26% of total referrals) and situations where the child9s parents disagreed with the doctors’ recommendations for the child9s care (22% of total referrals). Referrals came from 28 different departments. Cancer, cardiology/cardiac surgery and general medicine referred the highest numbers of cases. The most common patient age groups were children under 1, and 14–15 years old. For three controversial areas of paediatric healthcare, clinicians had initiated processes of routine review of cases by the clinical ethics service. These insights into the way in which one very active paediatric clinical ethics service is used further our understanding of the work of paediatric clinical ethics, particularly the kinds of ethically challenging cases that paediatricians view as appropriate to refer for clinical ethics support. (shrink)

We present a one per cent measurement of the cosmic distance scale from the detections of the baryon acoustic oscillations in the clustering of galaxies from the Baryon Oscillation Spectroscopic Survey, which is part of the Sloan Digital Sky Survey III. Our results come from the Data Release 11 sample, containing nearly one million galaxies and covering approximately 8500 square degrees and the redshift range 0.2 < z < 0.7. We also compare these results with those from the publicly released (...) DR9 and DR10 samples. Assuming a concordance Λ cold dark matter cosmological model, the DR11 sample covers a volume of 13 Gpc3 and is the largest region of the Universe ever surveyed at this density. We measure the correlation function and power spectrum, including density-field reconstruction of the BAO feature. The acoustic features are detected at a significance of over 7σ in both the correlation function and power spectrum. Fitting for the position of the acoustic features measures the distance relative to the sound horizon at the drag epoch, rd, which has a value of rd,fid = 149.28 Mpc in our fiducial cosmology. We find DV = at z = 0.32 and DV = at z = 0.57. At 1.0 per cent, this latter measure is the most precise distance constraint ever obtained from a galaxy survey. Separating the clustering along and transverse to the line of sight yields measurements at z = 0.57 of DA = and H =. Our measurements of the distance scale are in good agreement with previous BAO measurements and with the predictions from cosmic microwave background data for a spatially flat CDM model with a cosmological constant. © 2014 The Author Published by Oxford University Press on behalf of the Royal Astronomical Society. (shrink)

BackgroundExposure to early life stress is alarmingly prevalent and has been linked to the high rates of depression documented in adolescence. Researchers have theorized that ELS may increase adolescents’ vulnerability or reactivity to the effects of subsequent stressors, placing them at higher risk for developing symptoms of depression.MethodsWe tested this formulation in a longitudinal study by assessing levels of stress and depression during the COVID-19 pandemic in a sample of adolescents from the San Francisco Bay Area who had been characterized (...) 3–7 years earlier with respect to exposure to ELS and symptoms of depression.ResultsAs expected, severity of ELS predicted levels of depressive symptoms during the pandemic [r = 0.26, p = 0.006], which were higher in females than in males [t = −3.56, p < 0.001]. Importantly, the association between ELS and depression was mediated by adolescents’ reported levels of stress, even after controlling for demographic variables.ConclusionsThese findings underscore the importance of monitoring the mental health of vulnerable children and adolescents during this pandemic and targeting perceived stress in high-risk youth. (shrink)

Opinion leaders within the community may lead debate on animal welfare issues and provide a path for information to their social networks. However, little is known about OLs’ attitudes, activities conducted to express their views about animal welfare and whether they are well informed, or not, about husbandry practices in the red meat industry. This study aimed to identify OLs in the general public and among producers and compare OLs and non-OLs’ attitudes, knowledge and actions to express their views about (...) the red meat industry. Two questionnaires, one for the Australian general public and one for Australian red meat producers, were developed to identify general attitudes. From these questionnaires, OLs were identified using a two-step cluster analysis. Subsequently, a sub-sample of 19 OLs participated in a follow-up phone interview. Results disclosed some clear OLs’ characteristics. Public OLs held more negative perceptions of the red meat industry and perceived they had more knowledge about husbandry procedures. However, their actual knowledge about animal husbandry was not different from non-OLs. Public OLs also used and trusted social and internet media more than did non-OLs. In the producer group, a large percentage of OLs were identified. Producer OLs had more actual knowledge about animal husbandry and engaged in more behaviours to express dissatisfaction with the industry than non-OLs. Unlike the public respondents, this group used conventional media more than social and internet media, and their levels of trust in all kinds of media were low. While there were clear differences, both groups believed that is important to increase communication and educate about farm practices. This may present an opportunity to develop an opinion leader intervention strategy where informed OLs could later disseminate accurate information to their social networks. Further studies should test if sustained and facilitated educational sessions between public and producer OLs can assist in increasing communication, knowledge and perhaps, may assist in achieving convergence of concerns and expectations between both groups. (shrink)

Joint attention (JA) is hypothesized to have a close relationship with developing theory of mind (ToM) capabilities. We tested the co-occurrence of ToM and JA in social interactions between adults with no reported history of psychiatric illness or neurodevelopmental disorders. Participants engaged in an experimental task that encouraged nonverbal communication, including JA, and also ToM activity. We adapted an in-lab variant of experience sampling methods (Bryant, Coffey, Povinelli, & Pruett, 2013) to measure ToM during JA based on participants’ subjective reports (...) of their thoughts while performing the task. This experiment successfully elicited instances of JA in 17/20 dyads. We compared participants’ thought contents during episodes of JA and non-JA. Our results suggest that, in adults, JA and ToM may occur independently. (shrink)

This handbook provides an overview of the research on the changing nature of work and workers by marshalling interdisciplinary research to summarize the empirical evidence and provide documentation of what has actually changed. Connections are explored between the changing nature of work and macro-level trends in technological change, income inequality, global labor markets, labor unions, organizational forms, and skill polarization, among others. This edited volume also reviews evidence for changes in workers, including generational change, that has accumulated across domains. Based (...) on documented changes in work and worker behavior, the handbook derives implications for a range of management functions, such as selection, performance management, leadership, workplace ethics, and employee well-being. This evaluation of the extent of changes and their impact gives guidance on what best practices should be put in place to harness these developments to achieve success. (shrink)

A number of language evolution researchers have argued that while language as we now know it is a predominately vocal affair, early language plausibly made extensive use of gesture. Relatedly, these same researchers often claim that while modern language in general uses arbitrary symbols, it is very likely that early language made extensive use of iconicity. Anyone accepting an account of early language along these lines must therefore explain how language shifted over time from a heavily gestural and iconic communication (...) system to a predominately vocal and highly arbitrary one. This article looks at an intriguing theory advanced by Woll as to how this shift was made. We find the spirit of the theory plausible but take issue with its details. Specifically, we identify a serious tension at the core of the theory. We then go on to explore how that tension might be plausibly resolved. The result is a blueprint for a much-improved version of the theory, in our view. (shrink)

Producing emotional tears is a universal and uniquely human behavior. Until recently, tears have received little serious attention from scientists. Here, we summarize recent theoretical developments and research findings. The evolutionary approach offers a solid ground for the analysis of the functions of tears. This is especially the case for infant crying, which we address in the first part of this contribution. We further elaborate on the antecedents and functions of emotional tears in adults. The main hypothesis that emerges from (...) this overview is that crying evolved as an emotional expression that signals distress and promotes prosocial behaviors in conspecifics. Further, shedding tears may influence the mood of the crier and his/her outlook on life primarily as a consequence of fulfillment of the proposed signaling function of tears. We also describe how cultural phenomena such as ritual weeping nicely fit within this framework, as they often aim to support a request for help to a powerful person or deity and promote social bonding. (shrink)

As an alternative to universalism and particularism, Intermedialities: Philosophy, Arts, Politics proposes "intermedialities" as a new model of social relations and intercultural dialogue. The concept of "intermedialities" stresses the necessity of situating debates concerning social relations in the divergent contexts of new media and avant-garde artistic practices as well as feminist, political, and philosophical analyses.

Purpose Medical students receive a varying amount of training in medical ethics and are expected to navigate clinical ethical dilemmas innately. There is little literature on attempts to navigate ethical dilemmas experienced during early clinical experiences and whether current curricula prepare students for these dilemmas. This study explores the different ethical dilemmas experienced by medical students on their third-year clerkships and analyzes the factors, sources, and resolutions proposed by them.Methods From 2016 to 2018, third-year medical students completed a written assignment (...) to describe, analyze, and reflect on a clinical situation in which they experienced an ethical dilemma. They identified specific ethical dilemmas present, potential preventative and aftermath solutions, and reflected on their professional development from their experience. The research team utilized applied thematic analysis to identify themes and patterns in the data. A thematic matrix was utilized to examine similarities and differences across medical students.Results Of the 162 reflections, 144 (88.9%) students indicated an ethical dilemma that included issues related to autonomy and beneficence. Of these, 116 (71.6%) students found the two ethical principles in direct conflict. Students identified three common sources of this conflict: lack of communication; unclear understanding of clinical policies regarding family authority and psychiatric capacity; and medical negligence. Lastly, students suggested different solutions for dealing with and preventing this conflict.Conclusion Our findings suggest that an overwhelming number of students face ethical challenges when confronted with medical situations that raise conflicts between autonomy and beneficence. Their recommended solutions reveal an appeal among students to have tools and strategies in place to ease the need to make difficult decisions. Medical students might be better served by learning about the complexities of ethical decision-making and the likelihood of experiencing moral distress when they feel an inability to implement what they envision as the best solution. (shrink)

The relationship between dementia and criminal behavior perplexes legal and health care systems. Dementia is a progressive clinical syndrome defined by impairment in at least two cognitive domains that interferes with one's activities of daily. Dementia symptoms have been associated with behaviors that violate social norms and constitute criminal actions. A failure to address a gap in policies that support appropriate management of individuals with dementia reflects a failure in our social obligation to care for those who are most vulnerable (...) amongst us. Categorical protections, informed by precedent models applied to juveniles and individuals with psychiatric illness, could help meet a social obligation to provide protections to individuals with dementia. We propose an approach that integrates affirmative defenses to mitigate criminal liability and sentencing restrictions to prevent cruel and unusual punishment. (shrink)