Predictive genetic testing is now routinely offered to asymptomatic adults at risk for genetic disease. However, testing of minors at risk for adult-onset conditions, where no treatment or preventive intervention exists, has evoked greater controversy and inspired a debate spanning two decades. This review aims to provide a detailed longitudinal analysis and concludes by examining the debate's current status and prospects for the future. Fifty-three relevant theoretical papers published between 1990 and December 2010 were identified, and interpretative content analysis was (...) employed to catalogue discrete arguments within these papers. Novel conclusions were drawn from this review. While the debate's first voices were raised in opposition of testing and their arguments have retained currency over many years, arguments in favour of testing, which appeared sporadically at first, have gained momentum more recently. Most arguments on both sides are testable empirical claims, so far untested, rather than abstract ethical or philosophical positions. The dispute, therein, lies not so much in whether minors should be permitted to access predictive genetic testing but whether these empirical claims on the relative benefits or harms of testing should be assessed. (shrink)

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analyzed using interpretive content and thematic analysis. Three (...) key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices because psychologists described 5 distinct options. These can be conceptualized on a spectrum of varying degrees of client autonomy, ranging from “no disclosure” to “disclosure without the client’s knowledge or consent”. Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimize potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development. (shrink)

The Promise of Phenomenology: Posthumous Papers of John Wild includes articles that remained unpublished during Wild's lifetime, some of which he was preparing for publication, a journal that he kept, as well as a masterful exposition and commentary on Emmanuel Levinas' book, Totality and Infinity. This book gives a lively picture of a master philosopher at work conveying the vitality and importance of philosophy to everyday life.

A bottom-up approach grounded in micro-level understanding of the thinking, feeling, behavioral, and social aspects of living with low income and associated low literacy can lead to greater understanding and improvement of interactions in the health arena. This paper draws on what we have learned about marketplace interactions in subsistence economies to inform innovations in medical education, design and delivery of healthcare for lowincome patients, outreach education, and future micro-level research at the human-healthcare interface.

In the categorical approach to the foundations of quantum theory, one begins with a symmetric monoidal category, the objects of which represent physical systems, and the morphisms of which represent physical processes. Usually, this category is taken to be at least compact closed, and more often, dagger compact, enforcing a certain self-duality, whereby preparation processes (roughly, states) are interconvertible with processes of registration (roughly, measurement outcomes). This is in contrast to the more concrete “operational” approach, in which the states and (...) measurement outcomes associated with a physical system are represented in terms of what we here call a convex operational model: a certain dual pair of ordered linear spaces–generally, not isomorphic to one another. On the other hand, state spaces for which there is such an isomorphism, which we term weakly self-dual, play an important role in reconstructions of various quantum-information theoretic protocols, including teleportation and ensemble steering. In this paper, we characterize compact closure of symmetric monoidal categories of convex operational models in two ways: as a statement about the existence of teleportation protocols, and as the principle that every process allowed by that theory can be realized as an instance of a remote evaluation protocol—hence, as a form of classical probabilistic conditioning. In a large class of cases, which includes both the classical and quantum cases, the relevant compact closed categories are degenerate, in the weak sense that every object is its own dual. We characterize the dagger-compactness of such a category (with respect to the natural adjoint) in terms of the existence, for each system, of a symmetric bipartite state, the associated conditioning map of which is an isomorphism. (shrink)

The purpose of this study is to examine relationships among religious coping styles, the experience of daily hassles, and resiliency. Through the use of a set of questionnaires, positive and negative religious coping styles are identified and analyzed in relation to a direct measure of resiliency, level of psychological distress, and level of daily hassles. Negative religious coping is positively related to psychological distress, while individuals who experience more daily hassles but use higher levels of positive religious coping have greater (...) resiliency than individuals who use higher levels of negative religious coping. Additionally, the combination of daily hassles, major life stressors, level of positive religious coping, and resiliency accounted for a significant proportion of the variability in psychological distress. Post hoc analyses removed questions of spirituality from the resiliency scale that could possibly overlap with the measure of religious coping. These exploratory analyses indicate that negative religious coping is negatively correlated with non-spiritual resiliency. Exploratory analyses also indicate that individuals who experience more daily hassles but use higher levels of positive religious coping do not have greater levels of non-spiritual resiliency than individuals who use negative religious coping. (shrink)

In New Zealand, there are adolescents who are at risk of pregnancy and who do not want to become pregnant, but are not using contraception. Cost and other barriers limit access to contraception. To address the gap between contraceptive need and contraceptive access, this paper puts forward the concept of proactive contraception provision, where adolescents are offered contraceptives directly. To strengthen the case for proactive contraception provision, this paper addresses a series of potential objections. One is that such a programme (...) would cause harm; another that such a programme would not have sufficient benefit. In rebutting these objections, the conclusion is reached that proactive contraception provision is a model worth pursuing as a means of meeting the needs of the New Zealand adolescent population and may be of interest more widely. (shrink)

This book contains articles on ignorance in the medical field and where the contributing researchers would like research directed.

Variant Creutzfeldt–Jakob disease is a fatal, transmissible, neurodegenerative disorder for which there is currently no effective treatment. vCJD arose from the zoonotic spread of bovine spongiform encephalopathy. There is now compelling evidence for human to human transmission through blood transfusions from presymptomatic carriers and experts are warning that the real epidemic may be yet to come. Imperatives exist for the development of reliable, non-invasive presymptomatic diagnostic tests. Research into such tests is well advanced. In this article the ethical implications of (...) the availability of these tests are elaborated and comparisons drawn with predictive genetic testing for Huntington’s disease and screening for HIV. Paramount to considerations is the issue of whom to test, weighing up respect for personal autonomy against obligations to benefit and protect society. A paradigm is proposed similar to that used for HIV screening but with unique features: compulsory testing of all blood/organ donors and individuals undergoing surgery or invasive procedures who have a significant risk of disease transmission. (shrink)

The concept of selecting for a disability, and deafness in particular, has triggered a controversial and sometimes acrimonious debate between key stakeholders. Previous studies have concentrated on the views of the deaf and hard of hearing, health professionals and ethicists towards reproductive selection for deafness. This study, however, is the first of its kind examining the views of hearing children of deaf adults towards preimplantation genetic diagnosis and prenatal diagnosis to select for or against deafness. Hearing children of deaf adults (...) straddle both the deaf and hearing worlds, and this dual perspective makes them ideally placed to add to the academic discourse concerning the use of genetic selection for or against deafness. The study incorporated two complementary stages, using initial, semistructured interviews with key informants as a means to guide the subsequent development of an electronic survey, completed anonymously by 66 individuals. The participants shared many of the same views as deaf individuals in the D/deaf community. The similarities extended to their opinions regarding deafness not being a disability, their ambivalence towards having hearing or deaf children and their general disapproval of the use of genetic technologies to select either for or against deafness. (shrink)