Thirty-five current therapy clients, 47 former clients, and 42 college students with no therapy experience rated 27 items in terms of importance for inclusion in informed consent discussions. The current and former client samples rated information about inappropriate therapeutic techniques, confidentiality, and the risks of alternative treatments as most important, and information about the personal characteristics of the therapist and the therapist's degree as least important. The results of this study provide evidence for differential informed consent disclosure practices.

Extensive research has documented the harmful effects associated with working for a narcissistic supervisor. However, little effort has been made to investigate ways for victims to alleviate the burdens associated with exposure to such aversive persons. Building on the tenets of conservation of resources theory and the documented efficacy of functional assets to combat job-related stress, we hypothesized that subordinates’ resource management ability would buffer the detrimental impact of narcissistic supervisors on affective, cognitive, and behavioral work outcomes for subordinates. We (...) found support for our hypotheses across three independent samples of US workers. Specifically, higher levels of subordinate resource management ability attenuated the harmful effects of supervisor narcissism on employee-reported emotional exhaustion, job tension, depressed mood, task performance, and citizenship behavior. Conversely, these relationships further deteriorated for subordinates with lower levels of resource management ability. Overall, our research contributes to the literature that, although extensively documenting the harmful ramifications of narcissism in organizations, has neglected to investigate potentially mitigating factors. (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict or (...) come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

Extensive research has documented the harmful effects associated with working for a narcissistic supervisor. However, little effort has been made to investigate ways for victims to alleviate the burdens associated with exposure to such aversive persons. Building on the tenets of conservation of resources theory and the documented efficacy of functional assets to combat job-related stress, we hypothesized that subordinates’ resource management ability would buffer the detrimental impact of narcissistic supervisors on affective, cognitive, and behavioral work outcomes for subordinates. We (...) found support for our hypotheses across three independent samples of US workers (N = 187; 199; 136). Specifically, higher levels of subordinate resource management ability attenuated the harmful effects of supervisor narcissism on employee-reported emotional exhaustion, job tension, depressed mood, task performance, and citizenship behavior. Conversely, these relationships further deteriorated for subordinates with lower levels of resource management ability. Overall, our research contributes to the literature that, although extensively documenting the harmful ramifications of narcissism in organizations, has neglected to investigate potentially mitigating factors. (shrink)

Machiavelli's ambiguous treatment of religion has fueled a contentios and long-standing debate among scholars. Whereas some insist that Machiavelli is a Christian, others maintain he is a pagan. Sullivan mediates between these divergent views by arguing that he is neither but that he utilizes elements of both understandings arrayed in a wholly new way. She develops her argument by distinguishing among the three Romes that can be understood as existing in Machiavelli's political thought: the first is the Rome of (...) the Christian era, dominated by the pope; the second is the republican Rome of pagan times, which Machiavelli praises; and the third is an idealized Rome that is neither entirely pagan nor entirely Christian. Sullivan draws primarily from the Florentine Histories, The Prince, and the Discourses to offer a unique study of Machiavelli's political thought. Her examination of Machiavelli's three Romes will engage readers concerned with political thought, philosophy of the state, and Machiavelli. (shrink)

O presente artigo objetiva apresentar uma compreensão crítica do tempo presente, que se pode chamar de contemporaneidade. Nessa direção, as reflexões sobre esse momento histórico priorizaram os questionamentos filosóficos de Heidegger. Para interpretação mais ampla do pensamento heideggeriano, foi abordada, rapidamente, as concepções existenciais de homem e de mundo trazidas em sua obra “Ser e tempo”. Após essas considerações, a “Era da Técnica”, marcada pelo esquecimento do ser, foi tomada enquanto foco de discussão. Por fim, ressalta-se a inquietação não com (...) relação ao crescimento da técnica planetária, mas sim acerca do fato de o homem não compreender a dimensão e o sentido das transformações empreendidas por esta destinação; rejeitando, com isso, aquilo que tem de mais próprio, a condição de ser o único ser que reflete. (shrink)

This book offers both the theoretical background behind the minority effect, teachers' personal experiences as they experienced being a minority, and their analyses and insights for teaching diverse learners. This book uses real-life experiences of diverse people to illustrate that, if not understood and addressed, situational minorities at school or work are unlikely to perform at their highest potentials.

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

This article provides practical guidance for researchers who wish to enroll and collect data from pediatric research participants through online and mobile platforms, with a focus on the involvement of both children and their parents in the decision to participate.

Historically, patients have deferred to physicians′ judgments about appropriate medical care, thereby limiting patient participation in treatment decisions. In this model of medical decision making, physicians typically decided upon the treatment plan. Communication with patients focused on securing their cooperation in accepting a treatment decision that essentially had already been made.

Dance is an enjoyable, non-therapy-focused activity that may provide a range of benefits for people with Parkinson’s. The internal simulation of movement through observation, imitation, and imagery, is intrinsic to dance and may contribute to functional improvements for people with Parkinson’s. This study explored the feasibility and potential benefits of a dance program designed by a collaborative team of dance artists, researchers, physiotherapists, and people living with Parkinson’s. The program incorporated motor simulation through observation, imitation and imagery of movement, supported (...) by creative themes, expression, and music. A 6-week pilot trial of the program was conducted with 10 people with Parkinson’s. A focus group following the trial (N= 8) provided insights into the use of imagery, observation and imitation within dance, and the link between creativity and functional outcomes, as well as indicating multidimensional benefits of dance as reported in previous studies. Exploratory outcome measures also suggested potential effects on motor simulation, functional dexterity, and quality of life. The present study demonstrates the feasibility of a co-developed dance program for Parkinson’s and indicates how creative elements of dance may support functional outcomes. Future research should examine the role of motor simulation processes in dance for Parkinson’s, including the potential to develop transferable cognitive-motor skills. This study also highlights the value of collaborative partnerships in designing dance for health programs, which may optimise beneficial effects by using creative approaches to incorporate evidence-based elements, with guidance from individuals with lived experience to ensure the relevance to their goals. (shrink)

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define “critical portions” in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.

When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n (...) = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p. (shrink)

The promises of precision medicine are often heralded in the medical and lay literature, but routine integration of genomics in clinical practice is still limited. While the “last mile” infrastructure to bring genomics to the bedside has been demonstrated in some healthcare settings, a number of challenges remain — both in the receptivity of today's health system and in its technical and educational readiness to respond to this evolution in care. To improve the impact of genomics on health and disease (...) management, we will need to integrate both new knowledge and new care processes into existing workflows. This change will be onerous and time-consuming, but hopefully valuable to the provision of high quality, economically feasible care worldwide. (shrink)

Vacillating and mixed emotional experiences are often difficult to explore and understand because they confront the limits of our language's ability to capture private experiences in extreme or abnormal circumstances. In this paper, we build upon remarks by Wittgenstein (1953) to present a conceptual-discursive perspective based on naturalistic examples of individuals vacillating between pride and other emotions. This perspective is used to show how relevant emotion theories contain conceptual errors of the sort identified by Wittgenstein. The “assembled reminders” of shifts (...) between pride and other emotions are presented in contrast to analyses that focus on people's identification of causes of emotions, an approach which leads to theoretical speculation about underlying appraisal set changes or discussion of the empirical justification of cognitive ontology. We bypass a direct confrontation on these issues by examining how people's talk about the content of vacillating and mixed emotional experiences (i.e., aspect shifts) augments a shared “emotionology” with creative expressions and poetic comparisons. This last point is illustrated by the emotional instability experienced by individuals with Borderline Personality Disorder (BPD). Support for the conceptual-discursive perspective is provided by the success of a particular therapeutic approach, the Conversational Model, in ameliorating the developmental disruption of BPD by encouraging participation in empathic conversations. We conclude that a conceptual-discursive perspective undermines the cognitive appraisal “picture” of vacillating emotions and adds to our understanding. (shrink)

Montesquieu is famous as a tireless critic of despotism, which he associates overtly with Asia and the Middle East and not with the apparently more moderate Western models of governance found throughout Europe. However, Vickie B. Sullivan argues that a creaful reading of Montesquieu's enormously influential The Spirit of the Law reveals the surprising result that he recognizes that Europe itself is susceptible to despotic practices - and that the threat emanates not from the East but rather from certain (...) despotic ideas that inform Western institutions and practices. Sullivan guides readers through Montesquieu's sometimes veiled yet sharply critical accounts of Machiavelli, Hobbes, Aristotle, and Plato, as well as various Christian thinkers have brough forth despotic ideas in the form, for example, of brutal Machiavellianism, of Hobbes's justifications for the rule of one, of Plato's reasoning that denied slaves the right of natural defense, and of the Christian teachings that equated heresy with treason. Such ideas, Montesquieu shows, inform such revered European institutions as the French monarchy and the Roman Catholic Church. In this new reading of Montesquieu's masterwork, Sullivan corrects the misconception that it offers simple, objective observations, showing it to be instead a powerful critique of European politics that would become remarkably and regrettably prescient after Montesquieu's death, when despotism repeatedly emerged in Europe with virulent intensity. -- from dust jacket. (shrink)

In this issue of American Journal of Bioethics, Childress et al. address one of the most challenging modern clinical ethical dilemmas: the awake, competent patient dependent on extracorporeal membr...

Certain English writers of the seventeenth and early eighteenth centuries, whom scholars often associate with classical republicanism, were not, in fact, hostile to liberalism. Indeed, these thinkers contributed to a synthesis of liberalism and modern republicanism. As this book argues, Marchamont Nedham, James Harrington, Henry Neville, Algernon Sidney, and John Trenchard and Thomas Gordon, the co-authors of a series of editorials entitled Cato's Letters, provide a synthesis that responds to the demands of both republicans and liberals by offering a politically (...) engaged citizenry as well as the protection of individual rights. The book also reinterprets the writings of Machiavelli and Hobbes to show that each contributed in a fundamental way to the formation of this liberal republicanism. (shrink)

odi profanum uulgus et arceo.fauete linguis: carmina non priusaudita Musarum sacerdosuirginibus puerisque canto.I hate and spurn the unversed crowd.Mind your tongues: songs yet unheardI sing to boys and virgin girls,the Muses' priest.

Walter Moyle's work, An Essay upon the Constitution of the Roman Government, is much more Machiavellian than it initially announces itself to be. Informed by James Harrington's and Niccolò Machiavelli's earlier commentaries on Rome, Moyle readily embraces that on which both of his predecessors agree—the desirability of a republic that seeks armed increase. Harrington, though, explicitly disagrees with Machiavelli's embrace of a tumultuous republic that seeks a return to its beginning through fostering fear. In contrast to Machiavelli, Harrington looks to (...) economic and institutional arrangements that will render a republic so serene and stable that he claims immortality for it. Although initially Moyle forthrightly endorses Harrington's analysis, he ultimately relies on the harshest teachings of Machiavelli to maintain a republic, a reliance which finds him endorsing the distinctively Machiavellian directives to suspect, accuse, and punish its leaders in such a way as to return the republic to its beginnings. These teachings make Moyle's work a vessel for the transmission of a stern, aggressive republicanism. Even in this eventual enthusiastic embrace of Machiavelli's teachings, however, Moyle still displays some hesitation in citing him as the sole source for them as his attributions couple the Florentine's name inaccurately with other, more reputable republicans. (shrink)

Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27–103 years completed surveys including the 3-Dimensional Wisdom Scale and the San Diego Wisdom Scale. Analyses assessed gender differences in wisdom and gender’s moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS (...) but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step. (shrink)

Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)