What do the terms “profession, professional, professionalism” mean in 2002? One dictionary defines profession as “a calling requiring specialized knowledge and often long and intensive academic preparation,” and it defines professionalism as “the conduct, aims, or qualities that characterize or make a profession or professional person.” These definitions are appealingly simple. Complexity arises when we add the term “medical” as in the medical profession, a medical professional, or medical professionalism; and, here a specific understanding of “the conduct, aims, and qualities (...) that characterize” the field of medicine is required. To complicate matters, professionalism applies to both the profession as a whole as well as the individual professional persons, such as the physicians. (shrink)

Book reviewed in this article: Encounters Between Patients and Doctors: An Anthology. By John D. Stoeckle.

We surveyed selected physician members of the Society for Health and Human Values (SHHV) to study the benefits and problems of combining a medical career with a strong scholarly interest in the humanities. The 19 usable narrative responses characterized major benefits as experiential base and teaching opportunities. Barriers were numerous and fell under the general headings of: lack of time; lack of institutional rewards; lack of money for research and scholarship; lack of support from humanities peers; lack of suport from (...) medical colleagues; personal financial sacrifice; and lack of training. Some respondents offered creative solutions to these problems, including assertive negotiation of a job description, identification of helpful mentors, and various networking and administrative strategies. The survey results, while preliminary, suggest ways in which SHHV can assist clinicians who wish to develop a serious commitment to humanities study and teaching. (shrink)

Case-based instruction is a stable feature of ethics education, however, little is known about the attributes of the cases that make them effective. Emotions are an inherent part of ethical decision-making and one source of information actively stored in case-based knowledge, making them an attribute of cases that likely facilitates case-based learning. Emotions also make cases more realistic, an essential component for effective case-based instruction. The purpose of this study was to investigate the influence of emotional case content, and complementary (...) socio-relational case content, on case-based knowledge acquisition and transfer on future ethical decision-making tasks. Study findings suggest that emotional case content stimulates retention of cases and facilitates transfer of ethical decision-making principles demonstrated in cases. (shrink)

"Hellenistic Philosophy of Mind" is an elegant survey of Stoic and Epicurean ideas about the soul an introduction to two ancient schools whose belief in the soul's physicality offer compelling parallels to modern approaches in the ...

Higher order cognitive processes, including ethical decision making (EDM), are influenced by the experiencing of discrete emotions. Recent research highlights the negative influence one such emotion, anger, has on EDM and its underlying processes. The mechanism, however, by which anger disrupts the EDM has not been investigated. The current study sought to discover whether cognitive appraisals of an emotion-evoking event are the driving mechanisms behind the influence of anger on EDM. One primary (goal obstacle) and one secondary (certainty) appraisal of (...) anger were examined. Study results suggest that appraisals of certainty are the driving mechanism behind the negative relationship between anger and EDM. Certainty appraisals led to less application of EDM-promoting strategies and more unethical social motives. Findings further highlight the value of investigating appraisals of emotional events, given their cognitive nature, for their potential effects on cognitive operations, such as EDM. Future directions and implications are discussed. (shrink)

The results of some high-stakes aptitude tests in Austria have revealed sex differences. We suggest that such discrepancies are mediated not principally by differences in aptitudes, skills, and knowledge but gender differences in test takers’ perceptions of the test situation. Furthermore, previous research has indicated that candidates’ evaluations of the fairness of the testing tool are of great importance from an institutional point of view because such perceptions are known to influence an organization’s attractiveness. In this study, we aimed to (...) investigate how women and men perceive and evaluate certain aspects of a high-stakes test situation by using the results and evaluations of an actual medical school aptitude test (753 applicants; 59% women). Test takers voluntarily evaluated the test situation and rated specific aspects of it (e.g., the fairness of the selection tool) and provided information regarding their test anxiety immediately after they completed the 4-hour test. Data analyses indicated small, albeit significant sex differences in participants’ perceptions of the test. Men described the test situation as slightly giving more opportunity to socialize and possessing more opportunity to deceive than women did. Furthermore, the perception of the test situation did not directly predict the test results, but it served as a moderator for the indirect effect of test anxiety on test results. By contrast, there were significant direct effects but no indirect effects of situation perception on evaluations of the fairness of the selection tool: The more the test situation was perceived as a high-pressure situation, the lower the fairness ratings of the testing tool. Results were discussed with reference to gender roles and test fairness. (shrink)

De Marco and colleagues claim that the standard account of invasiveness as commonly encountered ‘…does not capture all uses of the term in relation to medical interventions1 ’. This is open to challenge. Their first example is ‘non-invasive prenatal testing’. Because it involves puncturing the skin to obtain blood, De Marco et al take this as an example of how an incision or insertion is not sufficient to make an intervention invasive; here is a procedure that involves an incision, but (...) it is regarded as non-invasive. However, this ignores the context, and the term should really be understood in reference to the fetus. It is hard to believe healthcare professionals regard taking blood to measure, for example, ferritin levels as invasive but taking blood to look for fragments of fetal DNA as not. If anyone uses the term thinking it is not invasive to the mother, the solution would be to call it invasive, not redefine what is invasive. De Marco and colleagues’ second example is describing electroconvulsive therapy (ECT) as invasive. However, this is not borne out by their referenced papers. The first cited source is about non-invasive brain stimulation2 and only contains a single sentence about ECT. This sentence may suggest that their view is that ECT …. (shrink)

El estallido de una epidemia o una pandemia es siempre un momento de amenaza, emergencia e incertidumbre. Cuando la salud y la vida de las personas se pone en peligro se requieren respuestas urgentes y coordinadas por parte de los agentes estatales a nivel nacional, regional y global que tengan el potencial de contener la pandemia y evitar su propagación. De esta situación de emergencia y de continuos cambios en las normas que imponen nuevas restricciones, obligaciones y responsabilidades a los (...) ciudadanos, se deriva dilema sobre el equilibrio entre la protección del derecho a la salud y otros derechos económicos, sociales y culturales. (shrink)

Early adversity and trauma can have profound effects on children’s affective development and mental health outcomes. Interventions that improve mental health and socioemotional development are essential to mitigate these effects. We conducted a pilot study examining whether a reading-based program improves emotion recognition and mental health through socialization in Syrian refugee and Jordanian non-refugee children aged 7–12 years old living in Jordan. To measure emotion recognition, children classified the expression in faces morphed between two emotions, while mental health was assessed (...) using survey measures of optimism, depression, anxiety, distress, and insecurity. Prior to the intervention, both groups of children were significantly biased to interpret ambiguous facial expressions as sad, while there was no clear bias on the fear–anger spectrum. Following the intervention, we found changes in Syrian refugee children’s bias in emotion recognition away from sad facial expressions, although this returned to pre-intervention levels 2 months after the end of the program. This shift in the bias away from sad facial expressions was not associated with changes in self-reported mental health symptoms. These results suggest a potential positive role of the reading intervention on affective development, but further research is required to determine the longer-term impacts of the program. (shrink)

Background Families whose child has unexplained intellectual or developmental differences often hope that a genetic diagnosis will lower barriers to community-based therapeutic and support services. However, there is little known about efforts to mobilize genetic information outside the clinic or how socioeconomic disadvantage shapes and constrains outcomes.Methods We conducted an ethnographic study with predominantly socioeconomically disadvantaged families enrolled in a multi-year genomics research study, including clinic observations and in-depth interviews in English and Spanish at multiple time points. Coding and thematic (...) development were used to collaboratively interpret fieldnotes and transcripts.Results Thirty-two families participated. Themes included familial expectations that a genetic diagnosis could be translated into information, understanding, and assistance to improve the quality of a child’s day-to-day life. After sequencing, however, genetic information was not readily converted into improved access to services beyond the clinic, with families often struggling to use a genetic diagnosis to advocate for their child.Conclusion Families’ ability to use a genetic diagnosis as an effective advocacy tool beyond the clinic was limited by the knowledge and resources available to them, and by the eligibility criteria used by therapeutic service providers’ – which focused on clinical diagnosis and functional criteria more than etiologic information. All families undertaking genomic testing, particularly those who are disadvantaged, need additional support to understand the limits and potential benefits of genetic information beyond the clinic. (shrink)

The effectiveness of case-based learning in ethics education varies widely regarding how cases are presented. Case process instruction may impact case-based ethics education to promote sensemaking processes, ethical sensemaking strategy use, and ethical decision making (EDM) quality. This study examined two teaching techniques, notes and review, and participants completed note-taking and review activities examining a case-based scenario during an ethics education course. Results suggest that providing case notes in outline form improves sensemaking processes, strategy use, and EDM quality. In addition, (...) combining processes of provided notes and passive review results in incremental, additive performance via certain ethical sensemaking strategies and EDM quality. (shrink)

The two target articles in this issue bring into focus the struggle for governance over biomedical interventions that may offer some families more agency—the capacity to act—in the context of many...

Requirements for business ethics education and organizational ethics trainings mark an important step in encouraging ethical behavior among business students and professionals. However, the lack of specificity in these guidelines as to how, what, and where business ethics should be taught has led to stark differences in approaches and content. The present effort uses meta-analytic procedures to examine the effectiveness of current approaches across organizational ethics trainings and business school courses. to provide practical suggestions for business ethics interventions and research. (...) Thus, the primary questions driving this research are as follows: what course characteristics moderate the effectiveness of ethics instruction?, and have ethics education and training efforts improved? Findings suggest that professional, focused, and workshop-based training programs are especially effective for improving business ethics. However, results also reveal considerable problems with many of the criteria used to evaluate the effectiveness of business ethics interventions. Practical suggestions for course design and evaluation in business ethics efforts are discussed along with future research needs. (shrink)

Dispositional forgiveness is positively associated with many facets of wellbeing and has protective implications against depression and anxiety in adolescents. However, little work has been done to examine neurobiological aspects of forgiveness as they relate to clinical symptoms. In order to better understand the neural mechanisms supporting the protective role of forgiveness in adolescents, the current study examined the middle frontal gyrus, which comprises the majority of the dorsolateral prefrontal cortex and is associated with cognitive regulation, and its relationship to (...) forgiveness and clinical symptoms in a sample of healthy adolescents. In this cross-sectional study, larger MFG volume was significantly associated with higher self-reported dispositional forgiveness scores and lower levels of depressive and anxiety symptoms. Forgiveness mediated the relationship between MFG volume and both depressive and anxiety symptom levels. The mediating role of forgiveness in the relationship between MFG volume and clinical symptoms suggests that one way that cognitive regulation strategies supported by this brain region may improve adolescent mental health is via increasing a capacity for forgiveness. The present study highlights the relevance of forgiveness to neurobiology and their relevance to emotional health in adolescents. Future longitudinal studies should focus on the predictive quality of the relationship between forgiveness, brain volume and clinical symptoms and the effects of forgiveness interventions on these relationships. (shrink)

Despite the growing body of literature on training in the responsible conduct of research, few studies have examined the effectiveness of delivery formats used in ethics courses. The present effort sought to address this gap in the literature through a meta-analytic review of 66 empirical studies, representing 106 ethics courses and 10,069 participants. The frequency and effectiveness of 67 instructional and process-based content areas were also assessed for each delivery format. Process-based contents were best delivered face-to-face, whereas contents delivered online (...) were most effective when restricted to compliance-based instructional contents. Overall, hybrid courses were found to be most effective, suggesting that ethics courses are best delivered using a blend of formats and content areas. Implications and recommendations for future development of ethics education courses in the sciences are discussed. (shrink)

As scientific and engineering efforts become increasingly global in nature, the need to understand differences in perceptions of research ethics issues across countries and cultures is imperative. However, investigations into the connection between nationality and ethical decision-making in the sciences have largely generated mixed results. In Study 1 of this paper, a measure of biases and compensatory strategies that could influence ethical decisions was administered. Results from this study indicated that graduate students from the United States and international graduate students (...) studying in the US are prone to different biases. Based on these findings, recommendations are made for developing ethics education interventions to target these decision-making biases. In Study 2, we employed an ethics training intervention based on ethical sensemaking and used a well-established measure of ethical decision-making that more fully captures the content of ethical judgment. Similar to Study 1, the results obtained in this study suggest differences do exist between graduate students from the US and international graduate students in ethical decision-making prior to taking the research ethics training. However, similar effects were observed for both groups following the completion of the ethics training intervention. (shrink)

In recent years, we have seen a new concern with ethics training for research and development professionals. Although ethics training has become more common, the effectiveness of the training being provided is open to question. In the present effort, a new ethics training course was developed that stresses the importance of the strategies people apply to make sense of ethical problems. The effectiveness of this training was assessed in a sample of 59 doctoral students working in the biological and social (...) sciences using a pre–post design with follow-up and a series of ethical decision-making measures serving as the outcome variable. Results showed not only that this training led to sizable gains in ethical decision making but also that these gains were maintained over time. The implications of these findings for ethics training in the sciences are discussed. (shrink)

Requirements for business ethics education and organizational ethics trainings mark an important step in encouraging ethical behavior among business students and professionals. However, the lack of specificity in these guidelines as to how, what, and where business ethics should be taught has led to stark differences in approaches and content. The present effort uses meta-analytic procedures to examine the effectiveness of current approaches across organizational ethics trainings and business school courses. to provide practical suggestions for business ethics interventions and research. (...) Thus, the primary questions driving this research are as follows: what course characteristics moderate the effectiveness of ethics instruction?, and have ethics education and training efforts improved? Findings suggest that professional, focused, and workshop-based training programs are especially effective for improving business ethics. However, results also reveal considerable problems with many of the criteria used to evaluate the effectiveness of business ethics interventions. Practical suggestions for course design and evaluation in business ethics efforts are discussed along with future research needs. (shrink)

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include (...) a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sensemaking processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed. (shrink)

Case-based reasoning has long been used to facilitate instructional effectiveness. Although much remains to be known concerning the most beneficial way to present case material, recent literature suggests that simplifying case material is favorable. Accordingly, the current study manipulated two instructional techniques, incremental case presentation and forecasting outcomes, in a training environment in an attempt to better understand the utility of simplified versus complicated case presentation for learning. Findings suggest that pairing these two cognitively demanding techniques reduces satisfaction and detracts (...) from the effectiveness of the learning approach. Implications regarding the use of instructional techniques in training programs are discussed. (shrink)

Power and organizational hierarchies are ubiquitous to social institutions that form the foundation of modern society. Power differentials may act to constrain or enhance people’s ability to make good ethical decisions. However, little scholarly work has examined perceptions of this important topic. The present effort seeks to address this issue by interviewing academics about hypothetical ethical problems that involve power differences among those involved. Academics discussed what they would do in these scenarios, often drawing on their own experiences. Using a (...) think-aloud protocol, participants were prompted to discuss their reasoning and thinking behind their ethical decisions. These interview data were content analyzed using a semantic analysis program that identified a number of distinct ways that academics think about power differences and abuses in ethical situations. Implications of these findings are discussed. (shrink)

Abstract:Open neural tube defects or myelomeningoceles are a common congenital condition caused by failure of closure of the neural tube early in gestation, leading to a number of neurologic sequelae including paralysis, hindbrain herniation, hydrocephalus and neurogenic bowel and bladder dysfunction. Traditionally, the condition was treated by closure of the defect postnatally but a recently completed randomized controlled trial of prenatal versus postnatal closure demonstrated improved neurologic outcomes in the prenatal closure group. Fetal surgery, or more precisely maternal-fetal surgery, raises (...) a number of ethical issues that we address including who the patient is, informed consent, surgical innovation and equipoise as well maternal assumption of risk. As the procedure becomes more widely adopted into practice, we suggest close monitoring of new fetal surgery centers, in order to ensure that the positive results of the trial are maintained without increased risk to both the mother and fetus. (shrink)

Traditional whistleblowing theories have purported that whistleblowers engage in a rational process in determining whether or not to blow the whistle on misconduct. However, stressors inherent to whistleblowing often impede rational thinking and act as a barrier to effective whistleblowing. The negative impact of these stressors on whistleblowing may be made worse depending on who engages in the misconduct: a peer or advisor. In the present study, participants are presented with an ethical scenario where either a peer or advisor engages (...) in misconduct, and positive and the negative consequences of whistleblowing are either directed to the wrongdoer, department, or university. Participant responses to case questions were evaluated for whistleblowing intentions, moral intensity, metacognitive reasoning strategies, and positive and negative, active and passive emotions. Findings indicate that participants were less likely to report the observed misconduct of an advisor compared to a peer. Furthermore, the findings also suggest that when an advisor is the source of misconduct, greater negative affect results. Post-hoc analyses were also conducted examining the differences between those who did and did not intend to blow the whistle under the circumstances of either having to report an advisor or peer. The implications of these findings for understanding the complexities involved in whistleblowing are discussed. (shrink)

This book features new essays by philosophers, psychologists, and a theologian on the important topic of virtue development. The essays engage with work from multiple disciplines and thereby seek to bridge disciplinary divides. The volume is a significant contribution to the emerging interdisciplinary field of virtue development studies.

Given the growing public concern and attention placed on cases of research misconduct, government agencies and research institutions have increased their efforts to develop and improve ethics education programs for scientists. The present study sought to assess the impact of these increased efforts by sampling empirical studies published since the year 2000. Studies published prior to 2000 examined in other meta-analytic work were also included to provide a baseline for assessing gains in ethics training effectiveness over time. In total, this (...) quantitative review consisted of 66 empirical studies, 106 ethics courses, 150 effect sizes, and 10,069 training participants. Overall, the findings indicated that ethics instruction resulted in sizable benefits to participants and has improved considerably within the last decade. A number of specific findings also emerged regarding moderators of instructional effectiveness. Recommendations are discussed for improving the development, delivery, and evaluation of ethics instruction in the sciences. (shrink)

Since the 1980s, foodbanks have become a widespread solution to addressing hunger within high-income countries. The primary reason for their establishment has been widely recognised as neoliberal policies, particularly those that led to massive cuts in social welfare assistance. Foodbanks and hunger have subsequently been framed within a neoliberal critique. However, we argue that critiques of foodbanks are not unique to neoliberalism but have deeper historical roots, meaning that the part neoliberal policies have played is not as clear-cut. In order (...) to understand the normalisation of foodbanks within society, and gain a more extensive understanding of hunger and appreciation as to how this issue could be addressed, it is therefore important to gain a historical understanding of food charity development. In this article, we achieve this by presenting a genealogy of food charity within Aotearoa New Zealand, which witnessed a fluctuation in the use of soup kitchens during the nineteenth and twentieth centuries, and a rise of foodbanks in the 1980s and ‘90 s. Highlighting the historical parallels and major economic and cultural shifts that have allowed for the institutionalisation of foodbanks, we explore the patterns, parallels and differences exposed, and how they yield an alternative understanding of hunger. Using this analysis, we then discuss the wider implications of the historical foundations of food charity and hunger to better understand the role neoliberalism has played in the entrenchment of foodbanks, and advocate the importance of looking beyond a neoliberal critique in order to entertain alternative solutions to addressing food insecurity. (shrink)

The narratives that emerging adults wrote about a time when they learned an important moral, value or lesson were explored in order to determine the characteristics of events that lead to internalized values as well as to compare the way different kinds of moral values are socialized. Lessons resulting from misbehavior were reported most frequently. Those involving direct teaching of values were most highly internalized, with internalization assessed by importance and current impact. Self-reflection and self-generation of values was identified as (...) a key means to value learning and was reported more frequently than any other source of values (e.g., parents, peers). Finally, it appears that a framework for understanding socialization that involves different domains can reflect how individuals categorize their value-learning experiences. (shrink)

This paper interrogates and reclaims clown practices in children’s rehabilitation as ‘foolish.’ Attempts to legitimize and ‘take seriously’ clown practices in the health sciences frame the work of clowns as secondary to the ‘real’ work of medical professionals and diminish the ways clowns support emotional vulnerability and bravery with a willingness to fail and be ridiculous as fundamental to their work. Narrow conceptualizations of clown practices in hospitals as only happy and funny overlook the ways clowns also routinely engage with (...) sadness, despair, discomfort and many other ways of being and doing. Our exploration of clown practices as foolish exposes the ways children’s rehabilitation upholds particular neoliberal models of success and invites a re-centring of rehabilitation and health care research and practice towards relationship building, supporting meaningful projects and a continued nurturing of aesthetic and pleasurable ways of being-in-the-world in the present moment as valuable unto themselves. (shrink)

For many children with complex medical conditions, decisions regarding their goals of care lie in the zone of parental discretion. That is, clinicians appropriately recognize that in many cases whether to prioritize quantity of life or quality of life is a deeply personal, values-laden decision best made by those who are most deeply invested in the outcome. Once a family has committed to a goal, however, there may be new or ongoing conflict between parents and clinicians regarding the specific interventions (...) provided or not provided in support of that goal. To what extent is it ethically permissible for a seriously ill child’s surrogate decision makers to reject individual interventions that support their desired goal of care? This question might be best described thus: is pediatric healthcare “prix fixe,” in which clinicians help parents decide the best of one or more set combinations (“menus”) of interventions, or is it “à la carte,” in which parents are free to accept or reject each individual intervention? We argue that the concept of a “prix fixe” approach should be discussed with families early in the development of the clinical relationship, as an essential facet of shared decision making. (shrink)