Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

ABSTRACT:Bioethicists today are taking a greater role in the design and implementation of emerging technologies by "embedding" within the development teams and providing their direct guidance and recommendations. Ideally, these collaborations allow ethical considerations to be addressed in an active, iterative, and ongoing process through regular exchanges between ethicists and members of the technological development team. This article discusses a challenge to this embedded ethics approach—namely, that bioethical guidance, even if embraced by the development team in theory, is not easily (...) actionable in situ. Many of the ethical problems at issue in emerging technologies are associated with preexisting structural, socioeconomic, and political factors, making compliance with ethical recommendations sometimes less a matter of choice and more a matter of feasibility. Moreover, incentive structures within these systemic factors maintain them against reform efforts. The authors recommend that embedded bioethicists utilize principles from behavioral science (such as behavioral economics) to better understand and account for these incentive structures so as to encourage the ethically responsible uptake of technological innovations. (shrink)

Background: Limited knowledge of the experiences of conflicts of conscience found in nursing literature. Objectives: To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. Research design: Interpretive description was selected to help situate the findings in a meaningful clinical context. Participants and research context: Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. Ethical consideration: Ethics approval from the Health Research Ethics Board at the University of Alberta. Findings: Three common (...) themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse’s voice, and the unique proximity of nurses. Discussion and conclusion: The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection. (shrink)

Building from an interactionist view of ethics, this study sought to integrate individual and contextual factors for understanding ethical perceptions in teams. Given the proximal nature of team members, this study specifically explored how individuals comparatively evaluate their own ethical behaviors and team members’ ethical behaviors to arrive at a perception of ethical person–group fit within a team. Grounding our theoretical arguments in relational schemas theory, we demonstrate that interpersonal ethical perceptions can have distal impacts on perceptions of team functioning. (...) The results support the hypotheses that a perceived ethical incongruence between the self and other team members negatively influenced perceptions of relationship conflict and ultimately information sharing. By exploring individual and team level aspects of ethics concurrently, we contribute to a deeper understanding of contextual forces in ethics through an interactionist approach. (shrink)

The hairdresser who carries Ovid's invitation to his puella in Amores 1.11 is almost immediately blamed for his rejection in 1.12, before that blame is transferred to the tablets carrying that invitation. Nape (the enslaved hairdresser of the puella) has been linked to the character Dipsas, appearing in 1.7, specifically through the descriptor sobria. By focussing on the use of the verb uerto, the reference to the mythical strix, and curses related to the old age of both Dipsas and the (...) tablets in 1.7 and 1.12, this note demonstrates that the supernatural word choice further connects Nape with Dipsas. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to experiences (...) of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

The AMA's Council on Ethical and Judicial Affairs' position statement on “Disaster Preparedness and Response” is a welcome discussion of an important issue: the extent to which physicians have a responsibility to treat people affected by disasters in which the nature, source, and cause of the harm is unclear and where the risk is largely unknown.

BackgroundDeep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies hav...

Do we need a right to mental privacy? In an era of increasing sophistication in recording, interpreting, and directly intervening on our neural activity – not to mention efforts at combining neural...

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

IntroductionDeep brain stimulation (DBS) is utilized to treat pediatric refractory dystonia and its use in pediatric patients is expected to grow. One important question concerns the impact of hope and unrealistic optimism on decision-making, especially in “last resort” intervention scenarios such as DBS for refractory conditions.ObjectiveThis study examined stakeholder experiences and perspectives on hope and unrealistic optimism in the context of decision-making about DBS for childhood dystonia and provides insights for clinicians seeking to implement effective communication strategies.Materials and MethodsSemi-structured interviews (...) with clinicians (n = 29) and caregivers (n = 44) were conducted, transcribed, and coded.ResultsUsing thematic content analysis, four major themes from clinician interviews and five major themes from caregiver interviews related to hopes and expectations were identified. Clinicians expressed concerns about caregiver false hopes (86%, 25/29) and desperation (68.9%, 20/29) in light of DBS being a last resort. As a result, 68.9% of clinicians (20/29) expressed that they intentionally tried to lower caregiver expectations about DBS outcomes. Clinicians also expressed concern that, on the flip side, unrealistic pessimism drives away some patients who might otherwise benefit from DBS (34.5%, 10/29). Caregivers viewed DBS as the last option that they had to try (61.3%, 27/44), and 73% of caregivers (32/44) viewed themselves as having high hopes but reasonable expectations. Fewer than half (43%, 19/44) expressed that they struggled setting outcome expectations due to the uncertainty of DBS, and 50% of post-DBS caregivers (14/28) expressed some negative feelings post treatment due to unmet expectations. 43% of caregivers (19/44) had experiences with clinicians who tried to set low expectations about the potential benefits of DBS.ConclusionThoughtful clinician-stakeholder discussion is needed to ensure realistic outcome expectations. (shrink)

Searches for the sources and means for a disciplined practical approach to exploring human experience.

The application of machine learning in health care holds great promise for improving care. Indeed, our own team is collaborating with experts in machine learning and statistical modeling to bu...

ABSTRACTIn our everyday life, we frequently switch between different tasks, a faculty that changes with age. However, it is still not understood how emotion impacts on age-related changes in task s...

Radical behaviorism is fundamentally different from traditional psychology, so it is not surprising that is has been widely misunderstood. It offers an alternative to the traditional treatments of mind that avoids some of the insoluble problems raised by those views. B. F. Skinner attempted many times to describe this alternative with limited success, partially attributable to the opacity of his prose and the excessiveness of his proposed applications. We offer annotated excerpts from one of his books dedicated to this end (...) in an effort to show how his approach deals with topics usually viewed as "cognitive psychology." While modern radical behaviorism has progressed beyond Skinner's conception in important ways, his writings remain instructive. (shrink)

Accurately assessing youth mental health involves obtaining reports from multiple informants who typically display low levels of correspondence. This low correspondence may reflect situational specificity. That is, youth vary as to where they display mental health concerns and informants vary as to where and from what perspective they observe youth. Despite the frequent need to understand and interpret these informant discrepancies, no consensus guidelines exist for integrating informants’ reports. The path to building these guidelines starts with identifying factors that reliably (...) predict the level and form of these informant discrepancies, and do so for theoretically and empirically relevant reasons. Yet, despite the knowledge of situational specificity, few approaches to integrating multi-informant data are well-equipped to account for these factors in measurement, and those that claim to be well-positioned to do so have undergone little empirical scrutiny. One promising approach was developed roughly 20 years ago by Kraemer and colleagues. Their Satellite Model leverages principal components analysis and strategic selection of informants to instantiate situational specificity in measurement, namely components reflecting variance attributable to the context in which informants observe behavior, the perspective from which they observe behavior, and behavior that manifests across contexts and perspectives. The current study represents the first construct validation test of the Satellite Model. A mixed-clinical/community sample of 134 adolescents and their parents completed six parallel surveys of adolescent mental health. Adolescents also participated in a series of simulated social interactions with research personnel trained to act as same-age, unfamiliar peers. A third informant viewed these interactions and completed the same surveys as parents and adolescents. We applied the Satellite Model to each set of surveys and observed high internal consistency estimates for each of the six-item trait, context, and perspective components. Scores reflecting the trait, context, and perspective components displayed distinct patterns of relations to a battery of criterion variables that varied in the context, perspective, and source of measurement. The Satellite Model instantiates situational specificity in measurement and facilitates unifying conceptual and measurement models of youth mental health. (shrink)

We report an experiment investigating the “special-process” theory of insight problem solving, which claims that insight arises from non-conscious, non-reportable processes that enable problem re-structuring. We predicted that reducing opportunities for speech-based processing during insight problem solving should permit special processes to function more effectively and gain conscious awareness, thereby facilitating insight. We distracted speech-based processing by using either articulatory suppression or irrelevant speech, with findings for these conditions supporting the predicted insight facilitation effect relative to silent working or thinking (...) aloud. The latter condition was included to investigate the currently contested effect of “verbal overshadowing” on insight, whereby thinking aloud is claimed to hinder the operation of special, non-reportable processes. Whilst verbal overshadowing was not evident in final solution rates, there was nevertheless support for verbal overshadowing up to and beyond.. (shrink)

This book searches for the sources and means for a disciplined practical approach to exploring human experience. The spirit of this book is "pragmatic" and relies on a Husserlian phenomenology primarily understood as a "method" of exploring our experience. The authors do not aim at a neo-Kantian "a priori" new theory of experience but instead they describe a concrete activity: how we examine what we live through, how we "become aware" of our own mental life. The range of experiences of (...) which we can become aware is vast: all the normal dimensions of human life (perception, motion, memory, imagination, speech, everyday social interactions), cognitive events that can be precisely defined as tasks in laboratory experiments (e.g., a protocol for visual attention), but also manifestations of mental life more fraught with meaning (dreaming, intense emotions, social tensions, altered states of consciousness). The central assertion in this work is that this immanent ability is habitually ignored or at best practiced unsystematically, that is to say, blindly. Exploring human experience amounts to developing and cultivating this basic ability through specific training. Only a hands-on, non-dogmatic approach can lead to progress, and that is what animates this book. (Series B). (shrink)

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both (...) distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

The target article tackles an important and complicated issue of the underlying links between curiosity and creativity. Although thought-provoking, the target article overlooks contemporary theories and research on these constructs. Consequently, the proposed model is inconsistent with prior research in the developmental and educational fields and would benefit from better specification and clarity around key constructs and processes.

Philosophers sometimes hope that our discipline will be transformative for students, perhaps especially when we teach so-called philosophy of the body. To that end, this article describes an experimental upper-level undergraduate course cross-listed between Philosophy and Physical Education, entitled “Thinking Through the Body: Philosophy and Yoga.” Drawing on the perspectives of professor and students, we show how a somatic practice (here, hatha yoga) and reading texts (here, primarily contemporary phenomenology) can be integrated in teaching and learning. We suggest that the (...) course raised questions about the ethics of evaluation as well as about the split between theory and practice, which have larger pedagogical implications. (shrink)

IntroductionCognitive impairment is a highly prevalent non-motor feature of Parkinson’s disease. A better understanding of the underlying pathophysiology may help in identifying therapeutic targets to prevent or treat dementia. This study sought to identify metabolic alterations in the prefrontal cortex, a key region for cognitive functioning that has been implicated in cognitive dysfunction in PD.MethodsProton Magnetic Resonance Spectroscopy was used to investigate metabolic changes in the PFC of a cohort of cognitively normal individuals without PD, as well as PD participants (...) with either normal cognition, mild cognitive impairment, or dementia. Ratios to Creatine resonance were obtained for glutamate, glutamine and glutamate combined, N-acetylaspartate, myoinositol, and total choline, and correlated with cognitive scores across multiple domains administered to the PD participants only.ResultsWhen individuals retain cognitive capabilities, the presence of Parkinson’s disease does not create metabolic disturbances in the PFC. However, when cognitive symptoms are present, PFC Glu/Cre ratios decrease with significant differences between the PD-NC and PPD groups. In addition, Glu/Cre ratios and memory scores were marginally associated, but not after Bonferroni correction.ConclusionThese preliminary findings indicate that fluctuations in prefrontal glutamate may constitute a biomarker for the progression of cognitive impairments in PD. We caution for larger MRS investigations of carefully defined PD groups. (shrink)

The present study tests a gestalt explanation for the gambler's fallacy which posits that runs in random events will be expected to reverse only when the run is open or ongoing. This is contrasted with the law of small numbers explanation suggesting that people expect random outcomes to balance out generally. Sixty-one university students placed hypothetical guesses and bets on a series of coin tosses. Either heads or tails were dominant . In a closed run condition the run ended prior (...) to the critical trial , and in an open run condition the run remained open . As hypothesised, participants showed the gambler's fallacy in the open run condition, but not in the closed run condition. This difference is not due to differential memory for the outcomes. Men, and people with more previous experience gambling, were also found to be more prone to the gambler's fallacy. It is argued that the gestalt explanation best explains the results. (shrink)

Curiosity is widely acknowledged as a crucial aspect of children’s development and as an important part of the learning process, with prior research showing associations between curiosity and achievement. Despite this evidence, there is little research on the development of curiosity or on promoting curiosity in school settings, and measures of curiosity promotion in the classroom are absent from the published literature. This article introduces the Curiosity in Classrooms Framework coding protocol, a tool for observing and coding instructional practices that (...) support the promotion of curiosity. We describe the development of the framework and observation instrument and the results of a feasibility study using the protocol, which gives a descriptive overview of curiosity-promoting instruction in 35 elementary-level math lessons. Our discussion includes lessons learned from this work and suggestions for future research using the developed observation tool. (shrink)

This article details the making of community and bodies in online environments, specifically the online pro-anorexia community. Building community among members of these groups is particularly fraught because tensions over claims to authenticity permeate these groups. Because these are embodied practices and online spaces are presumably disembodied, participants constantly grapple with authenticity, largely through the threat of the ‘wannarexic’. Participants manage these tensions through engaging in group rituals and deploying individual tools that attempt to make the body evident online. This (...) article documents the way in which tensions around authenticity and embodied practices are managed through treatment of the wannarexic. (shrink)

Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: (...) irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD. (shrink)