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)

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)

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)

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)

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)

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.

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.

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.

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)

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...

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)

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)

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)

The development of T cells and B cells from pluripotent hematopoietic precursors occurs through a stepwise narrowing of developmental potential that ends in lineage commitment. During this process, lineage-specific genes are activated asynchronously, and lineage-inappropriate genes, although initially expressed, are asynchronously turned off. These complex gene expression events are the outcome of the changes in expression of multiple transcription factors with partially overlapping roles in early lymphocyte and myeloid cell development. Key transcription factors promoting B-cell development and candidates for this (...) role in T-cell development are discussed in terms of their possible modes of action in fate determination. We discuss how a robust, stable, cell-type–specific gene expression pattern may be established in part by the interplay between endogenous transcription factors and signals transduced by cytokine receptors, and in part by the network of effects of particular transcription factors on each other. BioEssays 21:726–742, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethos in Steig’s and Sendak’s Picture Books: The Connected and the Lonely ChildEllen Handler SpitzThere was the child, listening to everything...—Yasunari Kawabata1IntroductionPicture-book characters spring to life in both verbal and visual registers. Moving about the page before our eyes as well as speaking and acting in their respective stories, they often make a long-lasting impact on children. Pictures and words, moreover, may overlap but are never commensurate; like the (...) words and notes of a song, they mean and evoke differently even while being experienced together. This brief essay considers a small selection of works by two distinguished twentieth-century American authors-artists: William Steig (1907–2003) and Maurice Sendak (b. 1928). It argues that, with their artful words and pictures, Steig and Sendak construct very different—even contrasting—visions of childhood. By “ethos” in this context I mean to suggest a vision of what a child is, a sense of what it means both to be a child and to address one. Such visions differ not only through the ages and from one culture and locale to another but also from one author-artist of the same period and locale to another. Invited to speak on Sendak’s and Steig’s respective works at meetings scheduled just a week apart in New York City during the winter of 2007, I found in these paired invitations a fortuitous opportunity to juxtapose several of their works and thereby discover some arresting contrasts and formulate the following readings.2First, a word on the topic of methodology. Nearly one hundred years have elapsed since Freud published his celebrated-cum-notorious foray into psychobiography with Leonardo da Vinci and a Memory of His Childhood,3 wherein shards of circumstantial biographical evidence were laid out in seductive mosaic patterns secured with a grout of ingenious speculation. Despite subsequent decades of critical reflection, Freud’s method soldiers on nonetheless as a modus operandi in the psychological interpretation of art and literature.4 By bracketing a small selection of Steig’s and Sendak’s works here and limiting myself to extracting a tentative underlying ethos from them, I am [End Page 64] taking the position that to write psychologically one need not mention or exploit a creator’s personal life. This essay points gently toward psychological approaches that ask what we can see when we look carefully at the pages of works. What can we find when we share children’s books with children? Why, for example, has Sendak’s Where the Wild Things Are sold over seventeen million copies (and its Amazon rank last time I checked was around 145, which means that only 144 other books in the United States were selling more copies at that particular moment), whereas his later work Outside Over There—a book that apparently figures prominently in his personal life—comes nowhere close?5 While market figures do not correlate flawlessly with children’s actual preferences (adults, not children, are the buyers), I would aver that, in this case, they do reflect the success and beloved status of Where the Wild Things Are, since the figures tally with additional facts: the book continues to appeal in its fifth decade post publication; it is known and has been translated worldwide, dramatized, and set to music6; and its characters have been fashioned into ubiquitous stuffed toys. On the other hand, in my (limited) experience, young children seem to find Outside Over There unsettling, unintelligible, even “creepy” and often have trouble sitting still through a full rendition. Some adults, on the other hand, praise that book as poetic and admire its more complex art. Such discrepancies in reception deserve our attention; they hint at fallow fertile fields lying over the rainbow, far beyond the much-plowed tracts of authorial psychobiography. This essay gestures casually toward those fields.The Connected Child“My dear Deborah,” said Doctor De Soto, “you must have been reading my mind.7Let’s begin with William Steig, who is best known for his New Yorker cartoons. His work for children extends back to 1968,8 however, when he was already a man in his sixties. Setting aside the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethos in Steig’s and Sendak’s Picture Books: The Connected and the Lonely ChildEllen Handler SpitzThere was the child, listening to everything...—Yasunari Kawabata1IntroductionPicture-book characters spring to life in both verbal and visual registers. Moving about the page before our eyes as well as speaking and acting in their respective stories, they often make a long-lasting impact on children. Pictures and words, moreover, may overlap but are never commensurate; like the (...) words and notes of a song, they mean and evoke differently even while being experienced together. This brief essay considers a small selection of works by two distinguished twentieth-century American authors-artists: William Steig (1907–2003) and Maurice Sendak (b. 1928). It argues that, with their artful words and pictures, Steig and Sendak construct very different—even contrasting—visions of childhood. By “ethos” in this context I mean to suggest a vision of what a child is, a sense of what it means both to be a child and to address one. Such visions differ not only through the ages and from one culture and locale to another but also from one author-artist of the same period and locale to another. Invited to speak on Sendak’s and Steig’s respective works at meetings scheduled just a week apart in New York City during the winter of 2007, I found in these paired invitations a fortuitous opportunity to juxtapose several of their works and thereby discover some arresting contrasts and formulate the following readings.2First, a word on the topic of methodology. Nearly one hundred years have elapsed since Freud published his celebrated-cum-notorious foray into psychobiography with Leonardo da Vinci and a Memory of His Childhood,3 wherein shards of circumstantial biographical evidence were laid out in seductive mosaic patterns secured with a grout of ingenious speculation. Despite subsequent decades of critical reflection, Freud’s method soldiers on nonetheless as a modus operandi in the psychological interpretation of art and literature.4 By bracketing a small selection of Steig’s and Sendak’s works here and limiting myself to extracting a tentative underlying ethos from them, I am [End Page 64] taking the position that to write psychologically one need not mention or exploit a creator’s personal life. This essay points gently toward psychological approaches that ask what we can see when we look carefully at the pages of works. What can we find when we share children’s books with children? Why, for example, has Sendak’s Where the Wild Things Are sold over seventeen million copies (and its Amazon rank last time I checked was around 145, which means that only 144 other books in the United States were selling more copies at that particular moment), whereas his later work Outside Over There—a book that apparently figures prominently in his personal life—comes nowhere close?5 While market figures do not correlate flawlessly with children’s actual preferences (adults, not children, are the buyers), I would aver that, in this case, they do reflect the success and beloved status of Where the Wild Things Are, since the figures tally with additional facts: the book continues to appeal in its fifth decade post publication; it is known and has been translated worldwide, dramatized, and set to music6; and its characters have been fashioned into ubiquitous stuffed toys. On the other hand, in my (limited) experience, young children seem to find Outside Over There unsettling, unintelligible, even “creepy” and often have trouble sitting still through a full rendition. Some adults, on the other hand, praise that book as poetic and admire its more complex art. Such discrepancies in reception deserve our attention; they hint at fallow fertile fields lying over the rainbow, far beyond the much-plowed tracts of authorial psychobiography. This essay gestures casually toward those fields.The Connected Child“My dear Deborah,” said Doctor De Soto, “you must have been reading my mind.7Let’s begin with William Steig, who is best known for his New Yorker cartoons. His work for children extends back to 1968,8 however, when he was already a man in his sixties. Setting aside the... (shrink)

Excerpt from The Fundamental Principle of Fichte's Philosophy The purpose of this monograph is to make a careful study of Fichte's conception of the ultimate principle. In his various writings the principle appears under many different names. 'The Ego, ' 'the Idea of the Ego, ' 'the moral world-order, ' 'God, ' 'the Absolute, ' 'Being, ' 'the Light, ' are some of the phrases by which it is most commonly designated. It is not the main purpose of this study (...) to examine tile much discussed question of the relation between the two periods of Fichte's philosophy. But the question is so intimately connected with the problem which I have undertaken that some discussion of it is inevitable. I have tried, however, to keep well within the limits of my theme, and instead of considering the relation between the two periods in all its aspects, have sought merely to determine how far the conception of the fundamental principle which we find in Fichte's later writings differs from that which appears in the earlier ones. The references to Fichte's writings are to the Sammtliche Werke (Berlin, 1845-1846, 8 vols.) and to the Nachgelassene Werke (Bonn, 1834-1835, 3 vols.). References to the Sammtliche Werke are indicated by the letters S. W.; to the Nachgelassene Werke, by the letters N. W. References to the Kritik der remen Vernunft arc indicated by the letters A (for the First Edition) and B (for the Second). All other references to Kant's writings are made to Hartenstein's second edition of the Sammtliche Werke (Leipzig, 1867-1868, 8 vols.) and are indicated by the letter H. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.". (shrink)

A History of Women Philosophers, Volume I: Ancient Women Philoophers, 600 B.C. - 500 A.D., edited by Mary Ellen Waithe, is an important but somewhat frustrating book. It is filled with tantalizing glimpses into the lives and thoughts of some of our earliest philosophical foremothers. Yet it lacks a clear unifying theme, and the abrupt transitions from one philosopher and period to the next are sometimes disconcerting. The overall effect is not unlike that of viewing an expansive landscape, illuminated (...) only by a few tiny spotlights. (shrink)

This study investigated the relationship between supervisor personality and subordinate reports of exposure to bullying and harassment at work. Three research questions were examined: (a) Is there a direct relationship between supervisor personality and reports of workplace bullying? (b) Is there an interaction between supervisor personality and supervisors' perceived stress as predictors of workplace bullying? (c) Will subordinates who experience bullying at their workplace rate their supervisor's personality more negatively (negative halo effect)? The sample consisted of 207 supervisors and employees (...) within 70 Norwegian restaurants. Supervisors low on conscientiousness, high on neuroticism and portraying high levels of exposure to stress were the subject of significantly more reports from subordinates of exposure to workplace bullying. An interaction between agreeableness and stress was found showing that agreeableness is related to bullying under low levels of stress. In addition, subordinates who perceived their supervisor as being low on agreeableness and high on introversion reported significantly more workplace bullying, supporting a negative halo effect hypothesis. (shrink)

Making Sense of Sex: Attitudes towards Sexuality in Early Jewish and Christian Literature. By William Loader. Grand Rapids, Mich.: William B. Eerdmans Publishing Co., 2013. Pp. vii + 168. $24.

Making Sense of Sex: Attitudes towards Sexuality in Early Jewish and Christian Literature. By William Loader. Grand Rapids, Mich.: William B. Eerdmans Publishing Co., 2013. Pp. vii + 168. $24.

Ethical dilemmas are often not discussed in the dissemination of educational research. While the ethical guidelines for research seem clear at first glance, a closer look at the intimate nature of qualitative research reveals that there are many ambiguities or ‘grey’ areas where researchers must rely on their personal value systems. This article discusses the challenges faced by an experienced educator, although novice researcher, in considering the ethical parameters of her own research with adolescents with hearing loss. In particular, the (...) grey ethical areas identified by the researcher include: (a) vulnerable population; (b) researcher role confusion; (c) consent; (d) privacy, confidentiality, and anonymity; as well as (e) the nature of risk. Based on the author’s own reflections on beginning the research process, the article presents possible pitfalls and ways of overcoming the possibility of becoming immobilized by the ethical enigmas of research. (shrink)