Who should decide? In When Doctors Say No, philosopher and bioethicist Rubin examines this controversial issue.

A structure has a (finite-string) automatic presentation if the elements of its domain can be named by finite strings in such a way that the coded domain and the coded atomic operations are recognised by synchronous multitape automata. Consequently, every structure with an automatic presentation has a decidable first-order theory. The problems surveyed here include the classification of classes of structures with automatic presentations, the complexity of the isomorphism problem, and the relationship between definability and recognisability.

Clinical psychologists' and nonpsychiatric physicians' attitudes and behaviors in sexual and confidentiality boundary violations were examined. The 171 participants' responses were analyzed by profession, sex, and status (student, resident, professional) on semantic differential, boundary violation vignettes, and a version of Pope, Tabachnick, and Keith-Spiegel's (1987) ethical scale. Psychologists rated sexual boundary violation as more unethical than did physicians (p<.001). Rationale (p<.01) and timing (p<.001) influenced ratings. Psychologists reported fewer sexualized behaviors than physicians (p<05). Professional experience (p<.01) and sex (p<.05) were (...) associated with confidence-violating behavior. Overall, 78% of the sample reported attitudes or behaviors associated with boundary violations. The behavior violations were correlated (r=.49). Actual violators rated vignette violators more leniently than did nonviolators (p<.01). (shrink)

Constructivist biosemiotics foundations imply the first-person basis of cognition. CBF are developed by the biology of cognition, relational biology, enactive approach, ecology of mind, second order cybernetics, genetic epistemology, gestalt, ecological perception and affordances, and active inference by minimization of free energy. CBF reject the idea of an objective independent reality to be represented by information processing in order to be the fittest. CBF assumes that perception is the behavioral configuration of an object and objects are tokens for eigen-behaviors. Cognition (...) takes place in the organism-environment structural coupling during the ontogeny and phylogeny of all biological unities including unicellular organisms. Therefore, if exogenous DNA particles are just tokens for the cell signalling eigen-behaviors, if there is no ‘information’ in the DNA sequence, how can we explain that the same virus or trans- sequence is associated with a similar phenotype? We call this ‘exogenomic problem’. With this basic example, but sufficiently generic to the whole biological world, we agree respectively with Autopoiesis, -system, and Gaia theory: i) ‘Information, code and meaning’ in the DNA sequence belong to the domain of the observer’s description. ii) Genetic ‘information’ is not a program or algorithmic software in DNA sequence. Rather it is a microphysical observable mode of eigen-behaviors in biological unities. iii) The transfer and acquisition of DNA particles is a biospheric phenomenon that maintains its homeorhesis, symbiotic and biosemiotic entailment. Based on the theoretical and experimental results of these theories, it is concluded that genetic ‘information’ is not a genomic sequence, nor any kind of information, but for the cell DNA must embody physical forcing. Genetic characters are the effects and not the cause of phenotype and DNA particles do not ‘use or manipulate’ cellular metabolism. Rather, any cellular configuration change that occurred before or during DNA perturbation is determined on the basis of the cellular standpoint. (shrink)

The debate about what constitutes the discipline of ethics and who qualifies as an ethics consultant is linked unavoidably to a debate that is potentiated by the reality of a rapidly changing and high-stakes health care consultation marketplace. Who we are and what we can offer to the moral gesture that is medicine is shaped by our fundamental understanding of the place of expert knowledge in the transformation of social reality. The struggle for self-definition is particularly freighted since clinical ethics (...) consultation aspires to be more than academic contemplation. Two recent books (Ethics Consultation by John La Puma and David Schiedermayer and The Health Care Ethics Consultant: A Practical Guide, edited by Francoise Baylis) exemplify the two most popular but most widely divergent positions on these issues. We argue that while useful, neither book addresses fully the particular and distinct role of the professional ethicist. (shrink)

Clinical ethics, like the broader field of bioethics from which it emerged, is at a critical crossroads in its development, with conflicting paths ahead. It can either claim its distinctive place in the clinical arena, insisting unapologetically on certain minimal standards of professional training, practice and competence, addressing head on debates about various models of and methodological approaches to consultation, and establishing a shared vision of the purpose and meaning of the enterprise of clinical ethics itself. Or, it can devolve (...) into a hobby that untrained, albeit interested, and generally well intentioned individuals can dabble in for fun or even profit, as they see fit, and without regard to the deep history and rich disciplinary roots of the field, the serious debates in the academic literature of bioethics, the foundational case histories and legal theories, or even any sense of professional accountability. (shrink)

A structure has a automatic presentationif the elements of its domain can be named by finite strings in such a way that the coded domain and the coded atomic operations are recognised by synchronous multitape automata. Consequently, every structure with an automatic presentation has a decidable first-order theory. The problems surveyed here include the classification of classes of structures with automatic presentations, the complexity of the isomorphism problem, and the relationship between definability and recognisability.

Clinical ethics, like the broader field of bioethics from which it emerged, is at a critical crossroads in its development, with conflicting paths ahead. It can either claim its distinctive place in the clinical arena, insisting unapologetically on certain minimal standards of professional training, practice and competence, addressing head on debates about various models of and methodological approaches to consultation, and establishing a shared vision of the purpose and meaning of the enterprise of clinical ethics itself. Or, it can devolve (...) into a hobby that untrained, albeit interested, and generally well intentioned individuals can dabble in for fun or even profit, as they see fit, and without regard to the deep history and rich disciplinary roots of the field, the serious debates in the academic literature of bioethics, the foundational case histories and legal theories, or even any sense of professional accountability. (shrink)

This article offers a narrative dimension to the evolution of professional ethics in psychology in Israel. The similarities and differences with ethics in the United States frame the discussion. The author's viewpoint and involvement in promoting ethics in academic and professional settings opens the article. This is followed by consideration of the licensing of the profession in 1977, and the ethics requirements that followed. Cultural developments that influenced Israeli society in the direction of greater individual autonomy and disillusionment with paternalism (...) are discussed. The Patient's Rights Law of 1996, the Ethiopian Blood crisis of 1996, and the sexual boundary violations of psychologist Falach in 1992 have had important implications for psychology in Israel. Examining ethics education, the requirements for ethical research, and current ethics resources for psychologists show that although much has been accomplished, there still remains a great deal to be done. (shrink)

Do psychotherapists' unethical practices influence how they are perceived? The 202 Israeli lay and professional psychology participants rated systematically varied descriptions of effective therapists and potential clients under conditions of no difficulties, practice without a license, and a previous sexual boundary violation on indexes of evaluation and willingness to refer. Participants completed a measure of important variables in therapist selection. Effective standard therapists were rated most favorably, unlicensed therapists were rated favorably, and therapists who violated sexual boundaries in the past (...) were rated least favorably. When results were analyzed by respondent characteristics, laypersons rated unlicensed professionals and sexual boundary violators more positively than did clinical psychologists. Men rated the violators more favorably than did women. Factor analysis of therapist selection measures identified professional and personal factors, but only the former were associated with ratings of "problem" therapists. The results underscore the gap between ethical standards and applied decisions made by professionals and laypersons. Further investigation is needed to ensure quality care in both professional and consumer approaches to psychotherapy. (shrink)

The debate about what constitutes the discipline of ethics and who qualifies as an ethics consultant is linked unavoidably to a debate that is potentiated by the reality of a rapidly changing and high-stakes health care consultation marketplace. Who we are and what we can offer to the moral gesture that is medicine is shaped by our fundamental understanding of the place of expert knowledge in the transformation of social reality. The struggle for self-definition is particularly freighted since clinical ethics (...) consultation aspires to be more than academic contemplation. Two recent books (Ethics Consultation by John La Puma and David Schiedermayer and The Health Care Ethics Consultant: A Practical Guide, edited by Francoise Baylis) exemplify the two most popular but most widely divergent positions on these issues. We argue that while useful, neither book addresses fully the particular and distinct role of the professional ethicist. (shrink)

With “The Zadeh Scenario,” Finder offers us a gift…a rich and thoughtful first-person account of the gradual unfolding of a specific ethics consultation conducted by a specific ethics consultant in a specific context. This is not your average case report, stripped to the bare facts and devoid of the ambiguity of real-time human interactions. It’s also not simply an example of thick description, offering the reader a detailed account of the context out of which an abstract ethical dilemma has emerged, (...) with the ethics consultant describing all from a distance, above the fray. What Finder offers and models for us instead is something entirely new and different. He offers us a case narrative into which he has chosen to place himself squarely and explicitly. And in the spirit of “peer review” he has generously revealed his own inner dialogue in response to twists and turns in the case, sharing his personal reflections as events unfolded, and his musings about various actions he took and choices he made in his role. By inviting us to ponder his story about the story of the case, he generously extends a gift to us: the opportunity to reflect on his—and therefore our own—consultation practice, and the opportunity to try a new kind of peer review. (shrink)

This article examines the clergy sexual abuse crisis in the Roman Catholic Church from an ethical point of view. The article uses the RRICC values model of ethical decision making (i.e., responsibility, respect, integrity, competence, concern) to review the behavior of Catholic bishops and other religious superiors as they have tried to manage clergy sex offenders and their victims. Hopefully, the recent press attention and resulting policy changes on these matters from the U.S. Council of Catholic Bishops will increase the (...) chances that future decisions will be ethical ones. (shrink)

This article examines the clergy sexual abuse crisis in the Roman Catholic Church from an ethical point of view. The article uses the RRICC values model of ethical decision making (i.e., responsibility, respect, integrity, competence, concern) to review the behavior of Catholic bishops and other religious superiors as they have tried to manage clergy sex offenders and their victims. Hopefully, the recent press attention and resulting policy changes on these matters from the U.S. Council of Catholic Bishops will increase the (...) chances that future decisions will be ethical ones. (shrink)

Yoga 365 presents a year's worth of daily readings that invite yoga lovers of every skill level to bring the inspiration they experience on their mats into their everyday lives. Each entry explores a mind-body theme such as balance, strength, and resilience in a short, illuminating paragraph that can be enjoyed in the morning or at bedtime, incorporated into a yoga session, or read on the go. Featuring a serenely beautiful hardcover and a spacious, color-washed interior, the package is as (...) calming in the hand as the readings are to the eye. Yogis will find it to be a motivating tool for personal growth and a lighthearted, gift-worthy way to share the joys of their practice with others. (shrink)

Whether surrogate decisionmakers have the authority to refuse pain and symptom management measures on behalf of incapacitated patients is a particularly timely question to ask in this era of growing commitment to ensuring appropriate pain and symptom management measures for all patients.

The number of family members caring and caregiving for a loved one undergoing physical and mental changes continues to increase dramatically. For many, this ongoing experience not only involves the “burden of caregiving” but also the “burden of grief” as their loved-one’s newfound medical condition can result in the loss of the person they previously knew. Dramatic cognitive, behavioral, and personality changes, often leave caregivers bereft of the significant relationship they shared with the affected person prior to the illness or (...) injury. This results in what we term conditions of acquired “non-death interpersonal loss”. Current approaches to these losses use an amalgam of models drawn from both death and non-death loss. Despite their utility, these frameworks have not adequately addressed the unique processes occurring in the interpersonal sphere where the grieving caregiver needs to reach some modus vivendi regarding the triad of “who the person was,” “who they are now,” and “who they will yet become.” In this paper we propose a process-based model which addresses cognitive-emotional-behavioral challenges caregivers meet in the face of their new reality. These require a revision of the interpersonal schemas and the relationships that takes into account the ongoing interactions with the affected family member. The model and its utility to identify adaptive and maladaptive responses to NoDIL is elaborated upon with clinical material obtained from caregivers of people diagnosed with major neuro-cognitive disorder and pediatric traumatic brain injury. The article concludes with implications for theory, research and clinical intervention. (shrink)

Although social justice is an integral component of medical professionalism, there is little discussion in medical education about how to teach it to future physicians. Using adult learning theory and the work of Brazilian educator Paulo Freire, medical educators can teach a socially-conscious professionalism through educational content and teaching strategies. Such teaching can model non-hierarchical relationships to learners, which can translate to their clinical interactions with patients. Freirian teaching can additionally foster professionalism in both teachers and learners by ensuring that (...) they are involved citizens in their local, national and international communities. (shrink)