Walter Sinnott-Armstrong and Franklin G Miller recently argued that the wrongness of killing is best explained by the harm that comes to the victim, and that ‘total disability’ best explains the nature of this harm. Hence, killing patients who are already totally disabled is not wrong. I maintain that their notion of total disability is ambiguous and that they beg the question with respect to whether there are abilities left over that remain relevant for the goods of personhood and (...) human worth. If these goods remain, then something more is lost in death than in ‘total disability,’ and their explanation of what makes killing wrong comes up short. But if total disability is equivalent with death, then their argument is an interesting one. (shrink)

We are very grateful to the commentators for taking the time to respond to our little article, ‘What Makes Killing Wrong?’ They raise many points, so we cannot respond to them all, but we do want to head off a few misinterpretations.Our critics in this journal avoid one careless misinterpretation, but less informed readers have pressed this misinterpretation in popular venues, so we need to start by renouncing it. We do not deny that killing humans is morally wrong. To the (...) contrary, we argue that killing humans is almost always morally wrong, because killing humans is almost always disabling, and disabling is morally wrong. Here we do not disagree with common sense. We also do not deny that killing partially or even profoundly disabled humans is morally wrong. People who are disabled in some ways still retain many other valuable abilities. This should be obvious. To kill a person with some disabilities but many other valuable abilities is to disable that person, so that is morally wrong. Here again we do not disagree with common sense. The one and only surprising application of our theory is to humans who are alive but totally disabled. We argue that, apart from special circumstances, it is not morally wrong to kill live humans who are totally disabled, whereas many people think that it would be morally wrong to kill even in these extreme and unusual cases, because they assume that killing is morally wrong for reasons apart from disabling.What could those reasons be? DeGrazia mentions three possibilities. First, ‘the harm of killing —in those ordinary cases in …. (shrink)

Walter Sinnott-Armstrong and Franklin Miller have presented an account of why killing is wrong that implies it can be permissible to kill certain human beings in order to use their organs for transplantation.1 Since I am going to criticise their arguments, I will begin by applauding their willingness to defend an unpopular position and by registering my agreement with their substantive conclusion about organ procurement. The criticisms I will offer are intended to be friendly in spirit; but they are also, (...) of course, meant to be effective.Sinnott-Armstrong and Miller argue that the wrongness of killing is reducible to the wrongness of disabling, in particular, the wrongness of totally disabling. ‘The rule against disabling,’ they write, ‘fully explains all that is bad and wrong with… killing.’1One might think that their view is just a slight modification of the familiar view that the wrongness of killing is reducible to the wrongness of harming. According to this view, killing is normally gravely wrong because it inflicts on its victim a particularly grievous harm by depriving him of all the good that his future life would otherwise have contained. If the authors' view were just a restatement of this harm-based account of the wrongness of killing, one might conclude that their emphasis on disability is needlessly provocative. But in fact their view is quite different. This is because disabling is only one form of harming. On might seriously harm a person—for example, by causing him to experience mild chronic pain for the remainder of his life—without in any way disabling him. He would retain all his abilities but would be less comfortable while exercising them. Because there are thus forms of harming that are not instances of disabling, a rule …. (shrink)

The formerly established medically-based idea of disability, with its charity-based approach to treatment and services, is being replaced by a human rights-based approach in which people with impairments are no longer considered medical problems, totally dependent on the beneficence of non-impaired people in society, but have fundamental rights to support, inclusion, and participation. This interdisciplinary book examines the diverse concerns that people with impairments face in the context of human rights, provides insights into new developments on important issues relating (...) human rights to disability, and features new approaches and solutions to vital problems in the current debate. (shrink)

The Middles Ages are often portrayed as a time in which people with physical disabilities in the Latin West were ostracized, on the grounds that such conditions demonstrated personal sin and/or God’s judgment. This was undoubtedly the dominant response to disability in various times and places during the fifth through fifteenth centuries, but the total range of medieval responses is much broader and more interesting. In particular, the 13th-15th century treatment of three groups (martyrs, mothers, and mystics - whose physical (...) ‘defects’ were often understood as signs of special connection to God in this life, and who were often represented as retaining these signs in the life to come) challenge standard notions of beauty, disfigurement, and bodily perfection, particularly as the notion is applied to eternal life and our ultimate end. (shrink)

This study was conducted to investigate the relationship between posttraumatic growth, resilience, positive coping style, and self-efficacy among the primary caregivers of children with developmental disorders in Chongqing, China. A total of 198 primary caregivers aged from 22 to 66 years old, including 155 females and 43 males, were enrolled. The Posttraumatic Growth Inventory, Connor-Davidson Resilience Scale-10, Simplified Coping Style Questionnaire, and General Self-Efficacy Scale were used for data collection. The results found that PTG could be positively predicted by resilience. (...) Positive coping style and self-efficacy mediated the relationship between resilience and PTG. The different levels of PTG were determined by the resident location, monthly income and education of the primary caregivers. The results suggest that it is critical to improve the mental health of the primary caregivers of children with developmental disabilities. Our results also provide a scientific basis for future research. (shrink)

Intersectional feminist scholars emphasize how overlapping systems of oppression structure gender inequality, but in focusing on the gendered, classed, and racialized bases of stratification, many often overlook disability as an important social category in determining economic outcomes. This is a significant omission given that disability severely limits opportunities and contributes to cumulative disadvantage. We draw from feminist disability and intersectional theories to account for how disability intersects with gender, race, and education to produce economic insecurity. The findings from our analyses (...) of 2015 American Community Survey data provide strong empirical support for hierarchies of disadvantage, where women and racial minority groups with disabilities and less education experience the highest poverty levels, report the lowest total income, and have a greater reliance on sources outside the labor market for economic security. By taking disability into account, our study demonstrates how these multiple characteristics lead to overlapping oppressions that become embedded and reproduced within the larger social structure. (shrink)

This study adapted the Physical Disability Resilience Scale to Chinese conditions and evaluated the psychometric characteristics of the Chinese version in individuals with physical disability. A total of 438 individuals with physical disability were included in this study. The PDRS was translated to Chinese using a backward translation method. Construct validity, internal consistency reliability, and convergent validity were examined. Confirmatory factor analysis failed to replicate the original five-factor structure of the PDRS. After removing the Spirituality factor and an underperformed item, (...) exploratory factor analysis yielded four trait factors and a method-effect factor. A correlated trait–correlated method model that included the four trait factors and a method-effect factor reported better model fit than the four-factor model, which did not consider method effects. The four subscales of the revised PDRS showed adequate internal consistency. The convergent validity of the revised PDRS was established by the moderate-to-strong associations between its four subscales and theoretically related constructs. We conclude that the revised PDRS is a reliable and valid measure in assessing resilience among Chinese people with physical disability. (shrink)

The Neuroethics of Memory is a thematically integrated analysis and discussion of neuroethical questions about memory capacity and content, as well as interventions to alter it. These include: how does memory function enable agency, and how does memory dysfunction disable it? To what extent is identity based on our capacity to accurately recall the past? Could a person who becomes aware during surgery be harmed if they have no memory of the experience? How do we weigh the benefits and risks (...) of brain implants designed to enhance, weaken or erase memory? Can a person be responsible for an action if they do not recall it? Would a victim of an assault have an obligation to retain a memory of this act, or the right to erase it? This book uses a framework informed by neuroscience, psychology, and philosophy combined with actual and hypothetical cases to examine these and related questions. (shrink)

Emerging New Voices in Critical Animal Studies: Vegan Studies for Total Liberation, co-edited by Nathan Poirier, Anthony J. Nocella II, and Annie Bernatchez of the Institute for Critical Animal Studies, is a brilliant radical engaging intersectional book promoting total liberation from new fresh critical animal studies voices throughout the world. This captivating critical animal studies collection, influenced by historical and ongoing radical movements such as green anarchism, Black liberation, prison abolition, feminism, Queer liberation, disability rights, and decolonization, is one of (...) the most powerful texts in the last decade within the animal liberation movement. We must begin to listen to new and young scholars for social justice to evolve in order to end speciesism and all forms of oppression. Read, share, reflect and act on this interdisciplinary collection of scholar-activists from sociology, anthropology, criminology, economics, philosophy, cultural studies, eco-theology, environmental studies, and education that will transform the global movement for radical social justice and propel total liberation forward. (shrink)

In ‘What Makes Killing Wrong?’ Sinnott-Armstrong and Miller make the bold claim that killing in itself is not wrong, what is wrong is totally-disabling. In ‘After-Birth Abortion: Why Should the Baby Live?’ Giubilini and Minerva argue for allowing infanticide. Both papers challenge the stigma commonly associated with killing, and emphasize that killing is not wrong at some margins of life. In this paper, we first generalize the above claims to the thesis that there is nothing morally wrong with (...) killing per se, so long as it is instant and unannounced. Then, from the perspective of social evolution, we explain why people refrain from killing others, the general guideline being that it is unadvisable to kill someone with whom you associate a Second Person Perspective (SPP). Finally, drawing from a seminal paper of Press and Dyson on the Iterated Prisoner’s Dilemma, we stress that an SPP without an SP (Second Person), or the other way around, can both lead to unwelcome results. (shrink)

In this issue, Walter Sinnott-Armstrong and Franklin G. Miller argue that what makes killing wrong, when it is wrong, is not that it ends life, but that it causes complete and irreversible disability—what they call total disability. They hold that the wrongness of killing should be explained by reference to the harm that killing causes to the person who dies. And the only harm of this sort that killing causes, they argue, is the harm of being totally disabled: once (...) one is totally disabled, there is no further harm to one in losing one's life. It is no worse to be dead, and thus totally disabled, than it is to be totally disabled but alive.In fact, Sinnott-Armstrong and Miller concede that the story may be more complicated than this. For example, it may be that what makes killing wrong, when it is wrong, is not that it causes harm, but that it is intended to do so, or that it violates a right which protects against harm. But either way, harm plays a crucial role in explaining the wrongness of killing, and the relevant harm, they claim, is the harm of being disabled, not that of losing one's life.The Authors’ argument has important implications for medical ethics. Their view implies that killing a person need not be wrong when that person is already completely and irreversibly disabled. This suggests, for example, that the dead donor rule in organ donation is mistaken. Contrary to the rule, it could be morally permissible to harvest organs from a living donor provided that the donor is totally disabled. Harvesting organs will kill the donor, but it will not disable her, since the donor has no abilities left to lose.Four …. (shrink)

In the past twelve to eighteen months, another perceived threat to the safety of America's blood supply has arisen. The fear is that Creutzfeldt-Jakob disease will join hepatitis, HW and AIDS in the public and medical consciousness as the 1990s next infectious disease epidemic. A particular kind of ethical dilemma has arisen causing much debate and consternation for hospitals, regulators, and blood suppliers, and has elicited a remarkably varied response.CJD is a rare but uniformly fatal neurological disease: it affects the (...) brain and the rest of the central nervous system. Its incidence in the population of the developed world is about one per million per year, although some geographic anomalies exist. CJD manifests itself in two broad ways. First, the disease is associated with symptoms of mental deterioration and dementia, including memory loss, anxiety, and cognitive impairment. Second, CJD is also associated with a range of neurological symptoms, including muscle rigidity, seizures, tremors, muscle twitching, and spasticity, as well as problems with muscle coordination and unsteady gait, sometimes resulting in total disability. (shrink)

In the past twelve to eighteen months, another perceived threat to the safety of America's blood supply has arisen. The fear is that Creutzfeldt-Jakob disease will join hepatitis, HW and AIDS in the public and medical consciousness as the 1990s next infectious disease epidemic. A particular kind of ethical dilemma has arisen causing much debate and consternation for hospitals, regulators, and blood suppliers, and has elicited a remarkably varied response.CJD is a rare but uniformly fatal neurological disease: it affects the (...) brain and the rest of the central nervous system. Its incidence in the population of the developed world is about one per million per year, although some geographic anomalies exist. CJD manifests itself in two broad ways. First, the disease is associated with symptoms of mental deterioration and dementia, including memory loss, anxiety, and cognitive impairment. Second, CJD is also associated with a range of neurological symptoms, including muscle rigidity, seizures, tremors, muscle twitching, and spasticity, as well as problems with muscle coordination and unsteady gait, sometimes resulting in total disability. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 31.1 (2001) 56-72 [Access article in PDF] Deconstruction and ZionismJacques Derrida's Specters of Marx Christopher Wise No differance without alterity, no alterity without singularity, no singularity without here-now. —Jacques Derrida, Specters of Marx Introduction Following Jacques Derrida's first sustained critique of Marx and Marxism in Specters of Marx: The State of the Debt, the Work of Mourning, and the New International (1994), an expanded version of his lectures (...) delivered at the University of California, Riverside, in May 1993, numerous "Marxist" theorists have responded to his provocative (and, for some, "untimely") intervention. Several of these critical responses have been gathered in Michael Sprinker's volume Ghostly Demarcations: A Symposium on Jacques Derrida's "Specters of Marx" (1999), which includes contributions from such diverse theorists as Pierre Macherey, Antonio Negri, Fredric Jameson, Terry Eagleton, Aijaz Ahmad, and many others. Important omissions from Sprinker's book include Gayatri Chakravorty Spivak's "Ghostwriting" (1995), an essay that Derrida nonetheless comments upon in his response "Marx & Sons," or any other feminist analysis of Specters of Marx, a curious absence in a text so riveted by questions of patriarchal affiliation. An even more startling omission from Sprinker's book is any analysis of Derrida's discussion of the Middle East, especially his remarks on the State of Israel and "a certain Jewish [i.e. Zionist] discourse on the Promised Land" [Specters of Marx 60] ("un certain discours juif de la Terre" [Spectres de Marx 104]). The myopic range of Marxist critiques of Specters of Marx is regrettable insofar as both Derrida and his Marxist critics ostensibly offer "radical" or "oppositional" perspectives on George H. W. Bush's New World Order while ignoring imperialist practices in places like Jerusalem, Golan Heights, the West Bank, and the Gaza Strip. In The End of the Peace Process (2001), Edward W. Said observes, "[w]hen one considers the broad lines of Jewish philosophy from [Martin] Buber to [Emmanuel] Levinas and perceives in it an almost total absence of reflection on the ethical dimensions of the Palestinian issue, one realizes how far one has to go" [208]. Said does not include Derrida in this trajectory of Jewish philosophers, possibly because Derrida has repeatedly disavowed any explicit affiliation with Judaism as religion, but I will argue here that Derrida's disavowal is implausible if not altogether disingenuous. In Ghostly Demarcations, Marxist responses to Derrida reveal how little real progress has been made in Western literary theory since the early 1980s, when now-tired debates about the Yale School echoed in nearly every humanities' corridor in the [End Page 56] United States. There are surely more compelling reasons to read Derrida today than to settle old scores with Ithaca-Irvine varieties of deconstruction. A key goal of this article is to enunciate Derrida's elision of the Palestinian question, not so much to undermine Specters of Marx, but to extend its power by venturing into domains that Derrida himself refuses to explore, a factor that weakens without totally disabling his deconstruction of Marxist theory. 1 The Rhetoric of Alterity In Specters of Marx, Derrida offers a complex, challenging, and virtuostic evaluation of Marx, focusing largely on "The Communist Manifesto" and The German Ideology. In particular, Derrida fixes his attention upon Marx's hostile and allegedly "obsessive" critique of Max Stirner, a rival Hegelian and "egological" anarchist. Derrida's criticisms of Marx turn on questions of spectrality, a suggestive way of describing the process whereby alienated or reified objects project illusory autonomy back upon the human subject. For purposes of the present essay, I draw attention to the rhetorical dimensions of the exchange between Derrida and his Marxist interlocutors, rather than the many subtleties implied by their respective analyses of this "new" concept formation. Such a strategy is useful not only because Derrida himself relies upon it in his essay "Marx & Sons," but also because it reveals key assumptions held by Derrida about deconstruction's political value, especially in the Middle East. Various contributors to Sprinker's volume do an impressive job of analyzing Derrida's critique of spectrality, especially Jameson, Warren Montag... (shrink)

ContextPeople with mental disorders can acquire long-term disabilities, which could impair their functioning and quality of life (QoL), requiring permanent care and social support. Systematic data on QoL and functioning, which could support a better management of these people, were not available.ObjectiveTo analyze the QoL, level of functioning and their association with sociodemographic and clinical factors of people with mental disorders who underwent deinstitutionalization using assisted living facilities.MethodsA Cross-sectional study was conducted between July 2018 and July 2019, through interviews using (...) the World Health Organization Quality of Life (WHOQOL-BREF) to determine the QoL scores, and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to determine the level of functioning. All adults (≥18 years old) with mental disorders, who underwent deinstitutionalization, users of assisted living facilities and assisted by the Psychosocial Assistance Centers III, in a city in the state of São Paulo, Brazil, were selected. For statistical analysis of the associated factors, Student’st-test was used for dichotomous variables and ANOVA for polynomial variables. Pearson correlation coefficient was used to measure the association between QoL and functioning scores.ResultsOut of 359 people who underwent deinstitutionalization with mental disorders, 147 met the eligibility criteria. The mean total score for the WHOQOL-BREF was 66.5 ± 13.4 and the mean score for WHODAS 2.0 was 10.4 ± 7.6. An association was found between people who were studying (n= 65.8; 95%CI, 63.5–68.1vs. n= 73.9; 95%CI, 67.5–80.3;p= 0.04) and better WHOQOL-BREF QoL scores or WHODAS 2.0 levels of functioning (n= 10.9; 95%CI, 9.6–12.2vs. n= 5.1; 95%CI, 2.5–7.7;p= 0.01). A weak negative correlation (r= 0.41) emerged between higher QoL scores and functioning improvement.ConclusionThis study indicates that the QoL of the sample is associated by their functioning levels, which, in turn, may reflect on their social interactions. Public policies that favor interventions increasing socialization of this population can result in better health outcomes. The QoL and functioning scores provide valuable insights to develop public policies more suited to this population profile. (shrink)

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

In this paper, I examine how advocates seek to improve the well-being of recipients who reside in organizations or systems of care in which factors influencing risk and jeopardy prevail. I use data from multiple action research projects to frame what I call ‘the advocate's compromise’: in systems and organizations regulating people who are considered vulnerable or dependent the advocate must advance collaborative relationships with care providers and supervisors so they become allies in advancing the well being of their charges. (...) I place the advocate's compromise in context by amplifying a theory of diminished status, which offers a rationale for advocacy in social work. By identifying variation in its forms I illuminate the richness of advocacy practice in which the compromise is readily observable. In considering the context influencing the practice of advocacy in social work, I elaborate central aspects of the compromise, and reveal some of its ethical demands. Finally, I delineate principal strategies and tactics I have observed advocates employ to make the compromise a useful tool, particularly in total institutions, so incremental and limited advancements can make marginal improvements to a recipient's well-being without threatening the regulatory regime of care or supervision. (shrink)

This article presents an archaeological inquiry into the early histories of Quality of Life measures, and takes this as an occasion to rethink the concept of the ‘medical model of disability’. Focusing on three instruments that set the ground for the emergence of QoL measures, namely, the Karnofsky Performance Scale, and the classification of functional capacity as a diagnostic criterion for heart diseases and as a supplementary aid to therapeutic criteria in rheumatoid arthritis – I discuss how medicine, throughout the (...) emergence of QoL, began to expand its gaze beyond the confines of the body to what that body does in daily life. Building upon Armstrong et al.’s notion of ‘distal symptoms’ and Wahlberg’s idea of ‘knowledge of living’, I propose the notion of disabilitization to encapsulate this expansion of the clinical gaze, through which medicine has come to articulate diseases and their treatments in new ways, and in so doing, has inadvertently created disability as a new kind of knowledge category in itself – a category that is defined not through its reduction to mere pathology, but through its dispersal into everyday life. I present this concept not as a periodization, but as a provocative discontinuity with the totalizing history assumed within the medical model of disability, and in so doing, ask what, in fact, holds ‘the medical model’ together, and whether there might be other ways of understanding medicine’s complex relationship to disability than what the concept of the medical model allows us to envisage. (shrink)

There is an apparent epidemic of mental illness. At the end of 2011, untreated mental disorders accounted for 13% of the total global burden of disease, and for 25.3% and 33.5% of all years lived with a disability in low-and middle-income countries, respectively. Depression affects 350 million people globally and is the leading cause of disability. One in five U.S. adults takes psychiatric medication. One study found that by age 32, 50% of people surveyed qualified for an anxiety disorder, more (...) than 40% for a mood disorder, and more than 30% for substance dependence. Another study reported that... (shrink)

Starting in early childhood, children are socialized to be honest. However, they are also expected to avoid telling the truth in sensitive situations if doing so could be seen as inappropriate or impolite. Across two studies (total N = 358), the reasoning of 3‐ to 5‐year‐old children in such a scenario was investigated by manipulating whether the information in question would be helpful to the recipient. The studies used a reverse rouge paradigm, in which a confederate with a highly salient (...) red mark on her nose asked children whether she looked okay prior to having her picture taken. In Study 1, children tended to tell the truth only if they were able to observe that the mark was temporary and the confederate did not know it was there. In Study 2, children tended to tell the truth only if they were able to observe that the mark could be concealed with makeup. These findings show that for children as young as age 3, decisions about whether to tell the truth are influenced by the likelihood that the information would be helpful to the recipient. (shrink)

Some philosophers and segments of the public think age is relevant to healthcare priority-setting. One argument for this is based in equity: “Old” patients have had either more of a relevant good than “young” patients or enough of that good and so have weaker claims to treatment. This article first notes that some discussions of age-based priority that focus in this way on old and young patients exhibit an ambiguity between two claims: that patients classified as old should have a (...) low priority, and that patients classified as young should have high priority. The author next argues, drawing on a problem raised by Christine Overall, that equity cannot justify giving “old” patients low priority, since there is wide variety in the total lifetime experiences of older people, partly influenced by gender, race, class, and disability injustice. Finally, the author suggests that there might be a limited role for age-based prioritization in the context of infant and childhood death, since those who die in childhood are always and uncontroversially among the worst-off. (shrink)

This paper assesses recent trends in international law regarding the availability and character of reparations. Presently, reparations issues have arisen particularly in domestic societies searching for transitional justice in the aftermath of authoritarian rule. These issues are shaped by national legal systems, but are also influenced by international practice. In these transitional settings, the search for justice is affected by political preoccupations such as the persistent influence of displaced prior authoritarian leadership as well as by real and alleged limitations on (...) the financial capabilities of transitional states. No general approach can address the interplay between national and international law at this stage. Reliance must be placed on a case by case approach, considering matters of context such as the degree of suffering and disability inflicted on particular categories of claimants, the balance of claims versus the State’s demands for resources to fund sustainable and equitable development. Remoteness in time bears on the credibility of the claimants as present victims tend to be given priority over victims in the distant past when assessing relative merits. Scale and selectivity suggests that if the total of claims overwhelms the administrative capacity of the state, there will be a tendency to substitute apology and symbolic gestures for material ones, and award reparations based on individual need associated with the prior deprivation. International law informs background moral and political thinking about reparations, but practical considerations of capability and prudence are decisive in most instances, making the influence of international law indirect and sometimes marginal. (shrink)

This book offers a cutting-edge perspective of design for space to increase astronauts’ wellbeing and performance creating a more sustainable and inclusive environment, but without to forget beauty. The relevant aspect is that these design principles are now also supported and promoted by the European Community with the New European Bauhaus project. It is legitimate to affirm that Space Design is a precursor and inspiring these principles. Space exploration has shown us how results of space research inspire management policies addressing (...) important earth issues such as the responsible use of resources as well as ethical behavior leading to sustainable and inclusive choices. The International Space Station (ISS) is the most successful virtuous example of circular economy and sustainability by almost totally recycling the waste produced. Recently the European Space Agency (ESA) launched the first call for “parastronauts” opening the fly possibilities to people with physical disabilities and thus affirming the principle of inclusion in space. Thanks to design—a bridge between science, technology, and beauty—space opens up to new creative experiments, placing the human being at the center of the interplanetary exploration programs to ensure extra-terrestrial habitats safer, more comfortable, and efficient, where crew will feel “like at home”. (shrink)

IntroductionThe relations of motor skills to different developmental domains, i.e., cognitive, emotional, and social domain, are well-documented in research on children with poor motor competence and children with disabilities. Less conclusive evidence on interaction of motor and social or emotional development can be seen in research on typically developing children. The purpose of this study was to determine a correlation between motor skills and social-emotional functioning in typically developing preschool children and to identify differences in social-emotional functioning in children with (...) different levels of motor competence.MethodsA total of 125 preschool children participated in this study. To assess children’s motor skills, we used the Test of Gross Motor Development–Second Edition that measures locomotor and object-control skills. To screen child’s social and emotional functioning, we used the Ages and Stages Questionnaire–Social Emotional: Second Edition. Spearman’s correlation analysis was used to determine association between motor skills and social-emotional functioning. Difference in social-emotional functioning between groups of preschool children with High and Low motor competences was calculated using Mann-Whitney U-test.ResultsThe main result of this study is weak correlation of child’s motor skills to social-emotional functioning. Furthermore, preschool children with High and Low motor competences do not differ in risk for social and emotional difficulties.ConclusionFurther research on typically developing children is needed to have more conclusive evidence on interaction of motor and social or emotional development. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Family, Friends, and Cancer:The Overwhelming Effects of Brain Cancer on a Child’s LifeLynne ScheumannOur son was diagnosed with a medulloblastoma at the old age of 13. The “lucky” part for him was his brain was almost fully developed at this age as opposed to most “medullo” patients. While this was a benefit to him it was also one of the hardest things for him.He went into surgery a highly (...) intelligent, active, and left handed boy and came out unable to move his left side, could barely speak, and very much aware of what he just lost. We, as a family, were totally unprepared for how globally this would [End Page 23] affect the rest of his life. As we spent time in the hospital I would look at the children with other types of cancer and see them walking and talking and doing their schoolwork and God forgive me I would be jealous. The fact that the cancer was in his brain, the part of his body that makes him who he is changed everything forever.He lost all of his friends because 13–year–old boys communicate best through physical activity and that was not an option for him. He still has the same personality and sense of humor, but he will not be the architect or engineer he once dreamed of being. Math, that was once so easy for him was now like a foreign language, never to be mastered again. He was able to graduate from High School and takes classes at our local Junior College in Computer Assisted Drafting, but he can only manage one or two classes a semester due to the fatigue he still suffers from.What I most worry about and wish I had been forewarned about is his long–term quality of life. Physically he has come such a long way from how he was after the resection. It was a very slow process in which the first year of rehab was slowed by the fact that one of the chemo agents causes peripheral neuropathy. He developed contractures in his ankles and needed serial casting and ankle–foot orthotics (AFO) not just on the left leg, but now the right. He was able to switch his handedness fairly easily and his left hand will always be of limited usefulness because of ataxia. I would get angry at him that he gave up on his left side so quickly until it was finally explained to me years later that the ataxia would never get better.As far as his walking ability goes he has come a long way. At first he was unable to walk and once he started rehab he went back to learning to crawl and progressed to a walker. The first time I saw him walk with the walker brought tears to my eyes. It was so much more of an event for me than when he took his first steps as a toddler. This was so much more hard fought. He never complained, just always did what was asked of him. It had to have been such hard work and also somewhat embarrassing, as he needed help to literally do everything for months. He progressed to a cane and about two years ago decided not to use that or his AFO’s. He now wears high top boots that substitute for the AFO’s but don’t make him appear disabled. Recently he decided there are times when he would be safer if he had his cane and purchased one that looks more like a hiking stick than a cane. I think he has come to terms with the fact that physically he is as good as he is going to get and works hard to maintain what he did regain. He has a trainer and goes to the gym on a regular basis with no prompting from us. I do not know if he realizes that as he ages things will be harder for him than the average person. I think in some way he is aware of that because he did decided to use the cane if safety is an issue.His... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Living with Blindness and Fibromyalgia while Occupying AgingKatherine SchneiderI’m blind from birth and in middle age developed fibromyalgia. I’ve retired from a thirty year career as a clinical psychologist and am working on my third book tentatively titled “Occupying Aging: Delights, Disabilities and Daily Life.” My relationship with medical professionals includes gratitude (without good care I would not be alive) and also frustration for assumptions often made about my (...) abilities. I write from the perspectives of an impatient patient, woman living in the United States, former provider of mental health services, person with both invisible and visible disabilities, and boomer moving into the world of the aged. My stories are mine of course, but when I swap medical stories with blind friends, similar happenings abound.When my mom fell down the stairs at a friend’s house, five months pregnant with me, she was told to go to bed for the next four months to save the pregnancy. Thus began the impact of health care professionals on me. I was born a month premature and spent my first month in an incubator. In 1949 it wasn’t known that the enriched oxygen atmosphere in an incubator would cause blindness. At least one lawsuit was filed against physicians and a hospital by a person blinded in this way. A large out–of–court settlement was received. The way I look at it, the health care community did the best they knew and without enough oxygen, I would have died.Early in my life, my parents took me to several ophthalmologists to see what could be done for my vision. Family folklore has it that I could smell a hospital as we entered and would begin howling. These early traumatic experiences may have led to my current healthy lifestyle so I don’t have to go to doctors much now. By about age five, it was clear that nothing could be done about my vision. For the next twenty years my forays into the health care system were for tonsillitis, sprains, and the usual childhood ills.In my early twenties, I developed acute glaucoma in one eye—caused, I’m convinced, by birth control pills. In seeking treatment for this condition, I encountered the first truly insensitive physician I’d met, who said, “Your eyes aren’t doing you any good; let’s take them out.” I was horrified! They were my eyes. I was attached to them, psychologically as well as physically. It turned out that a simple operation relieved the pressure and allowed me to keep my eyes. True, they are not the best looking big brown eyes around, but they did come with the package.Life with blindness seemed quite straightforward until my early forties, when I developed extreme fatigue and pain all over. I was worried. I knew a blind woman who had developed multiple sclerosis and I admired her, but I did not want to walk in her brave footsteps. Then a college student came to see me with the same symptoms and said that she had recently been diagnosed with fibromyalgia. I am often very empathetic with people’s concerns, but this time she complimented me by saying, “You’re great! You seem to know just how I feel.” I sagely counseled her about portioning out her energy carefully, prioritizing, using short cuts, and taking elevators when possible. Being an adult [End Page 216] student used to overachieving, she did not like what I was saying, but said she’d try to follow my advice because she could no longer do it all.What finally broke through my own denial was the day coiling up a hose and dragging it to the basement for the winter took me an hour. It left me totally exhausted and I figured that even being middle aged couldn’t account for feeling that awful.After a thorough physical and plenty of blood work to rule out Lyme disease and multiple sclerosis, I was diagnosed with fibromyalgia and placed on low doses of antidepressants to help me sleep through the night. The medication worked and I began to feel like myself again. My battle to accept that... (shrink)

The high prevalence of brain injury incidents in adolescence and adulthood demands effective models for re-learning lost cognitive abilities. Impairment in brain injury survivors’ higher-level cognitive functions is common and a negative predictor for long-term outcome. We conducted two small-scale interventions (N = 12; 33.33% female) with persons with acquired brain injuries in two municipalities in Sweden. Age ranged from 17 to 65 years (M = 51.17, SD = 14.53). The interventions were dialogic, inquiry-based, and inspired by the Philosophy for (...) Children Programme, a participatory thinking skills approach with documented higher-order cognitive outcomes, such as developed argumentation skills, in other target groups. Philosophical dialogues were conducted once a week in the two groups, totalling 12 dialogues per group. Group argumentation development was measured through compared scores from structured observations of filmed dialogues early and late in the intervention. Large positive changes in mean scores from early to late in the intervention, together with constantly high facilitator quality, suggest argumentation development in the sample due to the intervention. (shrink)

Background: New Zealand health and disability providers are expected to have local open disclosure policies in place, however, empirical analysis of these policies has not been undertaken. Aim: This study aims to examine the scope and content of open disclosure policies in New Zealand compare open disclosure policies in New Zealand, and provide baseline results for future research. Methods: Open disclosure policies were requested from all twenty New Zealand District Health Boards in June 2016. A total of twenty-one policies were (...) received, with nineteen policies included in the review. The data were analysed using conventional content analysis. Areas of identified guidance were categorised categorized under the headings: 1) identification of an adverse event, 2) actions before disclosure, 3) disclosure of harm, and 4) actions after disclosure. Results: A total of forty-six distinct areas of guidance could be categorized under the different phases of the open disclosure life-cycle. Conclusion: This review has identified significant unwarranted heterogeneity and important gaps in open disclosure documents in New Zealand which urgently needs to be addressed. Open disclosure policies which are both flexible and specific should enhance the likelihood that injured patients’ needs will be met. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Extramarital Contraception in the Catholic Faith:A Call to Action from a Physician and EthicistCara BuskmillerIntroductionDefinitionsBefore proceeding to a discussion of extramarital contraception, it is relevant to lay a foundation of definitions and limitations of this essay. Here, "sex" and "sexual act" will refer to acts of penile–vaginal intercourse and acts meant to lead to such intercourse, respectively. Other acts which are rightly called "sexual" are not relevant to this (...) essay, as the focus here is on encounters that could result in fertilization.The traditional natural law theory with its analysis of object, intention, and circumstances is at play in this essay, with a hylomorphic understanding of nature and ethics. In this understanding of ethics, the names of many acts include not only an object but an intention and circumstances (e.g., murder specifies an illegal type of killing with premeditation). Likewise, "contraception" here refers to the use of any drug or device which temporarily lowers fertility (object), to prevent fertilization (intention) due to presumed-fertile sex (circumstance). Such drugs or devices are called "contraceptives" in this essay. In this essay, "contraception" is not committed solely by intending to avoid fertilization, so acts such as trying to avoid fertilization by timing sex during infertile parts of a menstrual cycle are not contraception, and the pastoral term "contraceptive mindset" does not apply. "Contraception" is also not solely defined by the use of particular medical products, since the intention to avoid fertilization is part of the definition in this essay. Thus, [End Page 1245] prescribing or taking a birth control pill for polycystic ovarian syndrome, in the words of Pope St. Paul VI in his 1968 landmark encyclical Humanae Vitae (HV), is not at all illicit, here because such treatment is not contraception, and the problems of contraception do not apply (§15)."Marriage" in this essay refers principally to sacramental matrimony, made by the consent of a baptized man and a baptized woman.1 Civil marriage, cohabitation, long-term affairs, sex in dating, short-term hookups, prostitution, and sexual assault represent a spectrum of falling away from matrimony. This essay assumes that matrimony is God's one true plan for sex, fertilization, and childrearing. This essay also makes heavy use of the Scholastic-personalist perspective of HV on the unitive and procreative dimensions of sex. As sexual relationships "fall away" from matrimony, they lose resemblance to these dimensions."Consent" is here defined as a free act in which a person agrees to do, accept, or reject something.2 Consent is an act of the will, and it may be partial or total. Only when consent is total is a person held fully responsible for his or her actions; for example, only when consent is total can a person commit a mortal sin. Consent is different from assent, which is not of the will, but of the mind.3 In this paper, sex without consent is termed "sexual assault"—the status of the act as an assault is solely determined by consent. These definitions allow for a sexual assault in which a victim withholds consent and yet does not resist an attack,4 which is different from past legal and colloquial definitions.5 This definition also allows for assault victims that have positive emotional responses to or physical arousal from an attack. These responses from a victim do not make the assault consensual or desired, [End Page 1246] and in fact make post-traumatic recovery more difficult.6 Simply put, consent is of the will, and this is not diminished by whether the body follows suit; this differs from some legal definitions of consent in canon law, where the will of the person agreeing to a contract is signified by externals, even if there was no intention to fulfill the duties of the contract.7 Consent will be central to this essay, since it helps make the spectrum of relationships that "fall away" from marriage intelligible in two sets: one with consent, and one without."Intellectual disability" in medical and ethical literature refers to a large spectrum of differences in mental and behavioral performance, but this essay is only considering intellectually disabled persons who would be unable to... (shrink)

Background The article defines a comprehensive concept of cognitive objectivity applied to embodied subjects in health care. The aims of this study were: to specify some necessary conditions for the definition of a CCCO that will allow objective descriptions and assessments in health care, to formulate criteria for application of such a CCCO, and to investigate the usefulness of the criteria in work disability assessments in medical certificates from health care provided for social security purposes. Methods The study design was (...) based on a philosophical conceptual analysis of objectivity and subjectivity, the phenomenological notions ‘embodied subject’, ‘life-world’, ‘phenomenological object’ and ‘empathy’, and an interpretation of certificates as texts. The study material consisted of 18 disability assessments from a total collection of 86 medical certificates provided for social security purposes, written in a Norwegian hospital-based mental health clinic. Results Four necessary conditions identified for defining a CCCO were: acknowledging the patient’s social context and life-world, perceiving patients as cognitive objects providing a variety of meaningful data, interpreting data in context, and using general epistemological principles. The criteria corresponding to these conditions were: describing the patient’s social context and recognizing the patient’s perspective, taking into consideration a variety of quantitative and qualitative data drawn from the clinician’s perceptions of the patient as embodied subject, being aware of the need to interpret the data in context, and applying epistemological principles. Genuine communication is presupposed. These criteria were tested in the work disability assessments of medical certificates. The criteria were useful for understanding both how objectivity fails during work disability assessments and how it can be improved in the writing of certificates. Conclusion The article specifies four necessary conditions for the definition of a CCCO in health care and social security medicine and the corresponding criteria for its application. Analysis of the objectivity of work disability assessments in medical certificates for social security confirmed the usefulness of the criteria. (shrink)

This study purposed to provide a bibliometric overview of child language research from 1900 to 2021 and identify major trends in CL. A total of 48,453 research articles related to the CL were identified from the Web of Science. Co-authorship, co-word, and co-citation analysis was conducted by using VOSviewer and CiteSpace. The following was analyzed: annual distribution of related papers; related disciplines; mainstream journals; geographical and institutional distribution; hot topics; keyword burst detection; and co-citation analysis of journals, authors, and references. (...) Results showed that, under the impact of new empirical methods and new theories, the field of CL is undergoing great changes. Research hotspot and the research trends mainly concentrated on autism spectrum disorder, school readiness, oral language, reading comprehension, exposure, bilingualism, vocabulary, input, skills, kindergarten, cochlear implants, and intervention. More and more pieces of research focus on the individual difference in CL development and the importance of intervention in language education by typically developing children and some children with disabilities or language disorders. Besides, child second language acquisition also attracted a lot of attention. This bibliometric analysis is of great reference significance for researchers to understand the progress and discipline development trend in this field. (shrink)

All prospective studies and purposes to improve cure and create a race that would be exempt of various diseases and disabilities are generally defined as eugenic procedures. They aim to create the "perfect" and "higher" human being by eliminating the "unhealthy" prospective persons. All of the supporting actions taken in order to enable the desired properties are called positive eugenic actions; the elimination of undesired properties are defined as negative eugenics. In addition, if such applications and approaches target the public (...) as a whole, they are defined as macro-eugenics. On the other hand, if they only aim at individuals and/or families, they are called micro-eugenics. As generally acknowledged, Galton re-introduced eugenic proposals, but their roots stretch as far back as Plato. Eugenic thoughts and developments were widely accepted in many different countries beginning with the end of the 19 th to the first half of the 20 th centuries. Initially, the view of negative eugenics that included compulsory sterilizations of handicapped, diseased and "lower" classes, resulted in tens of thousands being exterminated especially in the period of Nazi Germany. In the 1930s, the type of micro positive eugenics movement found a place within the pro-natalist policies of a number of countries. However, it was unsuccessful since the policy was not able to become effective enough and totally disappeared in the 1960s. It was no longer a fashionable movement and left a deep impression on public opinion after the long years of war. However, developments in genetics and its related fields have now enabled eugenic thoughts to reappear under the spotlight and this is creating new moral dilemmas from an ethical perspective. Content Type Journal Article Pages 20-26 Authors Güvercin CH, Medical Ethics and History of Medicine, Ankara University Health Sciences Institute, Turkey Arda B, School of Medicine, Ankara University, Turkey Journal Human Reproduction & Genetic Ethics Online ISSN 2043-0469 Print ISSN 1028-7825 Journal Volume Volume 14 Journal Issue Volume 14, Number 2 / 2008. (shrink)

Patients with advanced Alzheimer's disease experience cognitive impairment and physical disabilities in daily life. Currently, there are no treatments available to slow down the course of the disease, and limited treatments exist only to treat symptoms. However, deep brain stimulation of the nucleus basalis of Meynert has been reported to improve cognitive function in individuals with AD. Here, we report the effects of NBM-DBS on cognitive function in a subject with severe AD. An 80-year-old male with severe AD underwent surgery (...) for bilateral NBM-DBS electrode placement. After 10 weeks of stimulation, Mini-Mental State Examination assessment improved from a score of 5 to 9 points, and assessment using the Alzheimer's Disease Assessment Scale–Cognitive Subscale showed a marked reduction in total score from 43 to 33 points, suggesting cognitive benefits from NBM-DBS. The patient's postoperative course was complicated by a subdural effusion that occurred several days after surgery, with complete recovery. Interestingly, the subject also displayed abnormal thermoregulation with stimulation initiation and stimulation parameter modifications. NBM-DBS may serve as a potential therapy for severe AD patients.Clinical Trial Registration: ChiCTR1900022324. (shrink)

ObjectiveThe objective of the study was to explore the relationship between social support and fatigue as well as the mediating role of social functioning on that relationship.BackgroundPsychosocial factors such as social support and social functioning may influence patients’ fatigue symptoms. There is limited evidence on the relationship between social support, social functioning, and fatigue in liver transplant recipients.MethodsA total of 210 patients with liver transplants from two tertiary hospitals were enrolled in the current study. Questionnaires used include one for general (...) demographic data, the Perceived Social Support Scale, Social Disability Screening Schedule, and Fatigue Symptom Inventory.ResultsA total of 126 recipients reported fatigue. Gender, residence, BMI, and liver function were the primary factors affecting fatigue. Social support was positively correlated with social functioning and was negatively correlated with fatigue. The effect of social support on fatigue was partially mediated by social functioning.ConclusionThe fatigue of liver transplant recipients should be attended to. The higher the social support, the lower the fatigue of liver transplant recipients. Social support may also reduce fatigue through social functioning. The liver transplant team should help the liver transplant recipient establish a social support system, restore social functioning, and reduce fatigue symptoms. (shrink)

E. H. Gombrich in 1968: Methodological Individualism and the Contradictions of Conservatism The commonalities Gombrich affirmed between his own positions on science, politics, and art and those of his friend Karl Popper are key to understanding both his work on the history of style and the conservative fulminations on method he published from the early 1950s onwards. United with Popper by their shared experience of exile from fascism, Gombrich failed to register the amateurish character of Popper's political theory and that (...) his aversion to notions of social determination disabled the historian. Popper's skepticism regarding the ontological status of social collectivities and rejection of the concept of totality reinforced Gombrich's suspicions of holistic analysis and led him to fall back on naturalistic descriptions of individuals acting in a social world glued together by such commonsensical categories as "traditions" and "institutions". In this regard he is representative of the common aversion to sociology of the British intellectual establishment in the early Cold War. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Expose of a BreakdownIngrid HindellIregard my pension as a social wage, and even though I wish it took my disability and the extra costs that brings into consideration, eighteen years ago, I felt privileged to be able to work in the community, not in a sheltered workshop.At this time, a number of us worked voluntarily for numerous little organizations when the government cut their funding and in effect, took (...) away our jobs.It was around this time that I started a “stress cough.” Foolishly, I didn’t take much notice. I was enjoying “life”—studying, working, taking part in a documentary called “Untold Desires” and being a member of the “Friendship Group”—in which a group of us tackled the subject and nature of friendship for people with and without disabilities....The processes and the cohesion of the group brought up a lot of “stuff” for me that I wasn’t able to articulate. It made me question the wisdom of my lifestyle up to then—of marrying a person without a physical disability, for example.My mother used to tell me to tell him to tidy the flat, not in the least realizing that: i) it was distressing that I couldn’t do this; ii) that given all our interests it was difficult to tidy up. (This situation was also not helped, I now realize, by us trying to live and run home businesses from my small three–roomed accommodation behind my parent’s home, without enough support worker hours....)The flat was always cluttered, not conducive to encouraging a feeling of ease in us bringing clients onto the premises. As Robert’s massage workload grew, so did our underlying tension, I see now. And when I was starting to counsel other people with disabilities the situation was made worse....Added to this, my mother had, just prior to this period in our lives, stopped giving us our main meal because we were becoming more and more interested in eating organic and vegetarian food.At the same time, listening to other group members’ stories made me realize how “undervalued” people with disabilities are in society as I had been brought up in a loving extended family and had not long been “out.”It made me realize how much people with disabilities were constrained by lack of governmental funding for recreational—especially relationship options—with each other and with able–bodied people. The government was trying to close down little advocacy organizations that could keep this issue in the forefront of policy makers’ minds. No wonder I was getting close to breaking point! [End Page E1]When I got really bad, my husband almost went mad himself trying to cope with me. I had been the outgoing partner in the relationship for the past 12 years. Now I was getting panic attacks and clinging like poison ivy....And the therapists I went to at that stage didn’t help. The Naturopath was so expensive she made me much worse. She had told a “friend” of Rob’s that she would treat me for $30.00 a time. She did not say that she would present me with an ever– increasing bill every time I had an appointment—to pay her back when I could! And that her admin assistant would keep commenting, in my hearing, that people wouldn’t pay their bills on time.... At last, when the amount got to $450.00, I paid her all my savings, and managed to quit.I now also believe she treated me with a totally inappropriate therapy—colonic irrigation—for far too long, any natural therapist would say nowadays—five weeks!I believe it made my mental state worse. People say that an unquiet mind can stress the body into illness but I believe losing too much weight too fast as I certainly did, stressed my mind, instead of other way around.By this time I wasn’t only having panic attacks. I had slipped into, what I recently discovered, was a clinical depression. This brought in its wake, a terror so real, so all encompassing that I wonder I lived through a day of it—much less four... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:CompassionEdward J. VolpintestaTo the Editor: In his essay, “Can We Mandate Compassion?” (March–April 2011), Ron Paterson, a former health and disability commissioner in New Zealand, discusses the decline of physicians’ compassion—an issue that is receiving more attention in the media, and in our journals, hospitals, and medical societies, as well.He decided—and I agree—that compassion should not be mandated. How could it be? After all, it’s unquantifiable; it’s not meted (...) out in milliliters or grams. Compassion is a spontaneous emotion that arises from the individual caregiver’s spiritual reservoirs. Trying to regulate or mandate it would be absurd—the ultimate attempt at dehumanizing medicine. Giving students more exposure to the humanities, however, and teaching doctors what is not acceptable in “terms of conduct, attitudes, and behavior” may increase awareness of its importance. Putting that awareness into action is another thing.Could it be that physicians are too hard-pressed for time and too overstressed with ordering and interpreting tests that they have little time and energy left for compassion? Has the threat of malpractice suits made physicians distrust patients, seeing them more as potential lawsuits than as suffering human beings, as horrible as that may sound to some? Or has the vast amount of new medical knowledge that rapidly reaches doctors given them an information overload so great that they have room only for cognition and none for emotion? When one adds the pressure physicians feel to control costs and to follow guidelines that often clash with their judgment, it becomes clear why compassion has declined.As a primary care doctor, there are days when all I have to offer some patients is compassion. A divorce, problems with personal finances, depression, a recent death, a child in trouble with the law or with drugs, an unwanted pregnancy—these are some of the problems that are the most difficult and time-consuming for me. They do not require any new scientific knowledge. Like compassion, they are not quantifiable, and there are no board exams to test how well I help my patients cope with them. There is also no code that I can send to an insurance company that will accurately convey what I have done, or its value to my patients. Only my patient and I are aware of whether I was able to use compassion in a way that helped. How could it be otherwise?It is much easier for me to treat a patient with pneumonia or conjunctivitis. I doubt that there ever will be a foolproof way to teach compassion to physicians. Perhaps performing psychological tests on incoming medical students may be the best way to determine which are most inclined to become compassionate physicians.The Flexner Report of 1910, which contained many recommendations for improving medical education, may have overstressed the importance of science while neglecting the human dimensions of medical practice. The Carnegie Foundation, which funded the original study, has undertaken a second examining any unintended consequences of the first. Unlike the first, which was dominated by one man, the second comprises a broad team of educators, doctors, philosophers, and psychologists. Perhaps this broader approach will restore compassion to its rightful place.Letters to the editor may be sent by e-mail to [email protected], or to Managing Editor, Hastings Center Report, 21 Malcolm Gordon Road, Garrison, NY 10524; (845) 424-4931 fax. Letters appearing in the Report may be edited for length and stylistic consistency.Statement of Ownership, Management, and CirculationThe Hastings Center Report is a bimonthly journal published by The Hastings Center, 21 Malcolm Gordon Road, Garrison, NY 10524. The editor is Gregory Kaebnick, at the same address. The annual subscription price is $80; contact person is Anne Marie Schoonhoven; telephone number is 845-424-4040. The tax status of the organization has not changed during the preceding twelve months.As of the filing date of September 6, 2011, the average number of copies of each issue during the preceding twelve months was 3,342; the actual number of copies of the single issue published nearest to the filing date was 3,150. The journal has a total paid and/or requested circulation... (shrink)

Chronic migraine is a difficult disease to diagnose, and its pathophysiology remains undefined. Its symptoms affect the quality of life and daily living tasks of the affected person, leading to momentary disability. This is a pilot, randomized, controlled, double-blind clinical trial study with female patients between 18 and 65 years old with chronic migraine. The patients underwent twelve mindfulness sessions paired with anodal transcranial direct-current stimulation over the left dorsolateral prefrontal cortex, with current intensity of 2 mA applied for 20 (...) min, three times a week for 4 weeks. In addition, 20 min of mindfulness home practices were performed by guided meditation audio files. A total of 30 participants were evaluated after the treatment, and these were subdivided into two groups—active tDCS and sham tDCS, both set to mindfulness practice. The FFMQ-BR, MIDAS, and HIT-6 questionnaires were used to evaluate the outcomes. After the treatment, the active mindfulness and tDCS group showed better results in all outcomes. The sham group also showed improvements, but with smaller effect sizes compared to the active group. The only significant difference in the intergroup analysis was the outcome evaluated by HIT-6 in the post treatment result. Our results provide the first therapeutic evidence of mindfulness practices associated with left DLPFC anodal tDCS with a consequent increase in the level of full attention and analgesic benefits in the clinical symptoms of patients with chronic migraine. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Memory and the Instituting Social ImaginaryNancy Nyquist Potter*, PhD (bio)Emily Walsh's Article on the way that colonialism is perpetuated in psychiatry through dominant collective memory is simultaneously exciting and challenging, and merits active engagement toward making changes (Walsh, 2022). This presents a challenge to clinicians to address entrenched, often subconscious, ways of being with and helping racialized people with historical memories and current experiences.Such changes are necessary in that (...) dominant collective memory is contributory to mental illness, as Walsh writes. It also contributes to what Walsh calls a traumatic loop, whichinvolves feeling unwell due to racist abuse or the effects racialization has on the psyche, then being unable to voice these concerns to the practitioners who desire to help you. Not having the opportunity to voice these concerns can make patients feel as though these memories are not important, thereby invalidating their own negative experiences of racialization.(Walsh, 2022, p. 232)For these reasons, it is crucial that psychiatrists fully understand the harm they can do by reproducing dominant collective memories and work to change this in themselves and in the institutional systems in which they see patients/service users.I focus on one question briefly and then turn to the heart of active engagement.The question concerns what the content of dominant collective memory is and how it might play out in a particular interaction in psychiatry. This is important for clinicians who want to learn what sorts of changes need to be made in order not to continue to enact colonialism and to avoid doing harm. Walsh does a fine job setting out forms of memory and how Fanon (and she) suggest that clinicians can assist patients toward liberation from dominant collective memory. Yet I am left with uncertainty about what sorts of dominant memory serve to deny the violence in the colonized. A bit of filling out on this idea would help the motivated to move toward change.A pressing question is how to facilitate such changes. Both the limitations and the possibilities of the social imaginary can help us understand why change is so difficult and yet how it nevertheless is possible and, in fact, necessary. The social imaginary, as Code explains it, "refers to implicit but effective systems" of values, meanings, interpretations of reality, norms for living, what counts as knowing and who can be knowers, that are found in a social-political order in ways that shape our sense of self, our ways of relating to others, our responsibilities, and a sense of place (Code, 2008, pp. 31–32). The instituted social imaginary, then, tells us what sorts of persons we should be and [End Page 241] how we should see and treat others. It shapes memories and limits which memories—and whose memories—get acknowledged and which ones and whose memories are erased or ignored. It is difficult to see for what it is because it is implicit and assumed to be fixed and natural. However, this is the instituted social imaginary, where the content of the imaginary is taken as given and is naturalized. It trades in stereotypes of Black and Indigenous and other people of color as well as stereotypes of queers, people living with disabilities, the homeless, and others. It is harmful in that it perpetuates those stereotypes, controls patients/ service users, negates their own personal and community identities, and erases episodic memory. It is difficult to change because it is entrenched and often not questioned. Nevertheless, the instituted social imaginary is not totalizing. There is hope, and energy, and excitement to be found in active engagement with an instituting social imaginary. Here, we find people and communities working to critique the given, the naturalized, and even ourselves: "Imaginatively initiated counterpossibilities interrogate the social structure to destabilize its pretensions to naturalness and wholeness, to initiate a new making" (Code, 2008, pp. 34–35). In the final section, I begin to fill out these moves in relation to Walsh's work on memory and psychiatry.Clinicians are trained to be good listeners, and many of them already practice good listening skills in interacting with their patients/service users. However, many patients' experiences... (shrink)

This essay comments on the articles by Loretta M. Kopelman and Anita Silvers. It extends their analyses and concludes that consistency and the total absence of conflict may be unavailable when one interprets and applies the Americans with Disabilities Act.

Emotional disorder symptoms are highly prevalent and a common cause of disability among children and adolescents. Screening and early detection are needed to identify those who need help and to improve treatment outcomes. Nowadays, especially with the arrival of the COVID-19 outbreak, assessment is increasingly conducted online, resulting in the need for brief online screening measures. The aim of the current study was to examine the reliability and different sources of validity evidence of a new web-based screening questionnaire for emotional (...) disorder symptoms, the DetectaWeb-Distress Scale, which assesses mood, anxiety, obsessive–compulsive disorder, post-traumatic stress disorder, suicidality, and global distress. A total of 1,499 participants completed the DetectaWeb-Distress Scale and specific questionnaires for emotional disorder symptoms, suicidal behaviors, and well-being through a web-based survey. Results indicated that a structural model of 10 correlated factors fits reasonably better in comparison to the remaining models; measurement invariance for age and gender; good internal consistency ; and significant positive correlation with other measures of anxiety, depression, PTSD, or distress, and negative correlation with well-being measures, displaying support for convergent-discriminant validity. We also found that girls scored higher than boys on most of the subscales, and children had higher scores for social anxiety, specific phobia, panic disorder, and obsessive–compulsive symptoms, whereas adolescents scored higher on depressive symptoms, suicidality, and generalized anxiety, but the effect sizes were small to medium for all comparisons. The DetectaWeb-Distress Scale is a valid, innovative, and useful online tool for the screening and evaluation of preventive programs for mental health in children and adolescents. (shrink)

Resumo: O objetivo deste trabalho é discutir o processo de inclusão de alunos com deficiência/necessidades educacionais especiais no Ensino Superior, destacando algumas questões sobre a prática pedagógica que vem sendo realizada na Universidade Estadual do Oeste do Paraná – UNIOESTE. Fundamenta-se na Psicologia Histórico-Cultural que permite compreender como ocorre o processo de desenvolvimento do sujeito a partir do estudo dos fenômenos em sua historicidade, em um processo dialético, contemplando as dimensões da totalidade. A educação desses alunos, embasada numa legislação que (...) vem se ampliando nos últimos anos, necessita, na maioria dos casos, de algum tipo de atendimento educacional especializado como apoio e complementação do trabalho docente. As práticas pedagógicas realizadas, historicamente, na maioria das universidades ainda apresentam uma concepção de desenvolvimento humano sustentada pelo caráter biológico. Compreende-se que tais orientações são coerentes com a formação de um homem que se adequa à sociedade capitalista que preconiza por uma formação unilateral, com aquisição de competências restritas e imediatas. Como resultado, espera-se refletir sobre a importância de uma prática pedagógica inclusiva, que contribua para a construção de um sujeito crítico e consciente, que possa se apropriar do conhecimento científico e concluir seus estudos com qualidade. Palavras-chave: Inclusão; Ensino Superior; Práticas Pedagógicas Inclusivas; Psicologia Histórico-Cultural. Inclusion and higher education: pedagogical practices with students with disabilities/SEN in the perspective of historical- cultural psychology Abstract: The objective of this work is to discuss the process of inclusion of students with disabilities / special educational needs in Higher Education, highlighting some questions about the pedagogical practice that has been carried out at the State University of Western Paraná – UNIOESTE. It is based on Historical-Cultural Psychology that allows to understand how the process of development of the subject occurs from the study of phenomena in their historicity, in a dialectical process, contemplating the dimensions of the totality. The education of these students, based on legislation that has been expanding in recent years, needs, in most cases, some kind of specialized educational assistance as support and complementation of teaching work. The pedagogical practices carried out, historically, in most universities still present a conception of human development sustained by the biological character. It is understood that such guidelines are consistent with the formation of a man who fits the capitalist society that advocates unilateral training, with the acquisition of restricted and immediate skills. As a result, it is expected to reflect on the importance of an inclusive pedagogical practice, which contributes to the construction of a critical and conscioussubject, who can appropriate scientific knowledge and conclude his studies with quality. Keywords: Inclusion; University Education; Inclusive Pedagogical Practices; Historical-Cultural Psychology. Inclusión y enseñanza superior: prácticas pedagógicas con alumnos con deficiencia/NEE en la perspectiva de la psicología histórico-cultural Resumen: El trabajo objetiva discutir el proceso de inclusión de alumnos con deficiencia/Necesidades Educativas Especiales en la enseñanza superior, señalando cuestiones sobre la práctica pedagógica realizada en la Universidad Estatal del Oeste del Paraná. El estudio está fundamentado en la Psicología Histórico-Cultural que permite comprender cómo ocurre el desarrollo del sujeto desde el estudio de los fenómenos en su historicidad, en un proceso dialéctico, considerando las dimensiones en su totalidad. La educación de esos alumnos, basada en una legislación que está siendo desarrollada desde los últimos años, necesita, en la mayoría de los casos, de algún tipo de atendimiento educacional especializado con el apoyo y la complementación del trabajo docente. Históricamente, las prácticas pedagógicas realizadas en la mayoría de las universidades aún presentan una concepción del desarrollo humano apoyada en la característica biológica. Se comprende que esas orientaciones son coherentes con la formación de un hombre que se ajusta a la sociedad capitalista que sigue por una formación unilateral, con obtención de competencias restrictivas e inmediatas. Como resultado, es esperado repensar la importancia de una práctica pedagógica inclusiva, que contribuya para la construcción de un sujeto crítico y consciente, que pueda apropiarse del conocimiento científico y concluir sus estudios con cualidad. Palabras Clave: Inclusión; Enseñanza Superior; Prácticas Pedagógicas Inclusivas; Psicología Histórico-Cultural. Data de registro: 14/04/2021 Data de aceite: 19/01/2022. (shrink)

Background:Since 2010, the United States has experienced 228 disasters, affecting over 86 million people. Because of population shifts, the growing number of people living with chronic conditions or disabilities, and the growing number of older citizens living independently, access and service gaps often exist for those without money or other transferable resources. There is a lack of evidence regarding individual community members’ capacity to prepare for emergencies.Research objective:The purpose of this study is to highlight participant experiences in becoming better prepared (...) for emergencies and provide insight from a social justice perspective.Research design:This is a descriptive qualitative study, staying very close to the data as an end product rather than a beginning for interpretation.Participants and research context:A total of 13 low-income, uninsured, or under-insured attendees at a medical outreach clinic were interviewed.Ethical considerations:Institutional Review Board approval was obtained from the University of Texas at Tyler.Findings:Four themes emerged from the interview data: (a) evaluation of the emergency-preparedness education, (b) making emergency plans, (c) challenges in preparing for emergencies, and (d) facilitators of emergency preparedness.Discussion:Identifying the potential challenges to individual emergency preparedness among vulnerable populations is the first step in overcoming them. The capacity to comply with such measures, especially the ability of those with limited incomes and other vulnerable populations, must be considered.Conclusion:Synchronized, well-ordered assistance will close gaps in recovery and enhance efficiency in pre- and post-event aid. Theoretically, doing so will promote engaged and resilient members of society who are better able to withstand adverse events. The importance of the relationship between individual preparedness levels and the resiliency of nations supports the social justice imperative to address the needs of vulnerable populations in the mitigation and planning phase of the emergency management cycle. (shrink)

Background: There are few standardized measures available to assess executive function in a naturalistic setting for children. The Children’s Cooking Task is a complex test that has been specifically developed to assess EF in a standardized open-ended environment. The aim of the present study was to evaluate the internal consistency, inter-rater reliability, sensitivity and specificity, and also convergent and divergent validity of the Norwegian version of CCT among children with pediatric Acquired Brain Injury and healthy controls.Methods: The present study has (...) a cross-sectional design, based on baseline data derived from a multicenter RCT. Seventy-five children with pABI from two university hospitals with parent-reported executive dysfunction and minimum of 12 months since injury/completed cancer therapy, as well as 59 HCs aged 10–17 years, were assessed with CCT using total errors as the main outcome measure. The pABI group completed tests assessing EF on the impairment level within the ICF framework, and on the participation level. In addition, they completed tests of intellectual ability, processing speed, attention, learning, and memory. Finally, overall functional outcome was evaluated for the children with pABI.Results: Acceptable internal consistency and good inter-rater reliability were found for the CCT. Children with pABI performed significantly worse on the CCT than the HCs. The CCT identified group membership, but the sensitivity and specificity were overall classified as poor. Convergent validity was demonstrated by associations between the CCT and performance-based tests assessing inhibition, cognitive flexibility, and working memory, as well as teacher-reported executive dysfunction. Divergent validity was supported by the lack of association with performance-based measures of learning and memory, attention, and verbal intellectual ability. However, there was a moderate association between the CCT and performance-based tests of processing speed. Lastly, better performance on the CCT was associated with a better functional outcome.Conclusion: Our study with a relatively large sample of children with pABI and HC’s demonstrated good psychometric properties of the CCT. CCT performance was associated with the overall level of disability and function, suggesting that CCT is related to the level of activity in everyday life and participation in society. Hence, our study suggests that the CCT has the potential to advance the assessment of EF by providing a valid analysis of real-world performance. Nevertheless, further research is needed on larger samples, focusing on predictors of task performance, and evaluating the ability of CCT to detect improvement in EF over time. The patterns of error and problem-solving strategies evaluated by the CCT could be used to inform neuropsychological rehabilitation treatmentand represent a more valid outcome measure of rehabilitation interventions. (shrink)