Harcourt argues that in clinical contexts, children and young people with mental health illness can experience epistemic, specifically testimonial, injustice when their perspectives are unjustifiably discounted by health service providers.1 Our goal in this commentary was to illustrate how caregivers, a critical component of CYP treatment triad, can also engage in testimonial injustice towards CYP patients. Testimonial injustice occurs when one suffers a credibility deficit and that credibility deficit is based on prejudice.2 Harcourt expands Fricker’s account of testimonial injustice by (...) arguing that for CYPs, the credibility deficits attributed to them by clinicians, for example, may result from epistemic arrogance in that CYPs are viewed as having unreliable knowledge about their condition. Harcourt writes: ‘Being a CYP is treated as a heuristic for epistemic unreliability across a wide range of domains’, including clinical settings. Harcourt’s expansion of Fricker’s account thus includes epistemic arrogance as an alternative necessary condition, in addition to prejudice, to apply the concept of testimonial injustice. We think Harcourt’s argument can also be extended to caregivers, who are central to the CYP treatment triad. We illustrate how this may be the case by drawing from research we conducted to understand the perspectives of clinicians and prospective families, both caregivers and paediatric patients with obsessive–compulsive disorder about the possibility of …. (shrink)

Dystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with (...) refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand. (shrink)

BackgroundPublic health guidelines have recommended that elective medical procedures, including deep brain stimulation surgery for Parkinson’s disease, should not be scheduled during the coronavirus pandemic to prevent further virus spread and overload on health care systems. However, delaying DBS surgery for PD may not be in the best interest of individual patients and is not called for in regions where virus spread is under control and inpatient facilities are not overloaded.MethodsWe administered a newly developed phone questionnaire to 20 consecutive patients (...) with PD who received DBS surgery in Ruijin Hospital in Shanghai during the COVID-19 pandemic. The questionnaire was designed to gather the patients’ experiences and perceptions on the impact of COVID-19 on their everyday activities and access to medical care.ResultsMost of the patients felt confident about the preventive measures taken by the government and hospitals, and they have changed their daily living activities accordingly. Moreover, a large majority of patients felt confident obtaining access to regular and COVID-19-related health care services if needed. Routine clinical referral, sense of security in the hospital during the outbreak, and poor control of PD symptoms were the three main reasons given by patients for seeking DBS surgery during the COVID-19 pandemic.ConclusionThe COVID-19 pandemic has considerably impacted medical care and patients’ lives but elective procedures, such as DBS surgery for PD, do not need to be rescheduled when the health care system is not overloaded and adequate public health regulations are in place. (shrink)

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

While the intellectual challenge of digital phenotyping (DP) has evolved from data collection to more complex data analysis (Onnela 2021), core ethical considerations remain centered on patient pri...

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

Volume 20, Issue 7, July 2020, Page 207-209.

The current study was a cross-sectional research and aimed to investigate the factor structure, internal consistency, and validities of the Persian version of the Teasing Questionnaire-Revised. Forward and backward translations of the TQ-R were performed; face and content validities were determined based on comments by a sample of psychology students and specialists. Using the cluster sampling method, 290 participants were recruited, and 201 valid data were analyzed. The factor structure was assessed by confirmatory and exploratory factor analysis. The result of (...) the confirmatory factor analysis did not confirm the proposed three, four, and five-factor models. EFA revealed four factors with 23 items, explaining 52.03% of the total variance. The internal consistency of the Persian version of Teasing Questionnaire 23 was in the excellent range, and its expected associations with external correlates supported the measure’s convergent validity. The findings indicated that the Persian version of the TQ-R has sound psychometric properties and can be used as a valid and reliable tool in research and clinical outcomes. (shrink)

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

New communication technologies such as the microcomputer, videotex/teletext systems, the videocassette recorder, and satellite receiving dishes have been available to farmers since the early 1980s. This longitudinal study examines ethical issues associated with the impact that differential patterns of adoption and use of these technologies have had on inequalities among farmers from 1982 to 1989. The results demonstrate a strong adoption and use bias toward larger scale farmers who already have well-developed skills for handling information. This bias is especially strong (...) for microcomputer and videotex/teletext systems, and it isincreasing over time. Although the same farmers are not adopting all communication innovations, there is a strong tendency toward the already information-rich making the most use of the innovations they adopt. The article concludes with several recommendations that would help minimize some of these information inequalities. (shrink)

With The Perils of Global Legalism, Eric A. Posner explains that such views demonstrate a dangerously naive tendency toward legalism—an idealistic belief that ...

Climate change and justice are so closely associated that many people take it for granted that a global climate treaty should--indeed, must--directly address both issues together. But, in fact, this would be a serious mistake, one that, by dooming effective international limits on greenhouse gases, would actually make the world's poor and developing nations far worse off. This is the provocative and original argument of Climate Change Justice. Eric Posner and David Weisbach strongly favor both a climate change agreement (...) and efforts to improve economic justice. But they make a powerful case that the best--and possibly only--way to get an effective climate treaty is to exclude measures designed to redistribute wealth or address historical wrongs against underdeveloped countries. In clear language, Climate Change Justice proposes four basic principles for designing the only kind of climate treaty that will work--a forward-looking agreement that requires every country to make greenhouse--gas reductions but still makes every country better off in its own view. This kind of treaty has the best chance of actually controlling climate change and improving the welfare of people around the world. (shrink)

Carroll Izard completed his dissertation in 1952, beginning a career spanning more than six decades that coincided with clinical psychology maturing as a profession, and the birth of clinical science and cognitive neuroscience. Izard’s focus on discrete emotions as evolved systems that organize information, prepare responses, and shape the development of personality and relationships persisted through his career, despite “emotions” often being overshadowed by psychodynamic, behavioral, or cognitive perspectives. His theoretical work anticipated and now integrates contemporary neuroscience and relational perspectives. (...) Exploration of discrete emotions has kept lines of inquiry open that enrich our understanding of psychopathology. Izard also embraced clinical science, combining basic research with effectiveness studies addressing the unmet need for mental health services via emotion-focused interventions. (shrink)

Despite the bad press, Plato has a valid argument for immortality from three premises: (1) if the natural evil of a thing cannot destroy it, then it is indestructible; (2) the natural evil of the soul is vice; and (3) vice cannot destroy the soul. These premises are contestable, of course, but Plato has some good reasons for advancing them.

Social referencing informs and regulates one’s relation with the environment as a function of the perceived appraisals of social partners. Increased emphasis on relational and social contexts in the study of emotion makes this interpersonal process particularly relevant to the field. However, theoretical conceptualizations and empirical operationalizations of social referencing are disjointed across domains and populations of study. This article seeks to unite and refine the study of this construct by providing a clear and comprehensive definition of social referencing. Our (...) perspective presents social referencing and social appraisal as coterminous processes and emphasizes the importance of a relational and interpersonal approach to the study of emotion. We conclude by outlining possible lines of research on this construct. (shrink)

To date, emotion research has primarily focused on the experience and display of the emoter. However, of equal, if not more, importance is how such displays impact and guide the behavior of an observer. We incorporate a functionalist framework of emotion to examine the development of differential responding to discrete emotion, theorize on what may facilitate its development, and hypothesize the functions that may underlie such behavioral responses. Although our review is focused primarily on development, the theoretical and methodological ideas (...) laid out are relevant for researchers of emotion at all ages. (shrink)

In a survey on research misconduct, roughly 20% of the respondents admitted that they have submitted federal grant proposals that include scholars as research participants even though those scholars were not expected to contribute to the research effort. This manuscript argues that adding such false investigators is illegal, violating multiple federal statutes including the False Statements Act, the False Claims Act, and False, Fictitious, or Fraudulent Claims. Moreover, it is not only the offending academics and the false investigators that face (...) civil and criminal penalties because administrators may also be liable if they sign off on proposals and are in a position to know that false investigators might be included. Policy recommendations that should reduce the use of false investigators include changing institutional cultures, better training and oversight of the responsible conduct of research, and, most importantly, making all grant reviews double blind. (shrink)

Armed reprisals are the limited use of military force in response to unlawful actions perpetrated against states. Historically, reprisals provided a military remedy for states that had been wronged by another state without having to resort to all-out war in order to counter or deter such wrongful actions. While reprisals are broadly believed to have been outlawed by the UN Charter, states continue to routinely undertake such self-help measures. As part of the roundtable, “The Ethics of Limited Strikes,” this essay (...) examines the doctrine of armed reprisals in light of recent instances of states using force “short of war” in this manner. We argue that the ban on reprisals has been largely ignored by states, and that recent attempts to apply the laws of armed conflict to the cyber domain are further weakening this prohibition. We conclude that this is a potentially dangerous development that lowers the bar for resorting to military force, risking escalation and thereby further destabilizing the international system. (shrink)

For over 700 years scholastic theologians of varying degrees of allegiance to the text(s) of Thomas Aquinas have discoursed on the mystery of Christ's being (esse): Did Christ have one or two acts of existence? Yet despite this frequent and recurring quaestio, nevertheless only a handful of scholastic commentators pause to note that this is not simply a debate between rival scholastic ‘schools’ in regard to a theological mystery, but that in fact there is an inconsistency within the Angelic doctor's (...) own texts. And while in more recent scholarship this discrepancy has not only been noticed but explicated in various ways, nevertheless it is the contention of this paper that a satisfactory exposition of the meaning of esse secundarium has not yet been achieved. Consequently, I propose in this paper that esse secundarium is the created, substantial, but absolutely supernatural participation of the human nature of Jesus in the uncreated communication of the divine esse of the Word and provide a robust textual defense of this interpretation. (shrink)

By endorsing the use of a vaccine that makes the experience of puffing on a cigarette deeply distasteful, Lieber and Millum have taken the first few tentative steps into a future filled with medical interventions that manipulate individual preferences. It is tempting to embrace the careful arguments of “Preventing Sin” and celebrate the possibility that the profound individual and social costs of smoking will finally be tamed. Yet there is something unsettling about the possibility that parental discretion may be on (...) the cusp of a radical expansion, one that involves a new and unexplored approach to behavior modification. (shrink)

The cost of health care, its growing share of the gross domestic product, and dire predictions about the future are a major political and economic issue in the U.S. The American legal system is commonly viewed as a significant part of the problem, particularly by those who believe that medical providers engage in defensive medicine in an effort to avoid malpractice litigation. Yet scholars and commentators in the U.S. have shown relatively little interest in how other nations manage legal conflict (...) over health care and whether they might learn something from abroad about the relationship between malpractice litigation and the health care system more generally.To that end, this article analyzes the Japanese health care experience, specifically the management of what are variously called adverse outcomes, medical accidents, and medical malpractice. How frequently do Japanese patients sue their doctors? Are medical malpractice litigation rates in Japan rising? If so, what is being done to control the increase and its impact on medical care? How well is Japan doing when it comes to balancing the needs of patients who believe they are victims of medical negligence with those of providers who think they are being unfairly accused? These are the questions, about Japan, that need to be asked by those interested in the nexus of law and health care in the U.S. (shrink)

Scholars in the U.S. have shown relatively little interest in the management of legal conflict over health care in other nations. This article examines the Japanese health care system, particularly litigation over medical malpractice, and asks what American scholars and policy makers can learn from the Japanese experience.

The American Urological Association (AUA) and American College of Surgeons (ACS) codes of professionalism require surgeons to disclose the specific roles and responsibilities of trainees to patients during the informed consent process. The objective of this study is to analyze how these requirements are met by urology training programs. An anonymous electronic survey was distributed to the program directors (PDs) of the 143 Accreditation Council for Graduate Medical Education urology residency programs in the United States in 2021. Information was collected (...) regarding program demographics, aspects of the program’s consent process, and the disclosure to patients of the role and participation of residents in their surgery. There were 49 responses to the survey (34.3% response rate). Nearly 70 percent of PDs reported that attending physicians lead the consent process. The topics covered during consent discussion include possible complications (25%), expected recovery time (23%), length of the surgery (22%), the people involved (18%), and their specific roles (7%). Many PDs do not explicitly discuss trainee involvement (48.8%) or when a resident is to perform the majority of the case (87.8%). The majority of PDs (78.8%) communicate medical student involvement, but 73.2 percent reported having a patient decline participation of a trainee after describing their role. Despite the AUA and ACS codes of professionalism, many urologists do not disclose resident involvement in surgery to patients. Further discussions are needed to explore how to better balance resident education and patient autonomy. (shrink)

Few novel or emerging infectious diseases have posed such vital ethical challenges so quickly and dramatically as the novel coronavirus SARS‐CoV‐2. The World Health Organization declared a public health emergency of international concern and recently classified Covid‐19 as a worldwide pandemic. As of this writing, the epidemic has not yet peaked in the United States, but community transmission is widespread. President Trump declared a national emergency as fifty governors declared state emergencies. In the coming weeks, hospitals will become overrun, stretched (...) to their capacities. When the health system becomes stretched beyond capacity, how can we ethically allocate scarce health goods and services? How can we ensure that marginalized populations can access the care they need? What ethical duties do we owe to vulnerable people separated from their families and communities? And how do we ethically and legally balance public health with civil liberties? (shrink)

Attempts to explain emotion typically emphasize the interaction of evolutionary and socialization processes. However, in describing this interplay the role of the person is typically underemphasized or unaccounted for. This paper lays out empirical and theoretical rationale for considering the person as a major contributor to emotion generation and development.

In 1864 - two years before the publication of The Communist Manifesto and 21 years before the publication of Das Kapital - Karl Marx published an essay titled Peuchet on Suicide. The essay was originally presented as a translation of excerpts from the memoirs of Jacques Peuchet, a leading French police administrator, economist and statistician. Plaut and Anderson reveal that Marx's Peuchet on Suicide is not a straightforward translation, but is an edited version in which Marx adds passages of his (...) own, altering the emphasis of the text from a moral and psychological focus to a profoundly social one. Thus, the essay very strongly reflects Marx's own position on this controversial subject. Sociologist Kevin Anderson provides an extensive introduction situating the essay in the context of Marx's work, especially that on gender; Plaut's essay focuses on the psychological aspects of the work, in particular contrasting Marx's thoughts on suicide with those of Freud and Durkheim. (shrink)

Human rights law does not appear to enjoy as high a level of compliance as the laws of war, yet is institutionalized to a greater degree. This Article argues that the reason for this difference is related to the strategic structure of international law. The laws of war are governed by a regime of reciprocity, which can produce selfenforcing patterns of behavior, whereas the human rights regime attempts to produce public goods and is thus subject to collective action problems. The (...) more elaborate human rights institutions are designed to overcome these problems but fall prey to second-order collective action problems. The simple laws of war institutions have been successful because they can exploit the logic of reciprocity. The Article also suggests that limits on military reprisals are in tension with self-enforcement of the laws of war. The U.S. conflict with Al Qaeda is discussed. (shrink)

Although much legal scholarship discusses the meaning of the religion clauses of the U.S. Constitution, very few articles analyze the ways in which state regulation affects actors' incentives to engage in religious behavior. Yet the question of how a law influences religious behavior is important for determining whether various laws are desirable, and whether they violate constitutional constraints. This article draws on recent economic models of religious organization to analyze the ways in which laws affect the behavior of religious groups. (...) Religious groups produce collective goods for their members, and the effect of laws can be analyzed by examining how they modify the payoffs members receive for cooperating or free riding. The article examines the use of laws to establish religious groups, to subsidize them with cash or tax benefits, to provide accommodations for them, to provide symbolic support for them, to provide secular substitutes for the collective goods they produce, and to regulate disputes between members. The article also briefly discusses the constitutional implications of the analysis. (shrink)

The mutations that cause many forms of inherited retinal degenerations have been identified, yet the mechanisms by which these mutations lead to death of photoreceptor cells of the retina are not completely understood. Investigations of the pathways from mutation to retinal degeneration have focused on spontaneous and engineered animal models of disease. Based on the studies performed to date, four major categories of degeneration mechanism can be identified. These include disruption of photoreceptor outer segment morphogenesis, metabolic overload, dysfunction of retinal (...) pigment epithelial cells, and chronic activation of phototransduction. Future investigations will likely identify additional mechanisms of photoreceptor damage. This review will summarize what has been learned from studying animal models of non-syndromic inherited retinal degenerations. BioEssays 23:605–618, 2001. © 2001 John Wiley & Sons, Inc. (shrink)