Medical-legal partnerships (MLPs) — collaborative endeavors between health care clinicians and lawyers to more effectively address issues impacting health care — have proliferated over the past decade. The goal of this interdisciplinary approach is to improve the health outcomes and quality of life of patients and families, recognizing the many non-medical influences on health care and thus the value of an interdisciplinary team to enhance health. This article examines the unique, interrelated ethical issues that confront the clinical and legal partners (...) involved in MLPs. We contend that the ethical precepts of the clinical and legal professions should be seen as opportunities, not barriers, to further the interdisciplinary nature of MLPs. The commonalities in ethical approaches represent a potential bridge between legal and health care advocacy for patient/client well-being. Bioethics has a role to play in building and analyzing this bridge: bioethics may serve as a discourse and method to enhance collaboration by highlighting common ethical foundations and refocusing legal and clinical partners on their similar goals of service for patients/clients. This article explores this bridging role of bioethics, through a series of case studies. It concludes with recommendations to strengthen the collaborations. (shrink)

Medical-legal partnerships — collaborative endeavors between health care clinicians and lawyers to more effectively address issues impacting health care — have proliferated over the past decade. The goal of this interdisciplinary approach is to improve the health outcomes and quality of life of patients and families, recognizing the many non-medical influences on health care and thus the value of an interdisciplinary team to enhance health. There are currently over 180 MLPs at over 200 hospitals and health centers in the United (...) States, with increasing federal interest and potential legislative support of this model.This article examines the unique, interrelated, and often similar ethical issues that confront the clinical and legal partners involved in MLPs. We contend that the ethical precepts of the clinical and legal professions should be seen as opportunities, not barriers, to further the interdisciplinary nature of MLPs. (shrink)

[T]each the law to empower physicians individually and collectively to use the law and law colleagues to serve patients and promote public welfare; in short to better foster the goals of the medical profession.And yet:[A]ntipathy appears to be deeper and more pervasive than ever before, making it hard to imagine that relations between attorneys and physicians can get much worse.It has long been recognized that an understanding of at least some core legal rules and concepts is an important piece of (...) medical training. To address this, law is now typically part of the core medical school curriculum, often incorporated into bioethics and/or practice of medicine coursework — whether as part of a distinct course or series of courses or threaded through the curriculum. While often this education focuses on rules, some have recommended that it also include fundamentals of legal reasoning, and go beyond knowledge to include skills, attitudes, and behaviors vis-à-vis the law. (shrink)

Law is now routinely included in the medical school curriculum, often incorporated into bioethics and/or practice of medicine coursework. There seems to lack, however, a systematic understanding of what works in terms of getting across an effective depth and breadth of legal knowledge for medical students — or what such would even look like. Moreover, and more critically, while some literature addresses these what, when, how, and who questions, a more fundamental question is left unanswered: why teach law in medical (...) school? This article suggests a process to reveal a more consensual understanding of this latter question. The author highlights findings and recommendations of some of the leading literature to date related to teaching law in medical schools, and also recent U.K. projects addressing legal teaching in medical schools. Reflecting on these materials and activities, the author suggests that we take a “pause” before we argue for more or different legal topics within the medical curriculum. Before we alter the curricula for more and/or different “law,” first, it is critical to have a meaningful, stakeholder-driven, consensus-seeking discussion of the goals of legal education: why do we think it matters that medical students learn about “the law”? (shrink)

This article describes implementation of a longitudinal curriculum in public health law, building on doctrinal coursework with skills-based coursework and opportunities for interdisciplinary, community-based engagement and service learning. It specifically describes development of a Policy Practicum, giving an example of how law students can learn policy skills and skills of effective community coalition work through a healthy homes partnership, highlighting areas where the curriculum can incorporate interdisciplinary education. It offers lessons learned during the curriculum-building process, and concludes with a more (...) intensive service-learning strategy through the development of a Policy Lab. (shrink)

This case describes an adolescent in a crisis of a chronic medical condition whose situation is complicated by substance abuse and mental illness. D. Micah Hester provides an analytic approach, teasing apart the multiple layers of medical, developmental, and moral issues at hand and describing possible responses and outcomes. Amy T. Campbell examines existing legal guidelines for adolescent decision making, arguing that greater space exists for clinical discretion in these matters than commonly thought. Cheryl D. Lew discusses the development (...) of agency in adolescent patients, the ideal of autonomous decision making in the context of impairment and chronic illness, and the obligation of healthcare teams to examine an adolescent patient’s decisions in relation to her identity. (shrink)

Irrelevant emotional stimuli often capture attention, disrupting ongoing cognitive processes. In two experiments, we examined whether availability of rewards can prevent...

Theories of sexuality, culture and modern personhood rarely take account of differences in the construction of sexuality between advanced industrial nations. This article reveals different conceptions and management of adolescent sexuality among white, middle-class American and Dutch parents of teenagers. The American parents describe adolescent sexuality as a biologically driven, individually based activity which causes disruption to the teenager as well as to the family. The Dutch parents, by contrast, emphasize the love relationships and social responsibility of teenagers which make (...) their sexuality a `normal' phenomenon. The American parents exclude the sexuality of teenagers from conversation and the family while the Dutch parents accommodate culturally prescribed forms of teenage sexuality within the home. The article demonstrates how the two constructions of adolescent sexuality, and the conceptions of personhood and social life that engender them, constitute fundamentally different cultural logics. Without denying variations within the two countries, or overlaps between them, it suggests that different dominant understandings of sexuality and the individual have prevailed in the USA and the Netherlands. (shrink)

Guided by principles of life history strategy development, this study tested the hypothesis that sexual precocity and violence are influenced by sensitivities to local environmental conditions. Two models of strategy development were compared: The first is based on indirect perception of ecological cues through family disruption and the second is based on both direct and indirect perception of ecological stressors. Results showed a moderate correlation between rates of violence and sexual precocity (r = 0.59). Although a model incorporating direct and (...) indirect effects provided a better fit than one based on family mediation alone, significant improvements were made by linking some ecological factors directly to behavior independently of strategy development. The models support the contention that violence and teenage pregnancy are part of an ecologically determined pattern of strategy development and suggest that while the family unit is critical in affecting behavior, individuals’ direct experiences of the environment are also important. (shrink)

Background Medical Assistance in Dying in Canada came into effect in 2016 with the passing of Bill C-14. As patient interest and requests for MAID continue to evolve in Canada, it is important to understand the attitudes of future providers and the factors that may influence their participation. Attitudes towards physician hastened death in general and the specific provision of MAID are unknown among Canadian residents. This study examined residents’ attitudes towards PHD and MAID, and identified factors that may influence (...) their decision to participate in PHD and provide MAID. Methods A cross-sectional survey was adapted from prior established surveys on MAID to reflect the Canadian setting. All Canadian family medicine programs were invited to participate. The survey was distributed between December 2016 and April 2017. Analysis of the results included descriptive statistics to characterize the survey participants and multivariable logistic regressions to identify factors that may influence residents’ attitudes towards PHD and MAID. Results Overall, 247 residents from 6 family medicine training programs in Canada participated. While residents were most willing to participate in treatment withdrawal, active participation in PHD and MAID by prescription of a lethal drug and lethal injection were less acceptable. Logistic regressions identified religion as a consistent and significant factor impacting residents’ willingness to participate in PHD and MAID. Residents who were not strictly practicing a religion were more likely to be willing to participate in PHD and MAID. Increased clinical exposure to death and dying crudely correlated with increased willingness to participate in PHD and MAID, but when examined in multivariable models, only a few activities had a statistically significant association. Other significant factors included the residents’ sex and location of training. Conclusions Residents are hesitant to provide MAID themselves, with religious faith being a major factor impacting their decision. (shrink)

We tested the hypothesis that choices determined by Type 1 processes are compelling because they are fluent, and for this reason they are less subject to analytic thinking than other answers. A total of 104 participants completed a modified version of Wason's selection task wherein they made decisions about one card at a time using a two-response paradigm. In this paradigm participants gave a fast, intuitive response, rated their feeling of rightness for that response, and were then allowed free time (...) to reconsider their answers. As we predicted, answers consistent with a matching heuristic were made more quickly than other answers, were given higher FOR ratings, and received less subsequent analysis as measured by rethinking time and the probability of changing answers. These data suggest that reasoning biases may be compelling because they are fluently generated; this is turn creates a strong FOR, which acts as a signal that further analysis is not necessary. (shrink)

Recent research conducted in Australia shows that many oncologists withhold information about expensive unfunded drugs in what the authors of the study suggest is unacceptable medical paternalism. Surprised by the Australian results, we ran a version of the study in New Zealand and received very different results. While the percentages of clinicians who would prescribe the drugs described in the scenarios were very similar (73–99% in New Zealand and 72–94% in Australia depending on the scenario) the percentage who would not (...) discuss expensive unfunded drugs was substantially lower in New Zealand (6.4–11.1%) than it was in Australia (28–41%). This seems surprising given the substantial similarities between the two countries, and the extensive interaction between their medical professions. We use the contrast between the two studies to examine the generalisability of the Australian results, to identify influences on clinicians' decisions about what treatment information to give patients, and so the tendency towards medical paternalism and, more pragmatically, about how such decisions might be influenced. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

As bioethics gains more prominence in public policy debates, it is time to more fully reflect on the following: what is its role in the public square, and what limitations relate to and barriers impede its fulfilment of this role? I contend we should consider the how of bioethics (as a policy influencer) rather than simply focus on the who or what of bioethical enquiry. This is not to suggest considerations of latter categories are not important, only that too little (...) attention has been paid to parallel or resulting policy involvement—involvement that will require specialised skills and knowledge that we can develop with a proactive (vs reactive) stance. Moreover, and equally critically, this how of public policy involvement will require more transparency regarding influences (eg, philosophical, ideological, cultural, socio-political) on what bioethicists bring to the table and what constituency base each represents—a humility as to the scope of one's role. In this vision, bioethics is not one single person or belief system for a policymaker to call to guide or give support to a position; rather, it offers tools—formed and utilised by a diverse disciplinary range of individuals—to help guide ethical analysis of biomedical endeavours, with the goal of infusion and diffusion of ethical enquiry and prioritisation in health policymaking, and greater humility among bioethicists who inform this discussion. (shrink)

Cultural effects can influence the results of causal genetic analyses, such as Mendelian randomisation, but the potential influences of culture on genotype–phenotype associations are not currently well understood. Different genetic variants could be associated with different phenotypes in different populations, or culture could confound or influence the direction of the association between genotypes and phenotypes in different populations.

Introductory Abstract Philosophers of science, in the course of making a sharp distinction between the tasks of the philosopher and those of the scientist, have pointed to the possibility of an empirical science of induction. A comparative psychology of knowledge processes is offered as one aspect of this potential enterprise. From fragments of such a psychology, methodological suggestions are drawn relevant to several chronic problems in the social sciences, including the publication of negative results from novel explorations, the operational diagnosis (...) of dispositions, the status of aggregates of persons as social entities, and the validation of psychological tests. (shrink)

Cultural evolution, producing group‐level adaptations, is more problematic than the cultural evolution of individually confirmable skills, but it probably has occurred. The “conformist transmission,” described by Boyd and Richerson (1985), leads local social units to become homogeneous in anadaptive, as well as adaptive, beliefs. The resulting intragroup homogeneity and inter‐group heterogeneity makes possible a cultural selection of adaptive group ideologies.All archaic urban, division‐of‐labor social organizations had to overcome aspects of human nature produced by biological evolution, due to the predicament of (...) genetic competition among the cooperators. The universal norms found in archaic moral systems are seen as curbs to this human nature, reinforced by beliefs in invisible sanction systems and rewarding and punishing afterlives (as in heaven or reincarnation). Perhaps the ubiquity of lavishly wasteful royal funerals is to be explained as contributing to this function. (shrink)

The goal of this review is to consider how culture impacts the socialization of emotion development in infancy, and infants’ and young children’s subsequent outcomes. First, we argue that parents’ socialization decisions are embedded within cultural structures, beliefs, and practices. Second, we identify five broad cultural frames (collectivism/individualism; power distance; children’s place in family and culture; ways children learn; and value of emotional experience and expression) that help to organize current and future research. For each frame, we discuss the impact (...) on parents’ socialization practices and infants’ subsequent outcomes relating to emotion-related experience, expression, and understanding. We also generate testable hypotheses to further our understanding of the relationships between the five frames and emotion development in infancy. (shrink)

T. D. Campbell; IV*—Equality of Opportunity, Proceedings of the Aristotelian Society, Volume 75, Issue 1, 1 June 1975, Pages 51–68, https://doi.org/10.1093/aris.

Analogical reasoning relies on subprocesses of long-term memory and problem-solving. Stress, with its accompanying hormones dehydroepiandrosterone and cortisol, has been shown to impair memo...