Studies have reported high rates of childhood maltreatment among individuals with drug addiction problems; however, investigation about the potentially protective factors to mitigate the effects of maltreatment experiences on motivation to engage in addiction treatment has received less attention. This study aims at exploring the mediating effects of forgiveness and self-efficacy on the association between childhood maltreatment and treatment motivation among drug addicts. A total of 360 male drug addicts were recruited from three mandatory inpatient rehabilitation (...) centers in Malaysia. Participants completed a package of self-report questionnaires including measures of childhood maltreatment experiences, forgiveness, self-efficacy, and motivation for treatment. The analysis conducted using the structural equation model revealed that childhood maltreatment significantly predicted lower treatment motivation, while forgiveness and self-efficacy played a fully mediating role regarding the effect of childhood maltreatment on treatment motivation. In conclusion, these findings suggest that combining the element of forgiveness and self-efficacy in treatment programs appears to benefit the drug addicts with childhood maltreatment history. (shrink)

Chronic widespread pain is one of the most difficult pain conditions to treat due to an unknown etiology and a lack of innovative treatment design and effectiveness. Based upon preliminary findings within the fields of motivational psychology, integrative neuroscience, diaphragmatic breathing, and vagal nerve stimulation, we propose a new treatment intervention, motivational nondirective resonance breathing, as a means of reducing pain and suffering in patients with chronic widespread pain. Motivational nondirective resonance breathing provides patients with a noninvasive means (...) of potentially modulating five psychophysiological mechanisms imperative for endogenously treating pain and increasing overall quality of life. (shrink)

What makes Jehovah's Witnesses tick? What motivates practitioners of medicine? How is benevolent human behaviour to be interpreted? The explanation that fear of censure, mind-control techniques or enlightened self-interest are the real motivators of human conduct is questioned. Those who believe that man was created in "God's image", hold that humanity has the potential to rise above selfishly driven attitudes and actions, and reflect the qualities of love, kindness and justice that separate us from the beasts. A comparison of general (...) medical ethics and disciplines, and those of the Jehovah's Witness community, is made in this context. The easy charge that frequent deaths result from refusal of blood transfusions is examined. The central source of antipathy towards Jehovah's Witnesses, namely the alleged imposition of extreme and even harmful refusal of blood therapy on our children is addressed. Of course, "...few dilemmas are likely to be resolved wisely or satisfactorily by a blinkered adherence to abstract principles alone. Solutions to most cases will be dictated by a combination of factors. The support of medical ethics by Jehovah's Witnesses, and their willingness to share in reasoned and ethical debate, while at the same time holding firm to their religious and conscientious principles are emphasised. (shrink)

The aim of this study was to validate the Polish adaptation of the Treatment Self-Regulation Questionnaire, which measures the degree of self-determination in risk behaviour changes. The study comprised 219 patients, beginning to undergo treatment. The Global Motivation Scale was used to test a convergent validity. The confirmatory factor analysis did not support the theoretical four-factor model, thus an exploratory analysis was conducted to determine an optimal model across risk behaviours. The adopted two-factor model matched original TSRQ (...) subscales: autonomous motivation and external regulation. The internal consistency of factors ranging from.78 to.89. Structural equation modeling revealed the impact of global motivation on contextual motivation, limited to the equivalent type of regulation. The action aimed at supporting patient’s autonomy should consider the particular behaviour and the global motivation as a resource in disease. (shrink)

As evaluation of practitioners’ competence is largely based on self-report, accuracy in practitioners’ self-assessment is essential for ensuring high quality treatment-delivery. The aim of this study was to assess the relationship between independent observers’ ratings and practitioners’ self-reported treatment integrity ratings of Motivational interviewing. Practitioners were randomized to two types of supervision [i.e., regular institutional group supervision, or individual telephone supervision based on the MI Treatment Integrity code]. The mean age was 43.2 years, and 62.7 percent were (...) females. All sessions were recorded and evaluated with the MITI, and the MI skills were self-assessed with a questionnaire over a period of 12 months. The associations between self-reported and objectively assessed MI skills were overall weak, but increased slightly from baseline to the 12-months assessment. However, the self-ratings from the group that received monthly objective feedback were not more accurate than those participating in regular group supervision. These results expand findings from previous studies and have important implications for assessment of practitioners’ treatment fidelity: Practitioners may learn to improve the accuracy of self-assessment of competence, but to ensure that patients receive intended care, adherence and competence should be assessed objectively. (shrink)

In 2014, American doctor Ian Crozier chose to travel to Sierra Leone to help fight the West African Ebola epidemic. He contracted Ebola himself and was evacuated to the US, where he received hospital treatment for 40 days. Crozier knowingly chose to expose himself to a risk of contracting Ebola, and thus appears to be at least somewhat morally responsible for his infection. Did this responsibility weaken his justice-based claim to publicly funded treatment? On one influential view—luck egalitarianism—the (...) answer is ‘yes’. Or so Albertsen and Thaysen suggest in this issue.1 According to luck egalitarianism, justice requires the elimination of inequalities between people, but only when the relative harm borne by those on the wrong end of the inequality is a matter of luck. Albertsen and Thaysen understand luck egalitarianism to entail that, when one is responsible for befalling a harm, one has no claim in justice to the mitigation of that harm. On this view, they suggest, Crozier’s claim to treatment would be similar to that of a reckless Alpine skier who is injured in a skiing accident, and would be weaker than that of those with a normal claim to treatment—those who bear no responsibility for their illness. Both of these implications seem implausible, however. Intuitively, Crozier’s claim to treatment is no weaker than those with normal claims, and certainly stronger than the reckless skier’s. Can luck egalitarianism be ‘adjusted or interpreted’ so as to avoid these implausible implications? The authors suggest that it can. Their innovation is to distinguish heroic doctors like Crozier from reckless skiers by invoking a distinction between being responsible for creating harm and for incurring harm. Their thought is that one creates harm when one brings harm on oneself without also preventing at least as much harm to others. Thus, the harm that …. (shrink)

_Treating Dissociative and Personality Disorders_ draws on major theorists and the very latest research to help formulate and introduce the Relational/Multi-Motivational Therapeutic Approach, a new model for treating such patients within a clinical psychoanalytic setting. Supported by her fellow contributors, Antonella Ivaldi provides an overview of existing theories and evidence for their effectiveness in practice, sets out her own theory in detail and provides rich clinical detail to demonstrate the advantages of the REMOTA model as applied in a clinical setting. (...) The narratives in this book show how it is possible to integrate different contributions within a multidimensional aetiopathogenic treatment model, which considers the mind as a manifestation of the relationship between body and world. From a conceptual perspective, according to which consciousness emerges and develops in the interpersonal dimension, this book shows how it becomes possible to understand, in the therapeutic space, what stands in the way of sound personal functioning, and how to create the conditions for improving this. Treating Dissociative and Personality Disorders will be highly useful in addressing the particular clusters of symptoms presented by patients, stimulating therapists of different backgrounds to explore the complexity of human nature. On reading this book, it will become clear that theories can truly become useful instruments, if approached with a critical mind and with humbleness, in order to venture into what we do not know and will never know completely: the relationship with the other, unique and irreplaceable. Treating Dissociative and Personality Disorders provides an integrative and comparative new approach that will be indispensable for combining relational clinical knowing and motivational theories. It_ _will appeal to psychoanalysts and psychotherapists, especially those in training, clinicians of different backgrounds interested in comparative psychotherapy, as well as social workers and graduate and postgraduate students. (shrink)

Moral Motivation presents a history of the concept of moral motivation. The book consists of ten chapters by eminent scholars in the history of philosophy, covering Plato, Aristotle, later Peripatetic philosophy, medieval philosophy, Spinoza, Locke, Hume, Kant, Fichte and Hegel, and the consequentialist tradition. In addition, four interdisciplinary "Reflections" discuss how the topic of moral motivation arises in epic poetry, Cicero, early opera, and Theodore Dreiser. Most contemporary philosophical discussions of moral motivation focus on whether and (...) how moral beliefs by themselves motivate an agent to act. In much of the history of the concept, especially before Hume, the focus is rather on how to motivate people to act morally as well as on what sort of motivation a person must act from in order to be a genuinely ethical person or even to have done a genuinely ethical action. The book shows the complexity of the historical treatment of moral motivation and, moreover, how intertwined moral motivation is with central aspects of ethical theory. (shrink)

The explanatory/pragmatic-trial distinction enjoys a burgeoning philosophical and medical literature and a significant contingent of support among philosophers and healthcare stakeholders as an important way to assess the design and results of randomized controlled trials. A major motivation has been the need to provide relevant, generalizable data to drive healthcare decisions. While talk of pragmatic and explanatory trials could be seen as convenient shorthand, the distinction can also be seen as harboring deeper issues related to inferential strategies used to (...) evaluate causal claims regarding medical treatments. A comprehensive, critical analysis of the distinction and underlying epistemological framework upon which the distinction is based, particularly with respect to treatment effectiveness, has yet to be forthcoming. I provide this, analyzing the distinction’s relationship to generalizability and cognate distinctions between ideal conditions and real-world practice, internal and external validity, and efficacy and effectiveness. I also analyze recent philosophical work that relies on the explanatory/pragmatic-trial distinction and that advocates for more pragmatic trials. I conclude that as an organizing principle for trial-design decisions and trial evaluation, the explanatory/pragmatic-trial distinction is conceptually problematic and not as useful as its proponents seem to think. Since some pragmatic-trial features can be inimical to establishing treatment effectiveness, pragmatic-trial features should not be conflated with pragmatic trials’ avowed goals. If the distinction is to be useful, it and some associated concepts, including generalizability, should be reformulated, lest they continue to underlie a medical epistemology that could contribute to methodologically flawed and potentially unethical advice for the design and interpretation of trials. (shrink)

This study analyses the sensitivity of public goods contributions through the lens of psychological motives. We report the results of a public goods experiment in which subjects were induced with the motives of care and anger through autobiographical recall. Subjects’ preferences, beliefs, and perceptions under each motive are compared with those of subjects experiencing a neutral autobiographical recall control condition. We find, but only for those subjects with the highest comprehension of the game, that care elicits significantly higher contributions than (...) anger, with the control treatment in between. This positive influence of the care motive on unconditional giving is accounted for partly by preferences for giving and partly by beliefs concerning greater contributions by others. Anger also affects attention to own and other’s payoffs and perceptions of the game’s incentive structure. (shrink)

Purpose: To determine motives and attitudes towards life-sustaining treatments by clinical and preclinical medical students. Methods: This was a scenario-based questionnaire that presented patients with a limited life expectancy. The survey was distributed among 455 medical students in preclinical and clinical years. Students were asked to rate their willingness to perform LSTs and rank the motives for doing so. The effect of medical education was then investigated after adjustment for age, gender, religion, religiosity, country of origin, and marital status. Results: (...) Preclinical students had a significantly higher willingness to perform LSTs in all cases. This was observed in all treatments offered in cases of a metastatic oncologic patient and an otherwise healthy man after a traumatic brain injury. In the case of an elderly woman on long-term care, preclinical students had higher willingness to supply vasopressors but not perform an intubation, feed with a nasogastric tube, or treat with a continuous positive air-pressure ventilator. Both preclinical and clinical students had high willingness to perform resuscitation on a twelve-year-old boy with a TBI. Differences in motivation factors were also seen. Discussion: Preclinical students had a greater willingness to treat compared to clinical students in all cases and with most medical treatments offered. This is attributed mainly to changes along the medical curriculum. Changes in reasons for supplying LSTs were also documented. (shrink)

Central to many discussions of motivated reasoning is the idea that it runs afoul of epistemic normativity. Reasoning differently about information supporting our prior beliefs versus information contradicting those beliefs, is frequently equated with motivated irrationality. By analyzing the normative status of belief polarization, selective scrutiny, biased assimilation and the myside bias, I show this inference is often not adequately supported. Contrary to what’s often assumed, these phenomena need not indicate motivated irrationality, even though they are instances of belief-consistent information (...) processing. Second, I engage with arguments purporting to show that belief-consistent information processing does not indicate motivated irrationality because of its mere differential treatment of confirming and non-confirming evidence, but rather because it reveals the undermining presence of an irrelevant influence, such as a desire or partisan identity-driven cognition. While linking belief-consistent reasoning to a deeper source of directional motivation to make good on the claim that it indicates motivated irrationality is indeed what’s needed, two prominent such arguments fail. The non-normativity of many reasoning processes often taken to indicate motivated irrationality is not in fact well established. (shrink)

This paper offers a critical survey and analysis of empirical studies on creativity, with emphasis on how imagination plays a role in the creative process. It takes as a foil the romantic view that, given features like novelty, incubation, and insight, we should be skeptical about the prospects for naturalistic explanation of creativity. It rebuts this skepticism by first distinguishing stages or operations in the creative process. It then works through various behavioral and neural studies, and corresponding philosophical theorizing, that (...) concern the preparation, generation, insight, and evaluation stages of creative processes. The result is not a complete explanation of creativity, but it identifies an explanatory path towards such an explanation, including the features of creativity that motivate that skepticism. (shrink)

Medical genetic interventions can be performed in two ways. First, genetic defects may be repaired (gene therapy). Secondly, a possible future individual (an embryo or a possible combination of gametes) may be preselected because of its favourable genetic make-up (by using genetic diagnostic methods and procedures from reproductive medicine so called Preimplantation Genetic Diagnosis). The first kind of intervention means that someone gets medical treatment in the normal sense, however, the second kind does not. Rather, in that case, the (...) potential patient is exchanged for another individual who is in no need of treatment. The paper explores to what extent arguments for and against these kinds of genetic intervention apply equally to all of them. For example, may the benefits that can be achieved through gene therapy be equally well achieved through genetic preselection? Are fears of a resurrection of eugenic practices through gene technology more warranted regarding therapeutic interventions than regarding preselective ones (or vice versa)? Since genetic preselection is an intervention at the germ-line level and is presently clinically applied: How is it possible to motivate that clinical application of germ-line gene therapy is not similarily permitted? (shrink)

Physicians commonly recommend ?placebo treatments?, which are not believed to have specific efficacy for the patient's condition. Motivations for placebo treatments include complying with patient expectations and promoting a placebo effect. In this article, we focus on two key empirical questions that must be addressed in order to assess the ethical legitimacy of placebo treatments in clinical practice: 1) do placebo treatments have the potential to produce clinically significant benefit? and 2) can placebo treatments be effective in promoting a therapeutic (...) placebo response without the use of deception? We examine evidence from clinical trials and laboratory experiments bearing on these two questions. The conclusion is reached that based on currently available evidence, it is premature to judge whether placebo treatments are ethically justifiable, with the possible exception of acupuncture for pain relief. (shrink)

As a result there is a considerable literature on the topic. I think, however, that the treatment in the literature is incomplete because there is a failure to examine the relevant emotions in significant detail, and in particular to consider their complexity and the conditions of their warrant. As a result, both defenses and critiques of the motive of duty in terms of reliability are inadequate as they stand.

In lieu of an abstract, here is a brief excerpt of the content:HUME, MOTIVATION AND MORALITY Hume remarks, in the Abstract, that his account of the passions in Book II of the Treatise has 'laid the foundation' (A 7 Ì1 for his theory of morals. Pall Ardal has shown how Hume's theory of certain indirect passions (pride, humility, love, hatred) underpins his theory of the evaluation of character. I propose to explore the links between Hume's account of motivation (...) and his treatment of an agent 'ß moral assessment of prospective action. Where Ardal stresses the moral spectator, my focus is on the agent. Hume himself attends primarily to the moral spectator, but the agent's perspective is central in two of his chief arguments concerning morals, that for the thesis that moral distinctions are derived from a moral sense, and that for the artificiality of justice. I shall take it that the argument of Treatise II, iii, 3 ("Of the influencing motives of the will") provides the framework for analysis: acting for moral reasons is like acting for any other reason; citing his moral principles to explain a man's actions is like citing his desire to preserve his health as an explanation of his taking exercise; deliberating about moral matters is like pondering the purchase of a pair of shoes. Of course there are differences; I shall look to them shortly. It is essential, however, to begin with the similarities. To a first approximation, the central doctrine is that the reasons that explain actions are rational causes of those actions. Reasons for actions are constituted by suitably related desires and beliefs; volitions are somehow implicated in intentional actions. Reasons are causes: the desires and beliefs that constitute reasons cause volitions, and thus actions. They are rational causes: there are links of special kinds between the contents of the desires and beliefs that constitute an agent's reasons for what he does, and the content of the volitions implicated in the actions done. Hume is at pains to deny that "reason [here: belief] alone can... be a motive to any action of the will" (T 413). But he insists there are "two principal parts [of human nature], which are requisite in all its actions, the affections and understanding' (T 493). I suggest that by "affections" he here means specifically (if broadly) desires, and so both the "direct passions" of desire and aversion and such "indirect passions" as benevolence, anger, pity, compassion and malice. Hume's official doctrines both of desires and of volitions are unsatisfactory as they stand; he treats each as simple impressions. To be sure, these simple impressions are said always to be accompanied by thoughts of (in Hume's phrase) their objects. Even such complex states, however, can play no satisfactory role in psychological theory. The insights that Hume's official doctrines mishandle can, I suggest, be incorporated into more defensible, and more-or-less Humean, analyses of the internal structure of desire and volition. Having made efforts along these lines elsewhere, however, I shall here concentrate on other features of desire and volition that are germane to Hume's moral psychology. Desires and volitions are alike in two linked respects, among others: neither takes a truth value (and so each differs from belief); each is a conative, not a cognitive, psychological state (and so, again, each differs from belief). Because desires and volitions are not capable of "an agreement or disagreement either to the real relations of ideas, or to real existence and matter of fact" it is "impossible... they can be pronounced either true or false" (T 458). Their general functional role is that of "propense and averse motions of the mind" (T 574). To be sure, there are differences. The principal difference is that of specific functional location: desires are constituents in reasons for acting: volitions are constituents of (or otherwise implicated in) actions done for such reasons. This functional difference is tied to differences of content. To grasp the many relations among belief, desire and volition, when the first two serve as 4 reason for (and so cause of) the third, it is useful to plot their causal relations onto the elements in an Aristotelian practical syllogism. Desires function as causally salient major premises... (shrink)

This article focuses on the unresolved scholarly question of how Confessiones, book 10 should be interpreted, proposing a new explanation as to how and why the second half of book 10 is critically important to this text. Emphasizing important relations between the introductory chapters and the second half of book 10, the article revisits Augustine’s treatment of ambitio saeculi, interpreted as a state of will, with which author Augustine continues to struggle, even during his act of confessing publicly (i.e., (...) in composing the book 10 text for publication). As a corruption of the motive behind his act of public confession, ambitio saeculi threatens to undermine the moral integrity of this same act. After Augustine recognizes that he cannot solve this moral flaw, he despairs and considers abandoning his human audience, and so, the very publication of his text. However, he is made newly capable of remaining, as confessant, before his readership, through a new, deeper conversion. This conversion to a new humility is given in and through the confessant’s participation in the eucharistic sacrament, which provides a hopeful resolution to his ambitio saeculi. (shrink)

Limited research has been done among pregnant people participating in investigational drug trials. To enhance the ethical understanding of pregnant people’s perspectives on research participation, we sought to describe motives and risk perceptions of participants in a phase 1 trial of ledipasvir/sofosbuvir treatment for chronic Hepatitis C virus during pregnancy. Pregnant people with chronic HCV infection enrolled in an open-label, phase 1 study of LDV/SOF participated in semi-structured, in-depth interviews to explore their reasons for participation and experiences within the (...) study. Pregnant people took 12 weeks of LDV/SOF and were interviewed at enrollment and at the end of study. We recorded the interviews, transcribed them verbatim, coded them using NVivo software, and performed inductive thematic analysis. Nine women completed the study yielding 18 interview transcripts. We identified two themes regarding motives and one regarding risk perception. Motives— Women conceptualized study participation as part of the caregiving role they associate with motherhood; participating was viewed as an act of caregiving for their infants, their families, themselves, and other pregnant women with chronic HCV. Women also noted that they faced multiple barriers to treatment prior to pregnancy that created a desire to receive therapy through trial participation. Risk perception— Women acknowledged personal and fetal risk associated with participation. Acceptance of risk was influenced by women’s concepts of motherhood, preexisting knowledge of HCV and medical research, family members, intimate partners, or by the study design. Women enrolled in a phase 1 trial for chronic HCV therapy during pregnancy acknowledged risks of participation and were motivated by hopes for fetal and personal benefit and by lack of prenatal access to treatment. Ethical inclusion of pregnant people in research should acknowledge structural factors that contribute to vulnerability and data deficiencies for treatment in pregnancy. (shrink)

The truth about health care policy lies between two exaggerated views: a market view in which individuals purchase their own health care from profit maximizing health-care firms and a control view in which costs are controlled by regulations limiting which treatments health insurance will pay for. This essay suggests a way to avoid on the one hand the suffering, unfairness, and abandonment of solidarity entailed by the market view and, on the other hand, to diminish the inflexibility and inefficiency of (...) the control view. It suggests that the way to mitigate these problems is to recognize the malleability of motivation and the range of factors, in addition to financial incentives, that may influence the behavior of patients and especially physicians. (shrink)

Research Ethics, Volume 18, Issue 2, Page 132-150, April 2022. Limited research has been done among pregnant people participating in investigational drug trials. To enhance the ethical understanding of pregnant people’s perspectives on research participation, we sought to describe motives and risk perceptions of participants in a phase 1 trial of ledipasvir/sofosbuvir treatment for chronic Hepatitis C virus during pregnancy. Pregnant people with chronic HCV infection enrolled in an open-label, phase 1 study of LDV/SOF participated in semi-structured, in-depth interviews (...) to explore their reasons for participation and experiences within the study. Pregnant people took 12 weeks of LDV/SOF and were interviewed at enrollment and at the end of study. We recorded the interviews, transcribed them verbatim, coded them using NVivo software, and performed inductive thematic analysis. Nine women completed the study yielding 18 interview transcripts. We identified two themes regarding motives and one regarding risk perception. Motives— Women conceptualized study participation as part of the caregiving role they associate with motherhood; participating was viewed as an act of caregiving for their infants, their families, themselves, and other pregnant women with chronic HCV. Women also noted that they faced multiple barriers to treatment prior to pregnancy that created a desire to receive therapy through trial participation. Risk perception— Women acknowledged personal and fetal risk associated with participation. Acceptance of risk was influenced by women’s concepts of motherhood, preexisting knowledge of HCV and medical research, family members, intimate partners, or by the study design. Women enrolled in a phase 1 trial for chronic HCV therapy during pregnancy acknowledged risks of participation and were motivated by hopes for fetal and personal benefit and by lack of prenatal access to treatment. Ethical inclusion of pregnant people in research should acknowledge structural factors that contribute to vulnerability and data deficiencies for treatment in pregnancy. (shrink)

It is unclear in the Groundwork exactly what Kant takes to be necessary for an act to be morally good or worthy. Traditionally it has been thought that for Kant there are two conditions: it is 1) done in accord with duty, or the moral law, and 2) done for the sake of duty alone. The second condition is commonly thought to entail that an act is not morally good if the agent has a ‘supporting inclination’ or desire to do (...) what is right — be it an inclination of self-interest, or one stemming from some emotion of ‘fellow feeling,’ such as sympathy, compassion, or love. Recent interpreters, however, claim that Kant is not so strict, because for him the mere presence of a supporting inclination does not necessarily impugn the moral goodness of a dutiful act. The moral goodness of an act in accord with duty is compromised, it is claimed, only if some such supporting inclination is the actual motive for the dutiful act. Moral worth, on this view, requires that duty is the actual motive, and, so long as it is, it doesn’t matter whether there is a supporting inclination or not. Be that as it may, it is clear in the Groundwork that for Kant there is something special about the motive of duty. A common suggestion for what makes it special is that it is more reliable than other motives in producing right action. Although it is debatable whether such reliability is the most important consideration for Kant and contemporary Kantians, there are clear indications that it is for them a matter of concern — perhaps a necessary but not sufficient condition for moral worth. As a result there is a considerable literature on the topic. I think, however, that the treatment in the literature is incomplete because there is a failure to examine the relevant emotions in significant detail, and in particular to consider their complexity and the conditions of their warrant. As a result, both defenses and critiques of the motive of duty in terms of reliability are inadequate as they stand. (shrink)

I hypothesize that people engage in religious practices, in part, because such practices activate the frontal lobes. Activation of the frontal lobes is both intrinsically rewarding and necessary for acquisition of many of the behaviors that religions seek to foster, including self‐responsibility, impulse and emotion modulation, empathy, moral insight, hope, and optimism. Although direct tests of the hypothesis are as yet nonexistent, there is reasonably strong circumstantial evidence (reviewed herein) for it. Recent brain‐imaging studies indicate greater anterior activation values and (...) increased blood flow to frontal sites during prayer and meditation. Regular prayer is positively correlated with better overall mental health. Religiosity is correlated with higher levels of self‐monitoring, empathy, and moral insight and other positive behaviors and negatively correlated with depression and impulsive and risky behaviors. Independent data show that self‐monitoring, empathy, hope, and moral insight are all selectively associated with intact frontal function, whereas depression, impulsiveness, and drug and alcohol abuse are associated selectively with frontal dysfunction. If religious practices do indeed preferentially activate and stimulate development of the frontal lobes, (a) religious practices should be considered as possible adjuncts for some patients in treatment for mental health disorders, and (b) the frontal lobes (rather than the temporal lobes) should be considered the major brain site that supports the core components of religious experience. (shrink)

Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender (...) affirming hormone treatment for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong. (shrink)

Objective: Theory and research suggest that the pursuit of personal goals that do not fit a person's affect-based implicit motives results in impaired emotional well-being, including increased symptoms of depression. The aim of this study was to evaluate an intervention designed to enhance motive-goal congruence and study its impact on well-being. Method: Seventy-four German students (mean age = 22.91, SD = 3.68; 64.9% female) without current psychopathology, randomly allocated to 3 groups: motivational feedback (FB; n = 25; participants learned about (...) the fit between their implicit motives and explicit goals), FB + congruence-enhancement training (CET; n = 22; participants also engaged in exercises to increase the fit between their implicit motives and goals), and a no-intervention control group (n = 27), were administered measures of implicit motives, personal goal commitments, happiness, depressive symptoms, and life satisfaction 3 weeks before (T1) and 6 weeks after (T2) treatment. Results: On two types of congruence measures derived from motive and goal assessments, treated participants showed increases in agentic (power and achievement) congruence, with improvements being most consistent in the FB+CET group. Treated participants also showed a trend-level depressive symptom reduction, but no changes on other well-being measures. Although increases in overall and agentic motivational congruence were associated with increases in affective well-being, treatment-based reduction of depressive symptoms was not mediated by treatment-based agentic congruence changes. Conclusion: These findings document that motivational congruence can be effectively enhanced, that changes in motivational congruence are associated with changes in affective well-being, and they suggest that individuals’ implicit motives should be considered when personal goals are discussed in the therapeutic process. (shrink)

It is proved that the basic framework of the premises and reasoning of Wittgenstein's “Tractatus Logico-philosophicus” corresponds quite well to the transcendental method (as formulated by H. Cohen). Whereas Kant’s philosophy proceeds from the fact of existence of mathematics and mathematised natural science and investigates their conditions of possibility, Wittgenstein proceeds from the fact that propositions of language describe reality and reveals the conditions of possibility of such descriptions. Kant, answering the question about the conditions of possibility of the named (...) sciences, comes to the idea of the transcendental subject and the distinction between the world of phenomena and the thing in itself. Wittgenstein's investigation of the conditions of possibility that the world is described by propositions leads to the assertion that both the world and language are together in logical space. The latter constitutes the a priori and transcendental condition of the possibility that language “reaches out” to reality. For both the theories - in the “Critique of Pure Reason” and in the “Tractatus Logico-Philosophicus” - the idea of the boundary is important. In the “Critique of Pure Reason” it is the boundary of possible experience and cognition, while in the “Tractatus Logico-Philosophicus” it is the boundary of what can be thought and expressed by meaningful propositions. Related to the different definitions of the boundary is the difference in the treatment of mathematised natural science. For “The Critique of Pure Reason” was created in the era of unconditional acceptance of Newtonian mechanics. And the “Tractatus Logico-Philosophicus” was created at the time of the crisis of the Newtonian paradigm and its replacement by other notions of time and space. However, the idea of boundary, which is present in both doctrines, determines closeness in the attitude towards metaphysics between the author of “The Critique of Pure Reason” and the author of “The Tractatus Logico-Philosophicus”. The study also shows that Wittgenstein did not follow logicism in his philosophy of mathematics. For him, both mathematical objects and propositions of logic are constructions. The conviction about the constructive character of mathematical and logical objects shows an affinity with the Kantian tradition in the philosophy of mathematics. (shrink)

According to Information-Motivation-Behavioural Skills model, accurate Information, strong Motivation and adequate Behavioural skills are prerequisites of treatment adherence. This model has been verified among chronically ills patients, usually suffering from one particular disorder. No studies report how the model fits data from a more diverse group. The aim of the study was to analyze adherence and its barriers in a group of three hundred patients suffering from various, common chronic disorders. They filled out IMB and Adherence Questionnaire. (...) Information and Motivation correlated moderately. Behavioural Skills was the strongest predictor of adherence. An additional relationship was found: Information and Motivation interacted and the role of either of these dimensions vanished if the indices of the other were high enough. The relationships between IMB dimensions and adherence were confirmed in a varied clinical sample. Behavioural skills must be considered when working with non-adherent patients, as they are the strongest predictor of adherence. Other interventions may be limited to either Information or Motivation only if there is a chance of raising one of them to extreme levels. This may be useful with special cases, when increasing both is problematic. (shrink)

Background/IntroductionInfertile couples that travel to another country for reproductive treatment do not refer to themselves as “reproductive tourists”. They might even be offended by this term. “Tourism” is a metaphor with hidden connotations. We will analyze these connotations in public media discourses on “reproductive tourism” in Israel and Germany. We chose to focus on these two countries since legal, ethical and religious restrictions give couples a similar motivation to travel for reproductive care, while the cultural backgrounds and conceptions (...) of reproduction are different. Results: Our research shows that the use of the metaphor “reproductive treatment” and its hidden messages depends on the writers’ intention and the target population. Although the phenomenon of patients travelling for reproductive treatment can fit into the definitions of tourism, the term emphasizes aspects that do not reflect patients’ reality. In both the German and the Israeli public media debate the term “reproductive tourism” is either used to criticize the economic aspects of the phenomenon or to attract patients as potential clients. Conclusions: Ethicists should be cautious when borrowing metaphors like “reproductive tourism” from the public debate. Our findings support Penning’s suggestion to use instead an unloaded term like cross-border reproductive care to describe the phenomenon in a more neutral way and to make it explicit whenever criticism is necessary. (shrink)

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal (...) decision-making study nested in a Thai acute HIV research cohort. In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks. These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. (shrink)

The random]ized clinical trial is widely accepted as the optimal approach to evaluating the safety and efficacy of medical treatments. Resistance to randomized treatment assignment arises regularly, most commonly in situations where the disease is life-threatening and treatments are either unavailable or unsatisfactory. Historical control designs, in which all participants receive the experimental treatment with results compared to a prior cohort, are advocated by some as more ethical in such circumstances; however, such studies are often highly biased in (...) favor of the new treatment and frequently yield misleading results. Alternative controlled designs motivated by the desire to maximize the number of patients with the treatment ultimately determined to be superior have been proposed, but have been challenged on both methodological and ethical grounds. Debates about appropriate and ethical study designs recurred during the recent Ebola Virus Disease epidemic in West Africa. Despite its devastating nature, the EVD epidemic showed the ongoing necessity of conducting randomized trials to obtain convincing evidence of the safety and efficacy of therapeutic interventions. (shrink)

The debate over moral bioenhancement has incrementally intensified since 2008, when Persson and Savulescu, and Douglas wrote two separate articles on the reasons why enhancing human moral capabilities and sensitivity through technological means was ethically desirable. In this article, we offer a critique of how Persson and Savulescu theorize about the possibility of moral bioenhancement, including the problem of weakness of will, which they see as a motivational challenge. First, we offer a working definition of moral bioenhancement and underscore some (...) of the challenges in determining whether moral bioenhancement, as conceptualized by Persson and Savulescu, falls into the category of enhancement or constitutes a type of therapeutic intervention. Second, we provide a critical analysis of the way Persson and Savulescu pathologize human behavior in relation to what they see as the main threat to the survival of the human species: weak moral motivation. Next, we critique the claim that the use of genetic manipulation and drug treatment will increase moral motivation. We argue that Persson and Savulescu mischaracterize the nature of human moral psychology because moral motivation includes affective and cognitive dimensions. The type of interventions they envision focus almost exclusively on the former. In the final two sections, we outline three main criticisms of moral bioenhancement and offer a more robust account of moral psychology and moral development than what Persson and Savulescu recommend, through the lens of Aristotle’s work on virtue ethics. Ultimately, we argue that what Persson and Savulescu, and Douglas consider as moral bioenhancement is a misnomer because they do not fully account for the complexity of moral agency. (shrink)

Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy. In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient’s motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the (...) nature and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient’s inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the ’error’ committed for which the depressed patient blames himself and the social repression of the maniacal patient’s affirmation of his inflated self-esteem. (shrink)

The adaptive BCI known as ‘closed-loop deep brain stimulation’ (clDBS) is a device that stimulates the brain in order to prevent pathological neural activity and automatically adjusts stimulation levels based on computational algorithms that detect or predict those pathological processes. One of the prominent ethical concerns raised by clDBS is that, by inhibiting or modulating the undesirable neural states of a cognitive agent automatically, the device potentially undermines her autonomy. It has been argued that clDBS is not a threat because (...) autonomy is fundamentally relational, i.e., it essentially depends on external (e.g., social or cultural) factors. If the relational approach to autonomy includes human-computer interaction, then the mechanisms of clDBS, even if external to the brain and exerting some degree of control over the individual, may support her autonomy. However, DBS applications are substantially different from one another, each involving a specific neurological or psychiatric condition, neural target, mechanism and symptom(s), and therefore at least some of them may not fit into the relational analysis. I examine different clDBS applications for treatment resistant depression and claim that while internal capsule/ventral striatum (VC/VS) clDBS is a case of relational autonomy, subgenual cingulate gyrus (Cg25) clDBS is not. Autonomy (relational or otherwise) requires some degree of self-regulation of our motivational states, which is supported by VC/VS DBS but is absent in Cg25 DBS. In Cg25 DBS the device itself directly influences motivational states, thus substituting or overriding (instead of supporting) the auto-regulatory cognitive processes required for autonomous action. (shrink)

In clinical research – whether pharmaceutical, genetic or biomarker research – it is important to protect research participants’ autonomy and to ensure or strengthen their control over health-related decisions. Empirical–ethical studies have argued that both the ethical concept and the current legalistic practice of informed consent should be adapted to the complexity of the clinical environment. For this, a better understanding of recruitment, for which also the physician–patient relationship plays an important role, is needed. Our aim is to ethically reflect (...) communication processes by identifying patterns used by physicians to motivate patients’ participation in clinical research and to assess whether patients also use these patterns in formulating their own research motivation. We conducted a secondary analysis with empirical data from a research project involving physicians and patients in a clinical research setting of a biomarker study for rectal cancer treatment. Our empirical data included observations of physician–patient consultations and semi-structured interviews with patients. Overall, we collected 93 interviews. We found two dominant communication patterns, which physicians applied for motivating patients to take part in this research study. Some forms of these patterns tend to mislead patients’ understanding, while others could justifiably be applied in this consultation setting without undermining patients’ autonomy. This insight that the physician–patient communication has a strong influence on patients increases the importance to strengthen physicians’ ethically acceptable communication patterns regarding research participation. We further suggest that there is a need for a critical reflection of the ethics committee’s requirements for information regarding research participation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Nicholas Pappas SOCRATES' CHARITABLE TREATMENT OF POETRY Of course this title seems wrong. If anything is certain about Socrates' treatment ofpoetry in Plato's dialogues, it is that he never gives a poem a chance to explain itself. He dismisses poems altogether on the basis of their suspect moral content {Republic II and III), or their representational form {Republic X), or their dramatic structure {Laws 719); he calls (...) poets ignorant {Apohgy, Ion) and—not obviously as a compliment—mad {Ion, Phaedrus); and when he wants to use a poem to support his own position, he unhesitatingly distorts its apparent meaning {Protagoras, Lysis). I will not argue that, in spite of this behavior, Socrates occasionally gives poetry its due, nor that even as he dismisses it he is willing to preserve some portion of it. When I refer to Socrates' charitable interpretations of poetry, I mean a way of reading a poem that motivates and grounds the mistreatments I have catalogued. Socrates is, at all times, prone to read a poem charitably; and that is part of his hostility toward poetry. To make this point I will discuss the last mistreatment of poetry I named: Socrates uses a poem in his defense by forcing it to say what its author plainly did not intend. We see the workings ofhis interpretive method in an extended analysis of Simonides in the Protagoras, and perhaps also in a use of Homer and Empedocles in the LysL·. I will argue that what looks at first simply odd in those passages may be shown to follow a principle of interpretation which in some extreme form resembles the principle of interpretive charity. Thus it is Socrates' excessive charity toward poetry that stands behind his abuse of it. That charity points to a new attitude toward poets, perhaps the first theoretically motivated rejection of the author. I think that this fate of 248 Nicholas Pappas249 the author in Socrates' interpretation will illuminate both his hostility toward poetry and his examination of his live interlocutors. More generally, Socrates' example will show how the search for truth in an interpretation is one way to deny appeals to the author. Although Socrates' interpretation of Simonides in the Protagoras has been discussed many times, its purport or explanation is usually left unexamined.1 What is uncontroversial is that in Protagoras 338e-348a, Plato's most extensive depiction of Socrates saying what a poem means, we find Socrates systematically misreading Simonides. He plucks individual lines out ofa poem, combines them with his own highly specific ethical beliefs, and from this conjunction deduces a point which he then attributes to the poet. We must decide whether this is all some sort of joke, or whether on the contrary, as I believe, the interpretation reveals a coherent and deliberate method. The text examined is a nearly continuous piece ofSimonides' writing, roughly twenty-five lines from a much longer poem. It is Protagoras who goads Socrates into interpreting the poem, as part ofthe intellectual battle between them that continues through the dialogue. Protagoras sets an interpretive problem for Socrates to solve: two bits ofSimonides' poem seem to contradict one another, for the first bit says it is hard to become good, and the second denies that it is hard to be noble (339). Socrates begins with the more modest aim of resolving that contradiction, but goes on through the poem to hang a sophisticated moral point on Simonides. At first Socrates tries to resolve the contradiction by saying that Simonides thinks it hard to become good or noble, but easy to remain in that state (to be noble) once it has been achieved (34Od). Protagoras ridicules this explanation, and Socrates quickly drops it in the face of objections (34Ie); but already the tone of Socratic interpretation has been set. In abroad sense, this paradoxical notion ofmoral improvement is a Socratic notion: the steps toward clarity of understanding are slow and taken only reluctantly, but the state of enlightenment can be maintained, Socrates usually seems to think, without effort (see, e.g., Symposium 21 Id ff.). Socrates, in other words, has made Simonides' thought consistent by identifying it with his own. But that is still too broadly... (shrink)

Ayahuasca is a psychoactive beverage that is mostly used in ritualized settings (Santo Daime rituals, neo-shamanic rituals, and even do-it-yourself-rituals). It is a common practice in the investigated socio-cultural field to call these settings “healing rituals.” For this study, 15 people who underwent ayahuasca (self-)therapy for a particular disease like chronic pain, cancer, asthma, depression, alcohol abuse, or Hepatitis C were interviewed twice about their subjective concepts and beliefs on ayahuasca and healing. Qualitative data analysis revealed a variety of motivational (...) patterns, subjective effects, and user types. Most participants were convinced that ayahuasca had influenced their illness positively or improved their coping with their illness. More importantly, it had enhanced their well being in general. As a result, we concluded that the effects of ayahuasca should not be reduced to a pharmacological model. The substance should be conceptualized as a psychological catalyst that unfolds within different fields of sociocultural ideas. (shrink)

Consider a case of a patient receiving life-supporting treatment. With appropriate care the patient could be kept alive for several years. Yet his latest prognosis also indicates that his mental abilities will deteriorate significantly and that ultimately he will become incapable of understanding what happens around and to him. Despite his illness, the patient has been eager to live. However, he finds the prospect that he is now faced with devastating. He undergoes an unconscious process that results in his (...) finding himself with a preference to die. Consequently, he requests his doctor to stop the treatment that she is providing. Other things being equal, standard medical ethics and the legislations of most Western countries allow the doctor to adhere to the patient’s request if it is autonomous. While its origins can be traced back to at least J.S. Mill’s work on women’s rights, unconscious alteration of one’s preferences in light of the options available for one has figured, for example, in recent discussion on female oppression and social choice theory. Yet the topic has not received attention in the debate on voluntary euthanasia. The inattention is unfortunate because the central problem with such adaptation has been taken to be that it undermines personal autonomy. This motivates the main question examined in this chapter, i.e. the problem of whether a request for euthanasia based on an adaptive preference is autonomous. (shrink)

Nationwide, almost 11% of women abuse drugs during their pregnancy. In some communities, these numbers are as high as 25–30%. Drug abuse is not limited to the poor or to African Americans, but is seen among affluent and white Americans as well. It is widespread, irrespective of race or social class. Annually, nearly 375,000 infants are exposed to drugs in America. Because of the terrible suffering caused by these births, and the conflicts caregivers experience in the treatment of these (...) infants, Trollope's quote is very apropos. Although caregivers have good motives in trying to rescue these babies and helping place them in a nurturing environment, despair about this objective is always close to the surface. (shrink)

This study aims to examine the perceptions of Black, Asian and Minority Ethnic staff in English local government on the ethical nature of their treatment at work, and its mediating effect on their Public Service Motivation. This is a particular imperative in a sector which itself delivers social justice within a strong regulatory system designed to ensure workplace equality and therefore is expected to be a model employer for other organisations. Employees place great importance on their fair (...) class='Hi'>treatment by their employers and, in particular, the endeavour of managerial authority to implement equality at work based on their discretionary powers. 2580 valid responses were collected from 15,000 questionnaires sent to staff in five local councils in England. Our analyses show that BAME employees have a significantly stronger PSM than their white colleagues; however, this has been eroded by their perception of unfair treatment: being underpaid allied with a lack of effort from management to ensure an equal work environment, to be specific, to prevent discrimination, bullying, and racism at workplace. Most importantly, the perceived exertion made by management to ensure an equal work environment has a significantly strong mediating effect on PSM and a compensational effect on perceived lower pay. Theoretical and practical implications are discussed. (shrink)

The growing Chinese middle class and their accumulation of wealth and economic capital have seen an increasing number of Chinese students pursuing their education in the West. Due to this growing number, motivations behind their decision to study abroad warrant scholarly treatment. This article discusses the motives of Chinese middle-class families and their children in seeking studying abroad. The paper reports on a recent study of 166 students on American campuses from 2017 to 2018. It uses Bourdieusian concepts of (...) capital, habitus, and the idea of social mobility and social reproduction, to understand Chinese middle-class families’ strategic decisions around studying overseas in relation to employability, labour market competitiveness, and family support. Studying abroad, therefore, is construed by Chinese middle class families as a way of pursuing and preserving their social status and social mobility. (shrink)

We are very grateful to Chong-Ming Lim for his thoughtful reply published in this journal on one of our articles, which motivated us to think more carefully about accommodating autistic individuals and treating autism. However we believe there are some confusions in Lim's argument. Lim uses the accommodation thesis, according to which we should accommodate autistic individuals rather than treat autism, as the starting point for his reasoning. He claims that if the accommodation thesis is right, then we should not (...) treat autistic individuals for their autism, not even low-functioning ones, because this would be disrespectful to all autistic individuals. We should instead limit ourselves to accommodate all autistic individuals. However, the opposition between accommodation and treatment is not valid in the case of autism, because of ambiguity in the concepts of accommodation and treatment. Moreover there is confusion in Lim's reasoning caused by omitting important facts about the practice of treating autism. (shrink)

In an attempt to move towards a non-linear dynamic system the present study concerns itself with investigating the applicability of sacred text motivation for general second language learners rather than specific learners with religious preferences. A mixed methods research was conducted with the help of 400 participants to examine the relationship between being motivated by sacred text and improving reading comprehension. The research confirms significance of relationship between STM-based treatment and improving reading comprehension as a result of quantitative (...) analyses and that the majority of participants hold positive opinion concerning the use of sacred texts in L2 learning to improve reading comprehension based on qualitative analyses. The analyses of the interviews conducted following the administered treatment revealed that the quantitative effect of STM-based treatment can be better explained through qualitative findings. (shrink)

Noting the important role of motivation in science students' reading comprehension, this 14-weeks quasi-experiment investigated the optimal timing for implementation of metamotivational scaffolding for self-regulation of scientific text comprehension. The “IMPROVE” metamotivational self-regulatory model was embedded at three different phases of secondary students' engagement with scientific texts and exercises to examine effects of timing on groups' science literacy and motivational regulation. Israeli 10th graders in eight science classrooms received the same scientific texts and reading comprehension exercises in four groups. (...) Three treatment groups received metamotivational scaffolding before, during, or after text engagement. The control group received standard instructional methods with no metamotivational scaffolding. Pretests and posttests assessed science literacy, domain-specific microbiology knowledge, and metamotivation regulation. Intergroup differences were non-significant at pretest but significant at posttest. The “before” group significantly outperformed all other groups. The “after” group significantly outperformed the “during” group, and the control group scored lowest. Outcomes suggested delivery of metamotivational scaffolding as a potentially important means for promoting students' science literacy and effortful perseverance with challenging science tasks, especially at the reflection-before-action stage for looking ahead and also at the reflection-on-action stage for looking back. More theoretical and practical implications of this preliminary study were discussed to meet the growing challenges in science teaching schoolwork. (shrink)

Background:Despite their negative consequences, evidence shows that futile medical treatments are still being provided, particularly to terminally ill patients. Uncovering the reasons behind providing such treatments in different religious and sociocultural contexts can create a better understanding of medical futility and help manage it effectively.Research objectives:This study was undertaken to explore Iranian nurses’ and physicians’ perceptions of the reasons behind providing futile medical treatments.Research design:This was a qualitative exploratory study. Study data were gathered through conducting in-depth semi-structured personal interviews and (...) analyzed using the conventional content analysis method.Participants and research context:Twenty-one nurses and nine medical specialists were recruited purposively from four teaching hospitals affiliated to Tehran University of Medical Sciences.Ethical considerations:This study was approved by the Nursing and Midwifery Research Center and the Research Ethics Committee of Tehran University of Medical Sciences. All participants gave informed consent for the research and that their anonymity was preserved.Findings:The main theme of the study was “having an obligation to provide medical treatments despite knowing their futility.” This theme consisted of three main categories including patients’ and family members’ request for continuing life-sustaining treatments, healthcare professionals’ personal motives, and organizational atmosphere and structure.Discussion and conclusion:Different personal and organizational factors contribute to providing futile medical treatments. Promoting the structure and the function of hospital ethics committees, establishing and developing home care facilities, increasing the number of palliative care centers and hospices, and educating healthcare professionals, patients, and family members about the services and the benefits of such centers can facilitate making wise decisions about continuing or discontinuing treatments which have been labeled as futile. (shrink)

In his article "How Certain Boundaries and Ethics Diminish Therapeutic Effectiveness", Lazarus asserts that many clinicians are adhering to strict therapeutic boundaries and ethics in a fear-driven effort to avoid unwarranted malpractice claims. Although I agree that maintenance of conventional therapeutic boundaries is apt to minimize malpractice claims in most cases, I believe that is because such boundaries are critical to protect patients' welfare and thereby promote effective treatment. My reasoning, discussed next, revolves around the following premises: 1. For (...) many, if not most, types of patient problems and patient populations, boundaries and the personal meaning of the therapeutic boundaries are an arena in which critical emotional issues are manifested and worked through. 2. Clear, consistent boundaries provide a structure and safety for many patients that is a curative factor in itself. 3. Patients' reactions to alterations in usual therapeutic boundaries are often unpredictable ahead of time (even if requested by the patient) and typically complex, ambivalent, and heavily colored by transferential meaning. 4. Because alterations in therapeutic boundaries typically add a new therapist role or activity that involves potential gratification of personal needs of the therapist, objectivity in evaluating such a change may be compromised by the inherent self-interest. 5. Consistent, clear boundaries need have no impact on therapist warmth and empathy. (shrink)

Background Doctors sometimes encounter parents who object to prescribed treatment for their children, and request suboptimal substitutes be administered instead. Previous studies have focused on parental refusal of treatment and when this should be permitted, but the ethics of requests for suboptimal treatment has not been explored. Methods The paper consists of two parts: an empirical analysis and an ethical analysis. We performed an online survey with a sample of the general public to assess respondents’ thresholds for (...) acceptable harm and expense resulting from parental choice, and the role that religion played in their judgement. We also identified and applied existing ethical frameworks to the case described in the survey to compare theoretical and empirical results. Results Two hundred and forty-two Mechanical Turk workers took our survey and there were 178 valid responses. Respondents’ agreement to provide treatment decreased as the risk or cost of the requested substitute increased. More than 50% of participants were prepared to provide treatment that would involve a small absolute increased risk of death for the child and a cost increase of US$<500, respectively. Religiously motivated requests were significantly more likely to be allowed. Existing ethical frameworks largely yielded ambiguous results for the case. There were clear inconsistencies between the theoretical and empirical results. Conclusion Drawing on both survey results and ethical analysis, we propose a potential model and thresholds for deciding about the permissibility of suboptimal treatment requests. (shrink)

In the presence of heterogeneity between the randomized controlled trial (RCT) participants and the target population, evaluating the treatment effect solely based on the RCT often leads to biased quantification of the real-world treatment effect. To address the problem of lack of generalizability for the treatment effect estimated by the RCT sample, we leverage observational studies with large samples that are representative of the target population. This article concerns evaluating treatment effects on survival outcomes for a (...) target population and considers a broad class of estimands that are functionals of treatment-specific survival functions, including differences in survival probability and restricted mean survival times. Motivated by two intuitive but distinct approaches, i.e., imputation based on survival outcome regression and weighting based on inverse probability of sampling, censoring, and treatment assignment, we propose a semiparametric estimator through the guidance of the efficient influence function. The proposed estimator is doubly robust in the sense that it is consistent for the target population estimands if either the survival model or the weighting model is correctly specified and is locally efficient when both are correct. In addition, as an alternative to parametric estimation, we employ the nonparametric method of sieves for flexible and robust estimation of the nuisance functions and show that the resulting estimator retains the root- n n consistency and efficiency, the so-called rate-double robustness. Simulation studies confirm the theoretical properties of the proposed estimator and show that it outperforms competitors. We apply the proposed method to estimate the effect of adjuvant chemotherapy on survival in patients with early-stage resected non-small cell lung cancer. (shrink)

In his massive 2019 work on the history of the faith-reason discourse in the West, Habermas replies to Kant’s question of rational hope with the prospect of an eventual intercultural agreement on cosmopolitan principles of justice. To warrant such hope he points to the growth of democratic institutions and human rights across the globe. Habermas’s answer thus relies on political structures that foster transformative social movements—but not on modern moral attitudes, which he regards as too individualistic to generate collective action. (...) I argue that Habermas, following Kant, relies on flawed assumptions about social movements. As a result, his structural approach provides an incomplete basis for hope. In the spirit of ongoing dialogue between religion and secular thought, I translate Aquinas’s treatment of fraternal correction into an ethics of moral leadership that can fill the gaps in Habermas’s project. (shrink)