BackgroundDo sexual minority persons who have undergone unsuccessful sexual orientation change efforts suffer subsequent psychological or social harm from the attempt? Previous studies have conflated present and past, even pre-SOCE, harm in addressing this question. This study attempts, for the first time, to isolate and examine the question of current psychosocial harm for former SOCE participants among sexual minorities in representative population data.MethodUsing nationally representative data across three cohorts of sexual minorities in the United States, persons exposed to SOCE were (...) compared with the remainder not exposed to SOCE on two measures of internal distress—psychological distress and current mental health—and seven measures of behavioral harm: substance abuse ; alcohol dependence ; self-harm; suicide ideation; suicide planning; suicide intentions; and suicide attempts.ResultsThe SOCE group was statistically indistinguishable from the non-SOCE group on any measure of harm. For behavioral harm, risk ratios were 0.97–1.02. Harm was equivalent for the two groups despite the SOCE group having experienced higher lifetime and current minority stress, greater childhood adversity, and lower socioeconomic status. Logistic regression models that adjusted for these differences suggest that SOCE exposure reduced the effect of minority stress and childhood adversity for suicide attempts, although this effect did not fully account for the equivalence between the SOCE and non-SOCE groups.ConclusionDespite higher exposure to factors predicting behavioral harm—minority stress, childhood adversity, and lower socioeconomic background—sexual minority persons who had undergone failed SOCE therapy did not suffer higher psychological or social harm. Concerns to restrict or ban SOCE due to elevated harm are unfounded. Further study is needed to clarify the reasons for the absence of harm from SOCE. (shrink)

Background:Nursing is an occupation that deals with humans and relies upon human relationships. Nursing care, which is an important component of these relationships, involves protection, forbearance, attention, and worry.Objectives:The aim of this study is to evaluate the ethical beliefs of psychiatric nurses and ethical problems encountered.Research Design:The study design was descriptive and cross-sectional.Research context:Methods comprised of a questionnaire administered to psychiatric nurses (n = 202) from five psychiatric hospitals in Istanbul, Turkey, instruction in psychiatric nursing ethics, discussion of reported ethical (...) problems by nursing focus groups, and analysis of questionnaires and reports by academicians with clinical experience.Participants:Participants consist of the nurses who volunteered to take part in the study from the five psychiatric hospitals (n = 202), which were selected with cluster sampling method.Ethical considerations:Written informed consent of each participant was taken prior to the study.Findings:The results indicated that nurses needed additional education in psychiatric ethics. Insufficient personnel, excessive workload, working conditions, lack of supervision, and in-service training were identified as leading to unethical behaviors. Ethical code or nursing care -related problems included (a) neglect, (b) rude/careless behavior, (c) disrespect of patient rights and human dignity, (d) bystander apathy, (e) lack of proper communication, (f) stigmatization, (g) authoritarian attitude/intimidation, (h) physical interventions during restraint, (i) manipulation by reactive emotions, (j) not asking for permission, (k) disrespect of privacy, (l) dishonesty or lack of clarity, (m) exposure to unhealthy physical conditions, and (n) violation of confidence.Discussion:The results indicate that ethical codes of nursing in psychiatric inpatient units are inadequate and standards of care are poor.Conclusion:In order to address those issues, large-scale research needs to be conducted in psychiatric nursing with a focus on case studies and criteria for evaluation of service, and competency and responsibility needs to be established in psychiatric nursing education and practice. (shrink)

ObjectivesFrom a self-determination theory perspective, the purpose of this cross sectional study was to better understand how to motivate hospitalized older adults’ behaviors and test an integrative model of the role of causality orientations and a supportive/controlled environment on basic need satisfaction, motivation for health oriented physical activity, positive and negative affective states, depressive symptoms, apathy, and boredom.MethodsOlder adults in French hospital units completed self-report questionnaires and socio-demographic data were also collected.ResultsPartial least squares path modeling results showed that participants’ (...) autonomy orientation positively associated with the perception of a supportive environment was related to need satisfaction, autonomous motivation for health-oriented physical activity, and high scores on positive affective states. Conversely, participants’ impersonal orientation positively associated with the perception of a controlled environment was related to undermining need satisfaction, controlled motivation for health-oriented physical activity, and amotivation, and high scores on both negative affective states, and boredom.ConclusionThe present results indicate that taking into account personality factors in hospital units can be useful and health professionals should take an interest both in the patients’ causality orientations and the supportive nature of the environment in order to understand better how to motivate patients’ behaviors. The present study points to the need to focus on all motivational dynamics which allow patients’ need satisfaction. (shrink)

Every year, thousands of undocumented Mexican workers enter the United States. Their presence, together with the settlement of undocumented and legal immigrants from many other countries, constitutes the source of one of the most persistent ideological conflicts in American history: the conflict over immigrants' rights. Official discourses in many cases identify being Hispanic with poor performance at school, drug abuse, poverty and violence. However, aside from mainstream images of who immigrants are, little research has been done on the identity that (...) immigrants themselves build and project, and on the processes that affect the formation of such identity. In this article I investigate identity through discourse analysis, looking specifically at linguistic strategies used by a group of undocumented Mexican immigrants to identify characters in storytelling. I argue that immigrants use ethnic identity as a central identification category for self and others in their stories, showing that ethnic mentions are widespread in story orientations, and that they exhibit different degrees and types of relevance depending on their relationship with the interactional context and/or the story world. Ethnic mentions are used in stories to affirm certain characteristics of one's own identity and of the identity of others via the presentation and evaluation of behaviors. In argumentative stories disputable behaviors are openly attributed to out groups, and so these stories help speakers to build images of who they are and how they stand in relation to others. In stories of personal experience, the connections between identities and behaviors are implicit, but they still respond to socially established expectations. Thus, individual stories also contribute to build those expectations about how belonging to certain ethnic groups may affect action in particular domains of life. The pervasiveness of ethnic identification in immigrant stories cannot be understood without resorting to wider social processes that frame the immigration experience of undocumented Mexican workers. In this case, I stress the importance of the pressure that the ideology of race and ethnicity, enacted through public discourse at all levels, exerts on every individual in American society. (shrink)

A sample of 227 business students from the United States and Australia was used to evaluate factors that impact business students' ethical orientation and factors that impact students' perceptions of ethical classroom behaviors. Perceptions of classroom behaviors was considered a surrogate for future perceptions of business behaviors. Independent factors included age, gender, religious orientation, country of origin, personality, and ethical orientation. A number of factors were related to ethical orientation, but only age and religious orientation exhibited much impact upon perceptions (...) of ethical classroom behaviors. (shrink)

While the prevalence of opioid use disorder among pregnant women has multiplied in the United States in the last decade, buprenorphine treatment for peripartum women with OUD has been administered to reduce risks of repeated cycles of craving and withdrawal. However, the maternal behavior and bonding in mothers with OUD may be altered as the underlying maternal behavior neurocircuit is opioid sensitive. In the regulation of rodent maternal behaviors such as licking and grooming, a series of opioid-sensitive brain regions are (...) functionally connected, including the ventral pallidum. In humans, these brain regions, interact with the supplementary motor area to regulate maternal behaviors and are functionally dysregulated by opioids. It is unclear how these brain regions respond to the emotions of their child for mothers receiving BT. In this functional magnetic resonance imaging pilot study in 22 mothers within the first postpartum year, including six mothers receiving BT and 16 non-OUD mothers as a comparison group, we devised a child face mirroring task in fMRI settings to assess maternal responses to pictures of facial expressions of own child and an unknown child in an empathic mirroring condition and a non-mirroring observation condition. In each condition, faces of neutral, ambiguous, distressed, and joyful expressions of each child were repeatedly displayed in a random order. The response of SMA during empathic mirroring vs. non-mirroring of own child was reduced among BT/OUD vs. CG. Within MBN, the left VP, critical for parental sensitivity, had a similar deficit. This study outlines potential mechanisms for investigating the risks of deficits in the neural responses to actual maternal sensitivity and parenting behavior in mothers with OUD, and potential targets for interventions that reduce stress and augment maternal behavior and child outcome. (shrink)

Millennials are a powerful workforce group and are quickly becoming established business leaders, consumers, and investors. Yet, millennials are often described as a uniformly homogeneous generation, despite mounting evidence of variances across their private and workplace behaviors, attitudes and preferences, and personal values. This article examines the personal value orientations of millennials in the Unites States, reporting consistencies, variations, and contrasts based on a large sample drawn from seven diverse universities. Results of this article suggest more similarities across a national (...) population of millennials than differences, suggesting a national identity among American millennials. Practical implications of our findings and future research are discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Phenomenology and Modern Behavioral PsychologyLindsay B. Fletcher (bio) and Steven C. Hayes (bio)Keywordsacceptance, contextualism, defusion, relational-frame-theoryPérez-Álvarez and Sass (2008) deserve praise for examining the philosophical roots of clinical psychological science. Modern psychology has moved away from the development of philosophy and theory that is needed to ground scientific investigation within a coherent system. The result is increasingly ill-defined constructs and research programs that each operate within their own divergent (...) paradigm. B.F. Skinner is one of the few modern experimental behavioral psychologists who attempted to build a coherent science of behavior based on observable events with testable hypotheses. Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, and Wilson 1999) and its associated basic science of cognition, Relational Frame Theory (RFT; Hayes, Barnes-Holmes, and Roche 2001), build on Skinner’s work to produce a more progressive science.Psychology and philosophy are different disciplines and how they are approached is defined by the objective. The purpose of philosophy from a scientific point of view is not the same as from a philosophical point of view. It is fine to compare radical behaviorism and phenomenology, but it seems important to ask whether and how this will lead to a more progressive science of behavior.In this commentary, we discuss the philosophy and theory that underlie ACT/RFT and show how they reflect on the relevant points made by the authors regarding the shared features of phenomenology and radical behaviorism. We make two adjustments to the explanation of radical behavioral concepts presented in the current paper to create a more coherent analysis. Finally, we show here how the development of a theory based on applied goals directly informs the methods used in clinical settings.Philosophical AssumptionsThe field of behavior analysis that originated with Skinner has different strands. Some are holistic and pragmatic, whereas others are elementalistic and mechanistic (Hayes, Hayes, and Reese 1988). ACT is based on an a-ontological philosophy termed functional contextualism (Hayes 1993), which views behavior analysis from a holistic and pragmatic perspective. Functional contextualism (AKA radical behaviorism) shares some of the assumptions of phenomenology, as has long been noted (Day 1969). For example, Pérez-Álvarez and Sass (2008) identify a-dualism, or monism, as a common feature. In functional contextualism, the whole is divided into functional units for the purpose of prediction and influence. A three-term contingency (antecedent–behavior–consequence) in behavior analysis is viewed as a [End Page 255] whole event with pragmatically distinguishable aspects, not an assemblage. As the authors point out, this results in a dialectic tension between stimulus control, action, and reinforcer because none are distinct units, and each is defined with reference to the others much as the front of a coin cannot exist without the back. These are not ontological entities, but functional units that are abstracted from the whole for pragmatic purposes. What is “radical” about radical behaviorism is that the philosopher, psychologist, or researcher participates in the event they are observing, and their own acts of scientific observation are identified based on their own functional properties.Behavioral ThinkingIn the service of further developing this philosophical and theoretical foundation and considering it along side phenomenology, we need to examine two aspects of the target article. The first regards the role of the environment in shaping behavior that is central to behavioral and contextual theories. The authors object to behaviorism’s notion of environment and suggest replacing it with the concept of the world, stating that “animals have environment, but man has world.” What is missing is an account of that shift. We believe that modern behavior analysis provides that account.Similarly, the paper argues that “reinforcers are not just things that follow behavior, but also, and above all, values that guide our life.” Again what is missing is an account of the precise behavioral basis for the distinction.In an attempt to do this, the authors incorrectly analyze operant behavior as future oriented, even appealing to final causality. In the three-term contingency, the discriminative stimulus sets the occasion for reinforcement of a particular behavior. The behavior of interest has been reinforced in similar contexts in the past, which gives... (shrink)

Theories of superior collicular and hippocampal function have remarkable similarities. Both structures have been repeatedly implicated in spatial and attentional behaviour and in inhibitory control of locomotion. Moreover, they share certain electrophysiological properties in their single unit responses and in the synchronous appearance and disappearance of slow wave activity. Both are phylogenetically old and the colliculus projects strongly to brainstem nuclei instrumental in the generation of theta rhythm in the hippocampal EECOn the other hand, close inspection of behavioural and (...) electrophysiological data reveals disparities. In particular, hippocampal processing mainly concerns stimulus ambiguity, contextual significance, and spatial relations or other subtle, higher order characteristics. This requires the use of largely preprocessed sensory information and mediation of poststimulus investigation. Although collicular activity must also be integrated with that of “higher” centres, its primary role in attention is more “peripheral” and specific in controlling orienting/localisation via eye and body movements toward egocentrically labelled spatial positions. In addition, the colliculus may exert a nonspecific influence in alerting higher centres to the imminence of information potentially worthy of focal attention. Nevertheless, it is noteworthy that collicular and hippocampal lesions produce deficits on similar tasks, although the type of deficit is usually different in each case. Functional overlap between hippocampus and colliculus is virtually certain vis-à-vis stimulus sampling, for example in the acquisition of information via vibrissal movements and visual scanning. In addition, insofar as stimulus significance is a factor in collicular orienting mechanisms, the hippocampus — cingulate – cortex — colliculus pathway may play a significant role, modulating collicular responsiveness and thus ensuring an attentional strategy appropriate to current requirements. A tentative “reciprocal loop” model is proposed which bridges physiological and behavioural levels of analysis and which would account for the observed degree and nature of functional overlap between the superior colliculus and hippocampus. (shrink)

The systems approach is a widely accepted method for addressing healthcare adverse events. However, when adverse events are behavioral in nature, such as self‐injury or aggression, a systems approach can restrict patient autonomy. We propose guidelines for balancing safety and autonomy considerations when developing systems for behavioral adverse events: interventions that do not limit patient liberty, or that therapeutically address the root causes of behavioral adverse events, should be fully utilized. Clinicians should collaborate with patients when designing systems that may (...) restrict patient liberty. And clinicians should be supported in managing the stress that accrues from working in hazardous environments. (shrink)

A sample of 227 business students from the United States and Australia was used to evaluate factors that impact business students' ethical orientation and factors that impact students' perceptions of ethical classroom behaviors. Perceptions of classroom behaviors was considered a surrogate for future perceptions of business behaviors. Independent factors included age, gender, religious orientation, country of origin, personality, and ethical orientation. A number of factors were related to ethical orientation, but only age and religious orientation exhibited much impact upon perceptions (...) of ethical classroom behaviors. (shrink)

Locked inpatient units are an increasing phenomenon, introduced in response to unforseen abscondences and suicides of patients. This paper identifies some value issues concerning the practice of locked psychiatric inpatient units. Broad strategies, practicalities and ethical matters that must be considered in inpatient mental health services are also explored. The authors draw on the published research and commentary to derive relevant information to provide to patients and staff regarding the aims and rationales of locked units. Further debate (...) is warranted in relation to best practice. Inpatient staff need to be aware of their practice values, be able to access education and supervision and negotiate apparent contradictions. Further patient/clinician focused enquiry is necessary to mitigate the negative and stigmatising effects of locked mental health units. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Positive Change in Perception and Care for a Difficult PatientMelissa CavanaughIf you asked any healthcare professional if they had ever cared for a difficult patient, I am certain the answer would be a resounding "Yes!" I have encountered many over my forty-two years as an RN. The story of Ms. E. is one of exceptional challenge and, I hope, success.I met Ms. E. in 2012 when I took a (...) nursing position in an outpatient primary care Geriatric Clinic. The clinic was located within an inner city, Level 1 Trauma health system whose mission is to care for the underserved. This organization had cared for the most vulnerable in the area for decades. The clinic model is unique in that it provides a "one-stop shop" for the common medical needs of the older adult. Other specialties, including podiatry, rheumatology, dementia care, and stroke, held appointments in this clinic area. The supporting staff team members assisted in each of these clinics, leading them to interact with the same patients frequently.Most of my previous experiences had been in inpatient units with a quick turnover of patients. There was no time or need to develop a long-term relationship with the patients in these settings. However, the comprehensive services found in this clinic coupled with the low staff turnover, led to a stable group of seniors receiving care in this office. Many of these individuals had been attending this clinic for over twenty years.I heard about Ms. E. before I ever met her. She was well known to the clinic team as a "problem" patient. The general response when she was on the schedule was eye rolling and audible moans. I soon learned that in addition to her scheduled visits, she would randomly appear outside the full glass interior doors. She would hover in the area, tapping on the glass to get the attention of a staff member. She did not hesitate to interrupt staff and other patients to make her needs known when she was in the exam room hallway. Often team members would scatter and hide to avoid dealing with her. If she was not in the building, she was on the triage line with a question or physical complaint. To complicate matters even further, her husband was our patient as well, and they always attended appointments together.Ms. E. suffered from common geriatric chronic diseases such as hypertension, diabetes, and osteoarthritis. Her morbid obesity complicated her diagnoses. Though she was able to safely ambulate with an assistive device such as a cane or walker, she routinely used a motorized chair. She and her husband admitted visiting fast food restaurants often even though they had met with a dietician for counseling on several occasions. They often requested help obtaining medications, yet related stories about visiting the local casino. Ms. E. spoke with a small, weak voice that added to the countenance of helplessness and pity. Unfortunately, these behaviors of noncompliance, attention seeking, and dependency on others extended to her immediate community, and she is estranged from family and friends who may have been a source of support to her. [End Page E1]Ms. E.'s appointments were scheduled at the end of the day due to the expectation and pattern of the extended time they would take. No matter her expressed concerns or needs, our recommendations and interventions were never enough. She continually questioned the assessment information and did not want to accept the education and orders given as the correct response to her problems. As one can see, her appointments could be exhausting!Ms. E. certainly deserved the best and most comprehensive care available from our team. Developing a more therapeutic relationship for her within the clinic became a priority for me. However, it was a daunting task to provide this level of care and to convince her that she deserved and was receiving such care. She presented a laundry list of characteristics that could lead to biases from the staff. Overcoming such individual biases toward her may be a barrier as well. These included her obesity, her lack of initiative, her self-centered behaviors, and her constant need for attention.As healthcare professionals... (shrink)

Using multisource data and multilevel analysis, we propose that the ethical stance of supervisors influences subordinates’ perceptions of corporate social responsibility which in turn influences subordinates’ trust in the organization resulting in their taking increased personal social responsibility and engagement in organizational citizenship behaviors oriented toward both the organization and other individuals. Using a multilevel model, we assessed the extent to which ethical leadership and CSR at the work unit level impacts subordinates’ behaviors mediated by organizational trust at (...) the individual level. We employed a sample of 71 work unit supervisors and 308 subordinates from five businesses of a conglomerate company located in mainland China. Subordinates were asked to rate supervisory ethical leadership practices, CSR, and their extent of organizational trust. Supervisors were asked to rate the personal social responsibility taking and OCB of their respective subordinates. A multilevel path analysis revealed that ethical leadership has a positive effect on CSR at the work unit level and that CSR has a positive cross-level effect on organizational trust at the individual level, which in turn significantly and positively impacts OCB through the mediating effect of taking personal social responsibility. Results are discussed in the context of China’s manufacturing sector. (shrink)

How is women’s conception of self affected by the caregiving responsibilities traditionally assigned to them and by the personal vulnerabilities imposed on them? If institutions of male dominance profoundly influence women’s lives and minds, how can women form judgments about their own best interests and overcome oppression? Can feminist politics survive in face of the diversity of women’s experience, which is shaped by race, class, ethnicity, and sexual orientation, as well as by gender? Exploring such questions, leading feminist thinkers have (...) reinvigorated work on the concept of self and personal identity, as demonstrated by the discussions in this insightful volume.The concerns that animate feminist scholarship have prompted feminist philosophers to sideline the theme of individualism and to focus on the theme of intersubjectivity. In conceptualizing the self, the contributors to this volume highlight emotional bonds among people, the stories people tell one another, and the systems of categories and behavioral norms that unite and divide groups of people. Topics addressed include sexual violence and the self, the social self and autonomy, the narrative self and integrity, self-ownership and the body, forgetting yourself and your race, group membership and personal identity, grief and gender, sympathy and women’s diversity, emotion and emancipatory epistemology, and dependency and justice. This volume will be important reading for students of feminist theory, ethics, and social and political philosophy. (shrink)

The metaphor of host and guest has value for exploring the practice and role identity of nurses on inpatient mental health units. Two complementary texts, one from the ancient Zen record of Lin‐chi, and the other from the contemporary hermeneutic philosopher Richard Kearney, are used to elaborate meanings of host and guest that can be applied to the situation of mental health nurses. In a doctoral study with a hermeneutic design, I addressed the topic of nurse–patient relationship using an (...) interpretive framework that included sources from Buddhist thought. The positions of host and guest emerged from interviews with nurses as one interpretive theme to open up new understanding of the topic. The two texts, originally distant in era and culture, both employ the host and guest metaphor. They are applied to extracts from interviews to open up discussions of hierarchy, status, patients' perspectives, otherness and resistances as features of nurses' complex experience. These provide insights into understanding practice and suggest implications for how institutional environments shape practice. An intercultural reading of texts can provide a source of new understanding of nurse–patient relationships. (shrink)

Background: The new human coronavirus that leads to COVID-19 has spread rapidly around the world and has a high degree of lethality. In more severe cases, patients remain hospitalized for several days under treatment of the health team. Thus, it is important to develop and use technologies with the aim to strengthen conventional therapy by encouraging movement, physical activity, and improving cardiorespiratory fitness for patients. In this sense, therapies for exposure to virtual reality are promising and have been shown to (...) be an adequate and equivalent alternative to conventional exercise programs.Aim: This is a study protocol with the aim of comparing the conventional physical therapy intervention with the use of a non-immersive VR software during COVID-19 hospitalization.Methods: Fifty patients hospitalized with confirmed diagnosis of COVID-19 will be divided in two groups under physiotherapy treatment using conventional or VR intervention: Group A: participants with COVID-19 will start the first day of the protocol with VR tasks in the morning and then in the second period, in the afternoon, will perform the conventional exercises and Group B: participants with COVID-19 will start the first day with conventional exercises in the morning and in the second period, in the afternoon, will perform activity with VR. All participants will be evaluated with different motor and physiologic scales before and after the treatment to measure improvements.Conclusion: Considering the importance of benefits from physical activity during hospitalization, VR software shows promise as a potential mechanism for improving physical activity. The results of this study may provide new insights into hospital rehabilitation.Trial Registration:ClinicalTrials.gov, identifier: NCT04537858. Registered on 01 September 2020. (shrink)

Background:Healthcare organizations are now challenged to retain nurses’ generation and understand why they are leaving their nursing career prematurely. Acquiring knowledge about the effect of ethical work climate and level of perceived organizational support can help organizational leaders to deal effectively with dysfunctional behaviors and make a difference in enhancing nurses’ dedication, commitment, satisfaction, and loyalty to their organization.Purpose:This study aims to determine the relationship between ethical work climate, and perceived organizational support and nurses’ organizational commitment, job satisfaction, and turnover (...) intention.Methods:A descriptive correlational research design was conducted in all inpatient care units at three major hospitals affiliated to different health sectors at Alexandria governorate. All nurses working in these previous hospitals were included in the study (N = 500). Ethical Climate Questionnaire, Survey of Perceived Organizational Support, Organizational Commitment Questionnaire, Index of Job Satisfaction, and Intention to Turnover scale were used to measure study variables.Ethical considerations:Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection.Findings:The result revealed positive significant correlations between nurses’ perception of overall ethical work climate and each of perceived organizational support, commitment, as well as their job satisfaction. However, negative significant correlations were found between nurses’ turnover intention and each of these variables. Also, approximately 33% of the explained variance of turnover intention is accounted by ethical work climate, organizational support, organizational commitment, and job satisfaction, and these variables independently contributed significantly in the prediction of turnover intention.Recommendation:Strategies to foster and enhance ethical and supportive work climates as well as job-related benefits are considered significant factors in increasing nurses’ commitment and satisfaction and decreasing their turnover intention. (shrink)

Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Healthcare is Demanding:Patience is a Virtue!Andrea TorrenceNursing is a rewarding career, but it can also be extremely challenging, depending on the type of patient you are assigned to. In my career, I have had a number of "difficult" patients, and every situation required a specific type of approach. Understanding how to interact with a difficult patient is a talent and requires a level of patience that exceeds the normal (...) amount one may have. As a nurse, if you want to be successful, you must have patience. Along with many natural characteristics required to be successful in nursing, patience, in my opinion, is the most required quality required for nursing. The difficult patient can be an emotional burden to the care provider. These burdens are not always related to the tasks associated with care. The patient that is emotionally exhausting is far more complex than a patient who requires physical work. Nursing is a trying and risky career, but the nurse is obligated to provide the best care possible to all patients regardless of how difficult that person may be.Our cardiac surgical telemetry unit received a patient from the emergency room diagnosed with a minor psychiatric problem and tachycardia (a fast heart rate). This patient required medical clearance before going to the psychiatric unit for further evaluation. At our facility, this frequently happens, depending on how many psychiatric beds are available and on the patient's medical status. There were no clinical indications for this patient to require a bedside caregiver—a bedside caregiver is assigned to a patient that may somehow be classified as a danger to themselves or others—and the patient was not "pink-slipped." Patients who may not be safe to leave the hospital once they've been evaluated in the emergency room will be pink-slipped for an inpatient evaluation. Also, suicidal or homicidal patients are pink-slipped until they undergo an extensive evaluation and are deemed safe to leave on their own. A pink slip is a legal hold document. The patient that we received at the time of her admission required neither. The initial description of the patient revealed that she was a young, pleasant, ambulatory (able to walk with no problems) woman and completely oriented (understands and can comprehend). This patient did not have any pain or complaints documented on her emergency room assessment. She was corporative and followed instructions.As soon as we received the patient to the unit, she began to protest the need for pain medication. There were no orders for pain medication because there was no notation of pain in the emergency room. The nurse addressed the patient's pain with the admitting physician and Tylenol was ordered. When the patient heard that the physician ordered Tylenol, she became very angry. The patient wanted a stronger medication. I have a reputation for connecting with patients who become angry, and those who are classified as difficult, so the primary nurse asked me to speak to this patient. After a brief conversation, I was able to calm the patient, and she returned to her room quietly. The patient was apologetic and sincere. I used a calm approach, reassuring words of affirmation, and the perfect body language to de-escalate this patient. I was pleased with myself because only a simple combination of techniques was used to resolve the patient's anger, and at that time, a therapeutic connection was made.The nurse entered the patient's room and noticed that the roommate looked somewhat bewildered, [End Page E11] but she did not address the roommate. The nurse was focused on completing her patient's admission assessment. After the nurse completed the assessment, the order for the patient to wear telemetry was discussed. Telemetry is a physician's order to continuously monitor the heart's function while hospitalized. Because the patient was mildly tachycardic, telemetry was ordered. The patient immediately refused the order and told the nurse that she was not going to wear the monitor. The nurse explained the need and informed the patient that she would not be confined to the bed while wearing it. The nurse left the room to find me to discuss the... (shrink)

Several scholars have claimed that small-scale agriculture in which farmers sell goods to the local market has the potential to strengthen social ties and a sense of community, a phenomenon referred to as “civic agriculture.” Proponents see promise in the increase in the number of community supported agriculture programs, farmers markets, and other locally orientated distribution systems as well as the growing interest among consumers for buying locally produced goods. Yet others have suggested that these novel or reborn distribution mechanisms (...) are still primarily means of instrumental economic exchange and that optimistic characterizations of a renewed sense of community emerging from these practices are unfounded. This study provides an empirical assessment of the extent to which these community-based agriculture markets are associated with connection to community, volunteerism, and civic and political activities. In order to assess the relationship between civic agriculture and community engagement, we surveyed over 1,300 people in the Mid-Hudson region of New York State. The study design includes “civic agriculture participants” as the unit of analysis, defined as CSA farm members, shoppers at independent health food stores, and farmers market patrons. For comparison, a telephone survey of randomly selected residents of the region’s general population was also conducted. Unlike studies that focus solely on the perceptions of certain civic agriculture participants, by comparing the perceptions and behaviors of those engaged in a range of civic agriculture practices, we are able to identify the effects of different forms of participation. The results demonstrate higher levels of voluntarism and engagement in local politics among civic agriculture participants relative to the general population. In addition, we found variation among those engaged in different forms of civic agriculture, with those immersed in more socially embedded forms of exchange demonstrating greater community and political involvement. These findings lend empirical support to the civic agriculture thesis. (shrink)

Multinational corporations dominate the global business arena, but new expectations for MNC boards call to question how they might effectively manage global stakeholder relationships in this new era of accountability. Uniting political behavior theory, which describes a board’s international political orientation, and global operating governance systems outlining a set of board behaviors, we develop a typology of four types of boards. We then provide recommendations for the development of an integrative governance structure, taking into account the mechanisms, structure, endorsements, and (...) codes of conduct that MNCs can use to promote ethical behavior across MNC horizons. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in (...) the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

Background:Psychiatric nurses are regularly confronted with the uses and effects of control interventions such as mechanical restraints. Although there are evident tensions in the literature regarding the use of mechanical restraints, very little research has focused on the lived and embodied experience of their use, whether from the patient’s perspective or the perspective of nursing staff responsible for their application.Research aims: to gain access to the bodily phenomenon of being placed in mechanical restraints; to give voice to the intimate experiential (...) understanding of this experience; and through phenomenological interpretation, to understand the subjective processes and meaning-making of this experience.Research design:For this research, we adopted a distinctly ethics-oriented application of the methodology known as interpretative phenomenological analysis, that is, the interpretive dimension of the research focused on ethical practice in mental healthcare – one that is informed by experiential accounts of the lived body.Participants and research context:A total of 40 in-depth semi-structured, nondirected interviews with both nurses and patients we conducted to meet the aims of this article. Participants were recruited from an inpatient psychiatric unit of a Canadian general hospital.Ethical considerations:The research received research ethics board clearance from both the hospital where the study took place and the University of Ottawa.Findings:The comparative analysis is presented under the following headings: context of care, meaning of quality of care, emotional reactions and nurse–patient relationship, meeting the needs and need for alternatives.Discussion/conclusions:The research findings are discussed in light of current literature and implications for practice. (shrink)

I am in the process of trying to organize an ethics committee at a large community mental health center in Central Massachusetts and am seeking advice from anyone with experience in this or a similar milieu. The agency is a large (almost 700 employees), nonprofit, community-based program that operates under the auspices of a broad, academically affiliated, behavioral health system. An independent board of trustees, responsible to the parent organization governs the agency. The agency primarily provides outpatient care and treatment (...) to adults and children with mental health, substance abuse, developmental disabilities, and homelessness issues. It does not provide any psychiatric emergency or acute in-patient mental health services but does operate an inpatient detoxification unit for substance abuse treatment and DUI program. Additionally, the agency has a vast network of residential programs and transitional facilities for individuals with a history of chronic mental illness and substance abuse problems. Outpatient medical care is also provided to homeless clients who reside in area shelters (including a shelter for men and women) and a large number of clients who have HIV/AIDS and/or who have been dually diagnosed (substance abuse and mental illness), and are part of a scattered-site supportive housing program. (shrink)

_Purpose._ This article aims at outlining the consider Ukrainian identity in the context of European collective action through the prism of value orientations/approaches. _Theoretical basis._ The following methods were used in order to cover the problem as objectively as possible: historical, analytical, comparative, socio-geographical, behavioral, and dialectical. The use of these methods contributed to tracing the peculiarities of identity and collective action in the dynamics of the historical process and social development. _Originality._ The role of identity in collective action formation (...) is considered. It was established that identity determines the socio-species structure and projects social development. After all, identification for a person in the formation process is a basic need that determines a person’s belonging, not identity. During the formation of "I" there is a combination of "I1" + "I2" + "Other" = "WE". This process is complex and long-term, but it is precisely the process that gives you the opportunity to clearly understand your "I" and know yourself. It was found that identity as a social phenomenon, which is related to the formation of the "I", is determined by certain circumstances, which can be conditionally divided into objective and subjective. After analyzing the scientific literature, a generalization was made that identity is not a new phenomenon, but it has certain features at each stage of social development. This became most noticeable in the conditions of globalization, when countries that are actually different perceive the "Other", unite around certain problems, and then this union forms a system of mutual relations. It is thanks to this approach that alliances, multicultural associations, etc. are formed, and an example of this is the heterogeneous European identity. Special attention is drawn to the role of values, which are the landmarks in the process of identity and the formation of collective action. Based on political, social, economic, historical processes and ontological features, it was established that identity is a dynamic process, since values during a person’s life, the existence of the state, etc. are variables. This is confirmed by the value orientation and various socio-political processes aimed at the formation of Homo in countries that have the status of "between". _Conclusions._ The article illustrates and justifies the existence of several forms of identity according to which the types of identity are formed. The fact proves that identity is not a constant process and varies due to multiple factors: social, political, economic, and religious as well as due to formations – regional, local, civilizational, etc. As practice shows, the problem of identity mostly has situational nature and arises due to the need for unification. The socio-historical process manifests the significance of the values in the formation of a collective European heterogeneous identity. These processes are influenced by many factors: geographical, historical, mythological, etc. (shrink)

The study aims to investigate visual attention and perceived attractiveness to known versus unknown products above and beyond self-report applying physiological methods. A cross-cultural exploratory approach allows for comparing results gathered in the United States and China. We collected field data on physiological parameters accompanied by behavioral data. Mobile eye-tracking was employed to capture attention by measuring gaze parameters and electrodermal activity serves as indicator for arousal at an unconscious level. A traditional scale approach measuring perceived attractiveness of known versus (...) novel products provide insights at a conscious level. US-American and Chinese consumers in our sample indeed process novel products differently. This can be observed at an unconscious and conscious level. Different gaze movements and arousal levels are observed at an unconscious level. Regarding behavioral data, the level of vertical orientation shapes the perceived attractiveness of novel products at a conscious level. The study showcases how physiological methods complement behavioral ones when investigating visual attention to products. It underlines varying conscious as well as unconscious visual attention and attractiveness ratings comparing known versus novel products, driven by cultural differences. Data from a field setting further enrich the implications derived for new product development and applied marketing. (shrink)

The overall purpose of this paper was to compare a representative sample of Polish middle managers with a representative sample of chief executive officers from six chosen countries, in regard to selected leadership traits and behaviors. We present a small portion of data collected under the GLOBE project, Phase 3, and longitudinal research findings concerning subordinates′ assessments of Polish middle managers in relation to their attributes from 2008 to 2012. The GLOBE, Phase 3 research is the first study to investigate (...) several thousands of CEOs and senior management teams in 24 countries, to empirically and directly assess the relationship between culture and leadership traits and behaviors. We provide research evidence that the investigated CEOs from the United States, Austria, Germany, China, and Taiwan were generally positively evaluated by their direct staff in regard to: inspirational, visionary, integrity, and performance-oriented leadership behaviors, team-oriented behavior, and participative leadership style. Empirical findings under the GLOBE project, Phase 3 revealed that the charismatic leadership behavior of CEOs has a huge influence on top management teams′ dedication to organizational goals, and is the most predictive of all leadership behaviors for TMT commitment to organizations. The analyzed research findings indicate that CEOs in Russia and Polish middle managers display strong similarities. They tend to behave in less charismatic, team-oriented, and participative ways than CEOs in the remaining countries. (shrink)

Spatial language is an important predictor of spatial skills and might be inspired by peer interaction and goal-oriented building behaviors during block play. The present study investigated the frequency, type and level of children’s spatial language during block play and their associations with the level of block play by observing 228 young children in classrooms equipped with unit blocks and allowing free play on a daily basis. The findings showed that during block play, young children used more words (...) about spatial locations, deictic terms, dimensions, and shapes and fewer words about spatial features or properties and spatial orientations or transformations. Spatial locations were used most frequently, and young children tended to use vertical location words to represent the corresponding location. Most young children used gestures in conjunction with spatial deictic terms. Among shape words, tetragon words were frequently used, and the representation of spatial shapes showed alternatives, collective tendencies and gender differences. The use of spatial language during the play process had a significant positive correlation with age, the construction structure, and form of block building. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:What's so Important about Music Education?Leonard TanJ. Scott Goble, What's so Important about Music Education? (New York, NY: Routledge, 2010)In What's so Important about Music Education, J. Scott Goble proposes a new philosophical foundation for music education in the United States based on the theory of semiotics by American pragmatist Charles Sanders Peirce. Following a brief summary, I will note several merits in Goble's book before sketching four (...) recommendations for future editions.In Chapter One, Goble notes how the inclusion of non-Western musics in the public schools as espoused in the 1967 Tanglewood Declaration has raised two crucial questions: "Whose music should be included in the curriculum?" and "What is the role or social importance of public school music education in the United States as a postmodern society?" Noting that music education was established in the United States during the modern era, and that the Tanglewood Declaration did not account for vast differences in beliefs about music, Goble argues that there is a need to establish a new philosophical foundation that can accommodate the varied beliefs and practices of diverse cultural groups in postmodern United States.In Chapter Two, Goble sketches and critiques five cultural anthropologists. Of the five, he singles out Clifford Geertz's conception of culture as "semiotic [End Page 201] webs" (p. 20) as the conceptual foundation that is appropriate for this study. He then links Geertz's notion of culture to the semiotic theory of C. S. Peirce which is to become the theoretical underpinning of the book. Subsequently, he unpacks many key Peircian themes: human conceptions are maintained not individually but collectively in cultural groups, provisional truth (as opposed to absolute Truth) is relative and dependent on conceptions of communities, and the scientific method is the sole mode of inquiry by which people in communities may use to satisfy their doubts to formulate beliefs. Most importantly, Goble expounds the "pragmatic maxim" that since humans live in communities united by common beliefs, "the 'clear' meaning of an idea held by a member of the community will almost inevitably stem from the beliefs—or ways of understanding—held by members of that community" (p. 30). Goble concludes the chapter by presenting the Peircian semiotic system of cognition which posits that a "sign" is conceptualized in a triadic relationship: the Sign or "Firstness," the Object or "Secondness," and the Interpretant or "Thirdness" (p. 33).In Chapter Three, Goble considers how music is a sign based on the theoretical framework laid in Chapter Two. Drawing on the work of ethnomusicologists, anthropologists, psychiatrists, and a neuroscientist, he formulates a Peircian pragmatic approach to musical practices which posits that "the musical practices of different cultural communities represent a diverse cluster of community-specific ritualized behaviors involving sound" (p. 252). Furthermore, each of the musical practices "serves those persons who meaningfully participate in it as a means of psychophysiological, psychosocial, and/or sociopolitical equilibration relative to the worldview—or ordered conception of Reality—they tacitly share" (p. 252). For Goble, this pragmatist conception of musical practices is neither ethnocentric, universalist, nor relativist, and can serve as a conceptual framework for all diverse musical practices in postmodern United States.With the Peircian pragmatic conception in mind, Goble examines historical factors that contributed to current conceptions of music in the United States in Chapter Four. He laments that as a result of European Enlightenment and three socio-political phenomena in the United States (the separation of church and state, promotion of no other worldview than democracy, and adoption of democratic capitalism), music is no longer pragmatically oriented but trivialized and pursued by self-serving musicians.In Chapter Five, Goble traces the philosophical justifications for music education throughout the history of the United States. While the sign "musical practice" was conceptualized as "worship" in colonial America, the sign "music" was conceived as "art" during the age of Enlightenment, and as "product" during the age of science and technology. Noting that Bennett Reimer's music education as aesthetic education is limited in its Western focus on music as works [End Page 202] of artistic objects, Goble aligns his Peircian conception along praxial lines—in particular, with... (shrink)

Codes of ethics are being increasingly adopted in organizations worldwide, yet their effects on employee perceptions and behavior have not been thoroughly addressed. This study used a sample of 613 management accountants drawn from the United States to study the relationship between corporate and professional codes of ethics and employee attitudes and behaviors. The presence of corporate codes of ethics was associated with less perceived wrongdoing in organizations, but not with an increased propensity to report observed unethical behavior. Further, organizations (...) that adopted formal codes of ethics exhibited value orientations that went beyond financial performance to include responsibility to the commonweal. In contrast to corporate codes of ethics, professional codes of ethical conduct had no influence on perceived wrongdoing in organization nor these codes affect the propensity to report observed unethical activities. (shrink)

Objectives“Attachment difficulties” is an umbrella term often used to describe various forms of non-secure attachment. Differentiating “attachment difficulties” from autism spectrum disorder and attention deficit hyperactivity disorder has been characterized as challenging. Few studies have explored how this happens in practice, from the perspective of professionals.DesignQualitative study.MethodsWe conducted in-depth semi-structured interviews with healthcare professionals from five NHS Foundation Trusts in the United Kingdom. Participants were recruited using a combination of snowballing, convenience and purposive sampling. Data were analyzed using a thematic (...) approach.ResultsWe identified six interrelated themes that might reflect difficulties with differential conceptualization. These include: a clinical lexicon of attachment; approaching attachment with caution; contextual factors; perceived characteristic behaviors; assessing attachment and adjacent supports; spotlighting intervention and dual conceptualization.ConclusionOur results indicate some of the ways suspicions around attachment are raised in practice. We advocate for more dialogue between research and practice communities on issues of differential conceptualization. We call for collaboration between a panel of experts consisting of attachment and neurodevelopmental orientated practitioners and researchers, to clarify issues around differentiating between attachment difficulties, ASD, and ADHD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in (...) the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

In the context of the current uncertain, complex, and interdependent work systems, teams have become organizations’ substantial working unit, which in turn challenges the traditional view of employee performance and ultimately results in the emergence of team member work role performance. Employee team-oriented work role behaviors with proficiency, adaptivity, and proactivity, which are integrated by the new construct, are so crucial to team effectiveness that many organizations keenly expect to achieve team member work role performance through implementing a (...) dispersed pay-for-performance plan within a team. This study seeks to address the organizational practitioners’ main concern that whether pay dispersion among team members could actually help realize team member work role performance and further examines why and when an employee could respond to HPD within a team by engaging in team member work role behaviors from the perspective of the performance-shaping basis and team member’s workplace benign envy. Drawing on emotion-related theory, social comparison theory, legitimacy theory, expectation theory, and relative deprivation theory, it proposes that performance-based HPD could not only positively impact team member work role performance via workplace benign envy but also exert a direct-positive effect. Moreover, the activating effect of performance-based HPD on workplace benign envy and the mediating role are much stronger when a team member’s pay position is higher. The multi-source data including objective information and subjective perception among 362 ordinary employees within 66 Chinese organizational teams primarily supported the moderated mediation model. Yet, the direct-positive effect was not established. (shrink)

A survey of 830 faculty members at 89 AASCB-accredited business schools throughout the United States was conducted in Fall 2002 to develop a snapshot of perceptions of ethical and unethical conduct with regard to undergraduate business instruction across a wide range of business disciplines. These behaviors fell into such categories as course content, evaluation of students, educational environment, disrespectful behavior, research and publication issues, financial and material transactions, social relationships with students, and sexual relationships with students and other faculty. Of (...) the 55 behaviors, two were almost universally perceived to be unethical. Eight behaviors were controversial in that there was wide variance on whether the behavior was perceived to be unethical. In addition, females' ethical perceptions differed significantly from males on three behaviors; older participants differed from younger participants on seven behaviors; participants at research-oriented institutions differed from participants at teaching-oriented institutions on one behavior; and tenured, untenured tenure-track, and untenured non-tenure-track participants differed on three behaviors. The findings of this study and the detailed comments of the respondents provide a starting point for discussing more systematic means to consider ethical issues within collegiate schools of business. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:What's so Important about Music Education?Leonard TanJ. Scott Goble, What's so Important about Music Education? (New York, NY: Routledge, 2010)In What's so Important about Music Education, J. Scott Goble proposes a new philosophical foundation for music education in the United States based on the theory of semiotics by American pragmatist Charles Sanders Peirce. Following a brief summary, I will note several merits in Goble's book before sketching four (...) recommendations for future editions.In Chapter One, Goble notes how the inclusion of non-Western musics in the public schools as espoused in the 1967 Tanglewood Declaration has raised two crucial questions: "Whose music should be included in the curriculum?" and "What is the role or social importance of public school music education in the United States as a postmodern society?" Noting that music education was established in the United States during the modern era, and that the Tanglewood Declaration did not account for vast differences in beliefs about music, Goble argues that there is a need to establish a new philosophical foundation that can accommodate the varied beliefs and practices of diverse cultural groups in postmodern United States.In Chapter Two, Goble sketches and critiques five cultural anthropologists. Of the five, he singles out Clifford Geertz's conception of culture as "semiotic [End Page 201] webs" (p. 20) as the conceptual foundation that is appropriate for this study. He then links Geertz's notion of culture to the semiotic theory of C. S. Peirce which is to become the theoretical underpinning of the book. Subsequently, he unpacks many key Peircian themes: human conceptions are maintained not individually but collectively in cultural groups, provisional truth (as opposed to absolute Truth) is relative and dependent on conceptions of communities, and the scientific method is the sole mode of inquiry by which people in communities may use to satisfy their doubts to formulate beliefs. Most importantly, Goble expounds the "pragmatic maxim" that since humans live in communities united by common beliefs, "the 'clear' meaning of an idea held by a member of the community will almost inevitably stem from the beliefs—or ways of understanding—held by members of that community" (p. 30). Goble concludes the chapter by presenting the Peircian semiotic system of cognition which posits that a "sign" is conceptualized in a triadic relationship: the Sign or "Firstness," the Object or "Secondness," and the Interpretant or "Thirdness" (p. 33).In Chapter Three, Goble considers how music is a sign based on the theoretical framework laid in Chapter Two. Drawing on the work of ethnomusicologists, anthropologists, psychiatrists, and a neuroscientist, he formulates a Peircian pragmatic approach to musical practices which posits that "the musical practices of different cultural communities represent a diverse cluster of community-specific ritualized behaviors involving sound" (p. 252). Furthermore, each of the musical practices "serves those persons who meaningfully participate in it as a means of psychophysiological, psychosocial, and/or sociopolitical equilibration relative to the worldview—or ordered conception of Reality—they tacitly share" (p. 252). For Goble, this pragmatist conception of musical practices is neither ethnocentric, universalist, nor relativist, and can serve as a conceptual framework for all diverse musical practices in postmodern United States.With the Peircian pragmatic conception in mind, Goble examines historical factors that contributed to current conceptions of music in the United States in Chapter Four. He laments that as a result of European Enlightenment and three socio-political phenomena in the United States (the separation of church and state, promotion of no other worldview than democracy, and adoption of democratic capitalism), music is no longer pragmatically oriented but trivialized and pursued by self-serving musicians.In Chapter Five, Goble traces the philosophical justifications for music education throughout the history of the United States. While the sign "musical practice" was conceptualized as "worship" in colonial America, the sign "music" was conceived as "art" during the age of Enlightenment, and as "product" during the age of science and technology. Noting that Bennett Reimer's music education as aesthetic education is limited in its Western focus on music as works [End Page 202] of artistic objects, Goble aligns his Peircian conception along praxial lines—in particular, with... (shrink)

Mind attribution may be divided into the subcategories of attribution of agency, associated with moral agency, and attribution of experience and emotion, associated with moral concern and moral patiency (Gray et al. Science 315(5812):619, 2007; Gray et al. Proceedings of the National Academy of Sciences of the United States of America 108(2):477–479, 2011b; Robbins and Jack Philosophical Studies 127(1):59–85, 2006). In this paper I attend to social context and the different psychological needs influencing the different types of mind attribution. A (...) need for social connection drives the attribution of experiences and emotions. The individual’s capacity to regulate emotional reactions is crucial for empathic concern. I further relate differences of mind attribution, attention, and emotional processing, to two different modes of functioning: In an interactive state of mind (comparable to the “second-person perspective” described by Schilbach et al. Behavioral and Brain Sciences, in press), social and emotional cues are attended to; In a detached task-oriented state of mind it may be beneficial to predict the behaviors of others but emotional information may not be attended to. The complexity and plasticity of mind attribution, including the possibility to train attentional mechanisms and regulation of emotions, is promising for the field of moral enhancement. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 623 Jaye Cee Whitehead, Kath Bassett, Leia Franchini, and Michael Iacolucci “The Proof Is in the Pudding”: How Mental Health Practitioners View the Power of “Sex Hormones” in the Process of Transition In the United States today, popular discourse touts the power of “sex hormones” and hormone receptors in the brain to chemically produce gender expressions (manifested in (...) physical sex traits, behaviors, and attitudes) and identities (a sense of self as feminine or masculine). These accounts range from common assumptions that Western ideals of femininity (such as empathy understanding, cooperative orientation, nurturing behavior) and masculinity (rational/spatial understanding, competitive orientation, violent behavior) are produced by corresponding sex hormones, to studies that reduce complex gender identities and macrosocial economic phenomena to presocial, binary, hormonal processes.1 For sociologists, accounts that reduce complex identities to internal hormonal reactions are problematic for two primary reasons: first, they are inaccurate because they fail to examine how hormonal reactions are embedded in a complex cultural process of meaning and interpretation; second, they operate as bioreductive ideologies that obscure the social power inherent to the process of gender identity construction. In what follows, we extend both of these insights by examining mental health 1. For an example of a hybrid popular-scientific account of the power of sex hormones to destabilize economic structures, see Jon Coates and Joe Herbert, “Endogenous Steroids and Financial Risk Taking on a London Trading Floor,” Proceedings of the National Academy of Sciences 105, no. 16 (April 2008): 6167–72. 624 Whitehead, Bassett, Franchini, and Iacolucci practitioners’ divergent interpretations of the power of sex hormones in the process of gender transition.2 In doing so, we examine the cultural power of sex hormones in crafting gender identities without reproducing reductionist interpretations of trans embodiment. Perhaps what is most perplexing about the way we speak of sex hormones is that we know it is inaccurate to describe these hormones as sexed; scientists have acknowledged since the 1930s that they are neither sex specific in their function, nor in terms of their location in male or female bodies.3 In her extensive historicization of sex hormones, Anne Fausto-Sterling concludes that it is more accurate to call androgen- and estrogen-based hormones, “steroid hormones” as they have functions that are not confined to corresponding sexed bodies. In fact she urges scientists to “break out of the sex hormone straightjacket” and to look at steroids as just one of a number of components that are important to the creation of sex and gender, including environment and experience.4 Scholars also point to an inextricable link between the chemical operation of hormones and the social process of constructing meaning, both at the level of social interaction and macrocultural constructions of sex categories and gender ideologies.5 While brain organization/activation theory attributes sex and gender differences to hormonal interactions within the developing brain, Fausto-Sterling questions the distinction between activation and organization by pointing out how “the brain can respond to hormonal stimuli with anatomical changes…hormonal systems, after all, respond exquisitely to experience, be it in the form of nutrition, stress, or sexual activity (to name but a few possibilities ).”6 Drawing from Elizabeth Grosz, Fausto-Sterling argues that the power of hormones is best understood according to the model of the 2. “Gender transition” is a controversial phrase, as it implies that transgendered individuals who receive hormone therapy are changing identities. We are only using it for lack of clear alternative phrasing, not because we believe body modifications change gender identities. 3. See Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York: Basic Books, 2000); Rebecca Jordan-Young, Brainstorm: The Flaws in the Science of Sex Differences (Cambridge, MA: Harvard University Press, 2010); and Nelly Oudshoorn, Beyond the Natural Body: An Archeology of Sex Hormones (New York: Routledge, 1994). 4. Fausto-Sterling, Sexing the Body, 193–94. 5. Fausto-Sterling, Sexing the Body. 6. Ibid., 232. Whitehead, Bassett, Franchini, and Iacolucci 625 Möbius strip, wherein internal components of the self are always connected to and continuous with outer components such as culture and environment.7 In other... (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

Liao and Carbonell argue that medical devices are often not merely biased, but rather materialize oppression through the perpetuation of oppression into the present and future (Liao and Carbonell 2...

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Studying Human Behavior: How Scientists Investigate Aggression and Sexuality by Helen LonginoRebecca KuklaReview: Helen Longino, Studying Human Behavior: How Scientists Investigate Aggression and Sexuality, University of Chicago Press, 2013In Studying Human Behavior: How Scientists Investigate Aggression and Sexuality, Helen Longino meticulously examines a wide variety of research programs devoted to studying human behavior, specifically aggression and sexual orientation. She teases apart the methodologies of the various approaches, examining (...) their epistemic structure, the assumptions they must hold fixed, the research questions they enable and those they necessarily occlude, their underlying ontologies, the interests that motivate them, the ideological investments they help buttress, and the practical and political uses they serve. By the end of the book she has made clear that the so-called ‘nature-nurture’ debates invoke a hopelessly simplistic and distorting dualism when it comes to any interesting question about the etiology of a behavior. This is a readable, informative, rigorous, and elegantly organized new work from a leading scholar who has had a major hand in turning the interplay among science, ethics, and social interests into a topic of rigorous philosophical study.In the first part of the book, Longino devotes a chapter or substantial section to each major methodological approach to studying aggression and sexual orientation, including (using her labels): quantitative behavioral genetics, social-environmental approaches, molecular behavioral genetics, neurobiological approaches, and several ‘integrative’ approaches (such as developmental systems theory) that focus on the interactions and dynamics between causal factors over time rather than trying to isolate one causal contribution. She also briefly discusses human ecology, which takes the unit of study to be the behavior of a population, studied in its material environment, rather than the behavior of an individual.Longino shows elegantly how each of these research programs is equipped to reveal certain specific kinds of truths about behavior, while making other important dimensions of the phenomena invisible. Many of her examples are technical and detailed, but I can recap a few relatively simple and powerful examples: (1) Behavioral researchers have no shared understanding of what an ‘environment’ is or which features of it we need [End Page E-97] to measure. Whatever operationalization of ‘environment’ is used within a study or set of studies, this operationalization is not itself scientifically validated, but merely presupposed (33). Thus how much of a behavior shows up in a study as due to the ‘environment’ depends on just what we measure. On the behavioral genetic approach this will include everything other than genes, but on, say, the neurobiological approach this will be everything other than neural structure. But these are quite different senses of ‘environment’ with different scopes, and there’s no good reason to think they are easily commensurable. (2) ‘GxExN’ researchers use techniques to study the etiology of behavior that were developed expressly for studying disorders (112). This work thus presupposes that we can understand whatever behavior is under study on the disorder model, and will yield no well-formed results to the extent that this model does not fit. But it is at best non-obvious that a disorder model is unproblematic when it comes to aggression or—especially!—sexual orientation. (3) Most of the research programs Longino covers treat the behaving individual as the unit of analysis and study, as opposed to, for example, human ecologists’ focus on whole populations. But as she demonstrates, this affects what kinds of causes we can study, because patterns at the population level may not be detectable using the kinds of measures that can be manipulated at the individual level. Furthermore, some kinds of behaviors may require more than one participant to exist at all; for instance, the very same thing that counts as an aggressive act within one interaction may be a peaceful act in another (175).Longino does a lovely job of showing what sorts of social interests are served and buttressed by which kinds of research. For example, social-environmental approaches will, in virtue of their methodology, focus on social factors that are manipulable, and this makes them particularly amenable to generating suggestions for social interventions. Such research thus better serves the ends of those who are looking to implement... (shrink)

Decisions about whether or not to become a parent are significant parts of normative human development. Many studies have shown that married different-sex couples are expected to become parents, and that many social pressures enforce this norm. For same-sex couples, however, much less is known about social norms surrounding parenthood within marriage. This study examined injunctive norms and descriptive norms for the pursuit of parenthood as a function of age, gender, and sexual orientation. Participants in an internet survey included 1020 (...) cisgender people from across the United States Findings showed that norms, especially descriptive norms, for the pursuit of parenthood for heterosexual people were much stronger than those for lesbian women and gay men, and that norms for lesbian women were stronger than those for gay men. These differences were more pronounced for older, heterosexual, and male participants. However, lesbian and gay participants, especially gay men, reported that lesbian and gay people ought to become parents to the same extent as heterosexual people. Overall, the results indicated that, regardless of sexual orientation, adults report that lesbian and gay married people ought to become parents, but that they expect only a minority of these couples will pursue parenthood. This research provided a glimpse into how Americans are envisioning family formation among same-sex couples today. (shrink)

Behavioral biologists have long sought to link behavioral units (e.g., aggression, depression, sociopathy) with biological units (e.g., genes, neurotransmitters, hormones, neuroanatomical loci). These units, originally contrived for descriptive purposes, often lead to misunderstandings when they are reified for purposes of causal analysis. This genetic and biochemical explanation for sociopathy reflects such problems.

Nunez is to be applauded for putting forward a theoretical brain model. In order to improve any model it needs to be experimentally testable. The model presented in the target article suffers from insufficient clarity as to how new experimental designs could be derived. This is a consequence of neglecting the purpose of the brain, which is to produce effective and adaptive behavior. It might be possible to overcome this drawback by including Hebb-based modeling.