The article presents new research about spiritual experiences during COVID-19. It starts with a wider discussion about the relationship between spirituality and wellbeing, based on research carried out in Brazil and the United Kingdom before the pandemic. The research showed a strict division between personal faith and medical treatment, reflecting a professional distance when treating patients that results in patients’ unwillingness to speak about their experience to anyone in the medical profession, even when these experiences impact their mental health. The (...) article then explores findings of a new research project about spiritual experience during COVID-19 and reflects on three themes that emerged from the data: 1) changes in patients’ relationships with their religious communities, 2) seeing spiritual figures and near death experiences, and 3) interpretations of COVID-19 as a spiritual contagion. These themes contribute to a nuanced understanding of how spiritual experiences that arise in moments of crisis are interpreted by the people who have them, potentially contributing to resiliance and coping. The last section discusses the reluctance to speak about non-ordinary experiences and reflects on the importance of integrating non-ordinary experiences for mental health. (shrink)

Name der Zeitschrift: Paragrana Jahrgang: 25 Heft: 1 Seiten: 299-312.

Spatial region concepts such as “front,” “back,” “left,” and “right” reflect our typical interaction with space, and the corresponding surrounding regions have different statuses in memory. We examined the representation of spatial directions in the auditory space, specifically in how far natural response actions, such as orientation movements toward a sound source, would affect the categorization of egocentric auditory space. While standing in the middle of a circle with 16 loudspeakers, participants were presented acoustic stimuli coming from the loudspeakers in (...) randomized order, and verbally described their directions by using the concept labels “front,” “back,” “left,” “right,” “front-right,” “front-left,” “back-right,” and “back-left.” Response actions varied in three blocked conditions: (1) facing front, (2) turning the head and upper body to face the stimulus, and (3) turning the head and upper body plus pointing with the hand and outstretched arm toward the stimulus. In addition to a protocol of the verbal utterances, motion capture and video recording generated a detailed corpus for subsequent analysis of the participants’ behavior. Chi-square tests revealed an effect of response condition for directions within the left and right sides. We conclude that movement-based response actions influence the representation of auditory space, especially within the sides’ regions. Moreover, the representation of auditory space favors the front and the back regions in terms of resolution, which is possibly related to the physiological characteristics of the human auditory system, as well as to the ecological requirements of action control in the different regions. (shrink)

BackgroundIn specific situations it may be necessary to make an exception to the general rule of informed consent for scientific research with an intervention. Earlier reviews only described subsets of arguments for exceptions to waive consent.MethodsHere, we provide a more extensive literature review of possible exceptions to the rule of informed consent and the accompanying arguments based on literature from 1997 onwards, using both Pubmed and PsycINFO in our search strategy.ResultsWe identified three main categories of arguments for the acceptability of (...) a consent waiver: data validity and quality, major practical problems, and distress or confusion of participants. Approval by a medical ethical review board always needs to be obtained. Further, we provide examples of specific conditions under which consent waiving might be allowed, such as additional privacy protection measures.ConclusionsThe reasons legitimized by the authors of the papers in this overview can be used by researchers to form their own opinion about requesting an exception to the rule of informed consent for their own study. Importantly, rules and guidelines applicable in their country, institute and research field should be followed. Moreover, researchers should also take the conditions under which they feel an exception is legitimized under consideration. After discussions with relevant stakeholders, a formal request should be sent to an IRB. (shrink)

How did academic medicine come to dominate scientific and medical opinions in local public spheres far away from universities? This contribution—based mainly on material from Lübeck journals and printed books—deals with the transformation of the public sphere in eighteenth century. A closer look at publication strategies and carrers of physicians shows that the new forms of self-empowerment provided by the Habermasian public sphere could only prove successful because they ran together with traditional forms of representation such as titles and official (...) posts. Local journals, books, instruments, and reputation could then provide scientific capital to be transformed into the symbolic capital of grades, titles and posts; which was in turn convertible into the economic capital of remunitions from patients or annual awards as town-, state- or court physicians. At the beginning of the nineteenth century professional organisation proved a still greater source of power than the individual strategies that had been developped before. (shrink)

The present study examined the effects of thought suppression on sleep-onset mentation. It was hypothesized that the decrease of attentional control in the transition to sleep would lead to a rebound of a suppressed thought in hypnagogic mentation. Twenty-four young adults spent two consecutive nights in a sleep laboratory. Half of the participants were instructed to suppress a target thought, whereas the other half freely thought of anything at all. To assess target thought frequency, three different measures were used in (...) the wake state and mentation reports were repeatedly prompted by a computer at sleep onset. In support of the hypothesis, results revealed a reversal of target thought frequency at sleep onset: Participants instructed to suppress reported fewer target thoughts than did controls before falling asleep, but more target thoughts afterwards. (shrink)

Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and (...) life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)

ContentTruth-telling is an integral part of medical practice in many parts of the world. However, recent public inquiries, including the Francis Inquiry reveal that a duty of candour in practise, are at times compromised. Consequently, the duty of candour became a statutory requirement in England. This study aimed to explore clinicians’ perspectives of the implications of the legislation for medical ethics education, as raising standards to improve patient safety remains an international concern.MethodsOne-to-one interviews with clinical educators from various specialties who (...) contribute to the MBChB programme at the authors’ university. Once data saturation had been assessed, transcripts were analysed using a thematic approach by the following concurrent activities: data reduction and coding into themes. Example quotations are used to illustrate that key themes are grounded in the data.ResultsEleven clinical educators were interviewed; three general practitioners, six physicians and two surgeons. Thematic... (shrink)

Subjects and Simulations presents essays focused on suffering and sublimity, representation and subjectivity, and the relation of truth and appearance through engagement with the legacies of Jean Baudrillard and Philippe Lacoue-Labarthe.

We respond to recent comments on our proposal to improve justice in ventilator triage, in which we used as an example New Jersey’s publicly available and legally binding Directive Number 2020-03. We agree with Bernard Lo and Doug White that equity implications of triage frameworks should be continually reassessed, which is why we offered six concrete options for improvement, and called for monitoring the consequences of adopted triage models. We disagree with their assessment that we mis-characterised their Model Guidance, as (...) included in the NJ Directive, in ways that undermine our conclusions. They suggest we erroneously described their model as a two-criterion allocation framework; that recognising other operant criterion reveals it ‘likely mitigate[s] rather than exacerbate[s] racial disparities during triage’, and allege that concerns about inequitable outcomes are ‘without evidence’. We highlight two major studies robustly demonstrating why concerns about disparate outcomes are justified. We also show that White and Lo seek to retrospectively—and counterfactually—correct the version of the Model Guideline included in the NJ Directive. However, as our facsimile reproductions show, neither the alleged four-criteria form, nor other key changes, such as dropping the Sequential Organ Failure Assessment score, are found in the Directive. These points matter because our conclusions hence stand, because the public version of the Model Guidance had not been updated to reduce the risk of inequitable outcomes until June 2021 and NJ’s Directive still does not reflect these revisions, and, hence, represents a less equitable version, as acknowledged by its authors. We comment on broader policy implications and call for ways of ensuring accurate, transparent and timely updates for users of high-stakes guidelines. (shrink)

This paper analyzes the reasons behind what it calls the erosion of democracy under George W. Bush's presidency since September 11, 2001, and claims that they are twofold: first, the erosion in question can be attributed to a crisis of the state and the belief that security is its only genuine function. In other words, the erosion of democracy is an erosion of the very idea of the public sphere beyond security and war. Secondly, the erosion of the ethical sphere (...) goes hand in hand with an extraordinary resurgence of what, still following Hegel, I call "morality," and which privileges the subjective over the objective, or moral feeling over institutions and the law. (shrink)