The biopsychosocial model is characterized by the systematic consideration of biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. This model opposes the biomedical model, which is the foundation of most current clinical practice. In the biomedical model, quest for evidence based medicine, the patient is reduced to molecules, genes, organelles, systems, diseases, etc. This reduction has brought great advances in medicine, but it lacks a holistic view of the person. To solve (...) the problem, we propose an early team based approach where the primary care physician leads a group of people that can help her/him address the psychosocial issues while she/he attends to the biomedical issues. This article addresses one case where the clinical ethicist facilitating a team based biopsychosocial model for the care of a patient worked as a bridge between the primary team, the critical care team, and the psychosocial team to advance the argument that good communication among the groups can lead to a true biopsychosocial model where the collaboration of the social worker, psychologist, chaplain, ethicist and the different medical teams can improve the overall patient experience. (shrink)
In this paper we outline the activities of young girls in a Toba community of northern Argentina and examine the effect of girl helpers on time allocation of nursing women. Activity budgets were obtained for 41 girls aged 3 to 15 using spot observations. Girls spent substantial portions of observations engaged in helping behaviors. Individual values varied with age, anthropometric characteristics, and birth order. Activity budgets of 21 nursing women were obtained through focal observation sessions. Women living in households with (...) girls aged 7 to 15 allocated 17% less time to domestic work and 9% more time to socializing during afternoon observation sessions. For nursing women in this community, direct childcare (provided by the infant’s own mother) seemed to be a priority. Living with a girl helper did not have any measurable effect on the frequency or duration of nursing, or on the time that women spent caring for their infants. Based on these findings, hypotheses are outlined for future work on the effect of girl helpers on women’s fertility. (shrink)
Moral distress is defined as the inability to act according to one’s own core values. During the COVID-19 pandemic, moral distress in medical personnel has gained attention, related to the impact of pandemic-associated factors, such as the uncertainty of treatment options for the virus and the accelerated pace of deaths. Measures to provide aid and mitigate the long-term pandemic effect on providers are starting to be designed. Yet, little has been said about the moral distress experienced by patients and the (...) relational and additive effect on provider moral distress. Pandemic-associated factors affecting moral distress in patients include the constraining effects of isolation on spiritual and religious traditions as well as the intentional separation of patients from their families. This paper will explore the idea that patients are suffering their own moral distress and further how this impacts the intensity of moral distress experienced by the providers—nurses and physicians. The paucity of research in this area with the implications on patient’s distress, decision making, and distress experienced by providers compels further investigation and analysis. (shrink)
The United Nations Educational, Scientific and Cultural Organisation’s Declaration on Bioethics and Human Rights refers to the importance of cultural diversity and pluralism in ethical discourse and care of humanity. The aim of this meta-narrative review is to identify indigenous ethical values pertaining to the Ojibway, Xhosa, and Mayan cultures from peer-reviewed sources and cultural review, and to ascertain if there are shared commonalities. Three main themes were identified, namely illness, healing, and health care choices. Illness was described with a (...) more complex and dynamic picture than from the western view, as illness is not considered to be one dimensional. Healing needs to take place on various levels in order to restore a state of equilibrium between the different spheres. Health care choices were also considered from a multi-level perspective. In all three of the indigenous cultures explored, good decision-making is seen to have occurred when choices are informed by commitments to one’s moral and ethical responsibilities towards the community, nature, and the spirit world. (shrink)
The precautionary principle (PP) aims to anticipate and minimize potentially serious or irreversible risks under conditions of scientific uncertainty. Thus it preserves the potential for future developments. It has been incorporated into many international treaties and pieces of national legislation for environmental protection and sustainable development. In this article, we outline an interpretation of the PP as a framework of orientation for a sustainable information society. Since the risks induced by future information and communication technologies (ICT) are social risks for (...) the most part, we propose to extend the PP from mainly environmental to social subjects of protection. From an ethical point of view, the PP and sustainability share the principle of intergenerational justice, which can be used as an argument to preserve free space for the decisions of future generations. Applied to technical innovation and to ICT issues in particular, the extended PP can serve as a framework of orientation to avoid socio-economically irreversible developments. We conclude that the PP is a useful approach for: (i) policy makers to reconcile information society and sustainability policies and (ii) ICT companies to formulate sustainability strategies. (shrink)
An important contribution to the philosophical inquiry on death. Ferrater Mora rescues the problem from the underground men of philosophy and places it in the ample yet fastidious perspective of reason. The first three chapters discuss "death" or "cessation" in inorganic, organic, and human nature. The last resumes the history of Western opinion on the subject. The subtitle, "an outline of an integrationist philosophy," indicates no facile eclecticism but a willingness to avoid absolutes. The main asset of this enormously learned (...) book is the brilliance with which the author leads us through a labyrinth of conflicting attitudes and presuppositions, always sustained by the dynamism of an inquiry in which doubt is not an abyss but a ground.--A. R. (shrink)
This article proposes to build up a relation between living conditions and the possibilities the Internet is offering to dream about new territories and transgressions. The Internet as the space to trespass physical frontiers; a media used for artists to question geo-political boundaries and to create new meeting points.
Um alinhamento responsável à alguma versão do naturalismo filosófico requer a articulação explicita e cuidadosa de um argumento em sua defesa. Em quatro passos, o texto que segue abaixo expande e examina a validade de um argumento que é frequentemente rascunhado em favor do naturalismo. Como veremos, contudo, a versão do naturalismo que esse argumento nos permite é um pouco diferente dos naturalismos filosóficos mais populares.
We elucidate the epistemological futility of using concepts such as unconscious thinking in research. Focusing on Newell & Shanks' use of the lens model as a framework, we clarify issues with regard to unconscious-thought theory and self-insight studies. We examine these key points: Brunswikian psychology is absent in UTT; research on self-insight did not emerge to explore the unconscious; the accuracy of judgments does not necessitate the unconscious; and the prescriptive claim of UTT is unfounded.
Stimuli such as surprised faces are ambiguous in that they are associated with both positive and negative outcomes. Interestingly, people differ reliably in whether they evaluate these and other ambiguous stimuli as positive or negative, and we have argued that a positive evaluation relies in part on a biasing of the appraisal processes via reappraisal. To further test this idea, we conducted two studies to evaluate whether increasing the cognitive accessibility of reappraisal through a brief emotion regulation task would lead (...) to an increase in positive evaluations of ambiguity. Supporting this prediction, we demonstrated that cuing reappraisal, but not in three other forms of emotion regulation (Study 1a-d; n = 120), increased positive evaluations of ambiguous faces. In a sign of robustness, we also found that the effect of reappraisal generalised from ambiguous faces to ambiguous scenes (Study 2; n = 34). Collectively, these findings suggest that reappraisal may play a key role in determining responses to ambiguous stimuli. We discuss these findings in the context of affective flexibility, and suggest that valence bias (i.e. the tendency to evaluate ambiguity more positively or negatively) represents a novel approach to measuring implicit emotion regulation. (shrink)
Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)
