Achieving a good clinical trial design increases the likelihood that a trial will take place as planned, including that data will be obtained from a sufficient number of participants, and the total number of participants will be the minimal required to gain the knowledge sought. A good trial design also increases the likelihood that the knowledge sought by the experiment will be forthcoming. Achieving such a design is more than good sense—it is ethically required in experiments when participants are at (...) risk of harm. This paper argues that doing a power analysis effectively contributes to ensuring that a trial design is good. The ethical importance of good trial design has long been recognized for trials in which there is risk of serious harm to participants. However, whether the quality of a trial design, when the risk to participants is only minimal, is an ethical issue is rarely discussed. This paper argues that even in cases when the risk is minimal, the quality of the trial design is an ethical issue, and that this is reflected in the emphasis the Belmont Report places on the importance of the benefit of knowledge gained by society. The paper also argues that good trial design is required for true informed consent. (shrink)

As the world held its breath for news surrounding COVID-19 and hunkered down amidst stay-at-home orders, medical students across the U.S. wondered if they would be called to serve on the front lines of the pandemic. Medical school administrators faced the challenge of protecting learners while also minimizing harm to their medical education. This balancing act raised critical questions in medical education as institutions reacted to changing guidelines. COVID-19 has punctuated already contentious areas of medical education and has forced institutions (...) and organizations to take quick action. From the perspectives of a recent medical school graduate and current resident and a practicing clinician-educator, we examine the pandemic’s impact on undergraduate medical education through an ethical lens. First, we explore the value of medical education, what drives this value, and how COVID-19 may alter it. We next consider student choice and how shifts toward utilitarianism in healthcare during a pandemic may affect learning and career exploration. Then, we inquire how access to technology may impact the experience of medical students from diverse backgrounds and varied institutions during a rapid shift to socially distanced learning. We identify vulnerabilities for students at several phases of the journey: premedical, preclinical, clinical, and preparation for residency. Finally, we address the hidden curriculum of COVID-19, its potential erosion of empathy among current medical students, and possible long-term consequences for future physicians and patients. (shrink)

As nations strengthen borders and restrict refugee admissions, national security officials are screening for fraudulent nationality claims. One tool to investigate nationality claims is DNA testing, either for claimed relationships or for ancestral origins. At the same time, the plight of global statelessness leaves millions without documentation of their nationality, and DNA testing might be the only recourse to provide evidence of heritage or relationships. DNA testing has been used sparsely to date to determine ancestral origin as a proxy for (...) nationality but could increase as border controls tighten. Given the historic lessons in eugenics and the potential for misuse of personal genetic information, it is essential to consider the ethical parameters in order to guide the implementation of genetic data for such purposes. Here, we break down examples of the use of DNA testing for nationality, and the risks and benefits of genetic testing for this purpose. Important ethical considerations discussed include (1) empowerment of stateless individuals with evidence for citizenship proceedings; (2) imprecise correlation between genetic heritage and nationality; (3) effective protection of state interests; and (4) practicalities of DNA testing. (shrink)

Modifying images for scientific publication is now quick and easy due to changes in technology. This has created a need for new image processing guidelines and attitudes, such as those offered to the research community by Doug Cromey (Cromey 2010). We suggest that related changes in technology have simplified the task of detecting misconduct for journal editors as well as researchers, and that this simplification has caused a shift in the responsibility for reporting misconduct. We also argue that the concept (...) of best practices in image processing can serve as a general model for education in best practices in research. (shrink)

Responsible data management is a multifaceted topic involving standards within the research community regarding research design and the sharing of data as well as the collection, selection, analysis and interpretation of data. Transparency in the manipulation of images is increasingly important in order to avoid misrepresentation of research findings, and research oversight is also critical in helping to assure the integrity of the research process. Intellectual property issues both unite and divide academe and industry in their approaches to data management. (...) Central to the realization and promulgation of responsible data management is clear and careful communication of standards and expectations within the research community to trainees as well as among colleagues. These topics are examined and explored in depth in a special issue of Science and Engineering Ethics on responsible data management. (shrink)

Purpose – This aim of this paper was to highlight the awareness of ethical issues across the group of information systems professionals from a range of geographical regions. Design/methodology/approach – An initial survey was conducted that informed in-depth interviews with 26 IS professionals from across the globe. The study identified that around 70 per cent of the sample were over 50 years old. This provided an opportunity to consider age-related differences in perception regarding ethical awareness of both current and emerging (...) technologies. Findings – The project revealed that the more mature IS professionals had a significantly higher level of awareness and perceived understanding regarding the importance of ethical issues than the younger IS professionals. Research limitations/implications – The research was limited to IS professionals and so the findings do not generalise further. Future research would be beneficial to find out if the higher level of ethical awareness is also evident across older people in general or whether it is specific to technology professionals. Practical implications – IS professionals need to be exposed to high standards and expectations of ethical behaviour from senior colleagues, as well as embedding this within technical education. Social implications – Caution with regards to youth culture and youthitisation of the workforce needs to be exerted to avoid rash decision-making and short-termism, which could undermine progress and development. A change in the view of employers to older workers will also require a change in attitudes across Western society, particularly as demographics continue to skew towards an aging population. Originality/value – This paper provides new insight into the ethical awareness of older employees and goes some way to dispel the myths surrounding stereotypes of older workers as being fearful of technology and resistant to change. (shrink)

Background Families whose child has unexplained intellectual or developmental differences often hope that a genetic diagnosis will lower barriers to community-based therapeutic and support services. However, there is little known about efforts to mobilize genetic information outside the clinic or how socioeconomic disadvantage shapes and constrains outcomes.Methods We conducted an ethnographic study with predominantly socioeconomically disadvantaged families enrolled in a multi-year genomics research study, including clinic observations and in-depth interviews in English and Spanish at multiple time points. Coding and thematic (...) development were used to collaboratively interpret fieldnotes and transcripts.Results Thirty-two families participated. Themes included familial expectations that a genetic diagnosis could be translated into information, understanding, and assistance to improve the quality of a child’s day-to-day life. After sequencing, however, genetic information was not readily converted into improved access to services beyond the clinic, with families often struggling to use a genetic diagnosis to advocate for their child.Conclusion Families’ ability to use a genetic diagnosis as an effective advocacy tool beyond the clinic was limited by the knowledge and resources available to them, and by the eligibility criteria used by therapeutic service providers’ – which focused on clinical diagnosis and functional criteria more than etiologic information. All families undertaking genomic testing, particularly those who are disadvantaged, need additional support to understand the limits and potential benefits of genetic information beyond the clinic. (shrink)

In the present study we elucidate the emotional and executive control interactions that might underlie optimism and pessimism. Participants completed a self-report measure of optimism/pessimism and performed an emotion faces categorisation task and an emotion n-back task in which they indicated whether each of a series of faces had the same or a different emotional expression (happy, sad, neutral) as the face presented two trials before. Trials were structured to measure latency to update emotional content in working memory (WM). More (...) pessimistic individuals formed connections among positive stimuli, and broke connections among positive and sad stimuli, in WM more slowly than did less pessimistic individuals; levels of optimism/pessimism did not affect the rate with which individuals formed and broke connections among neutral representations in WM. It appears, therefore, that levels of pessimism are related to specific affective cognitive mechanisms in WM that may be involved in emotion regulation. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Purpose In this paper, faculty librarians at an academic institution explore the ethical dimensions of conducting research with user-generated social networking service data. In an effort to guide librarian-researchers, this paper first offers a background discussion of privacy ethics across disciplines and then proposes a library-specific ethical framework for conducting SNS research. Design/methodology/approach By surveying the literature in other disciplines, three key considerations are identified that can inform ethical practice in the field of library science: context, expectation, and value analysis. (...) For each of these considerations, the framework is tailored to consider ethical issues, as they relate to libraries and our practice as librarian-researchers. Findings The unique role of the librarian-researcher demands an ethical framework specific to that practice. The findings of this paper propose such a framework. Practical implications Librarian-researchers are at a unique point in our history. In exploring SNSs as a source of data to conduct research and improve services, we become challenged by conflicting and equally cherished values of patron privacy and information access. By evaluating research according to context, expectations, and value, this framework provides an ethical path forward for research using SNS data. Originality/value As of this paper’s publication, there is no existing ethical framework for conducting SNS research in libraries. The proposed framework is informed both by library values and by broader research values, and therefore provides unique guidelines for the librarian-researcher. (shrink)

We propose a model of reference that contrasts with standard linguistic approaches in that it focuses on the role of interaction in reference, arguing that referring expressions in conversations are not designed for interchangeable audiences but rather exploit the common ground between partners. Our model also differs from psycholinguistic approaches in that it uses conversational data, since critical aspects of natural conversations are absent from laboratory tasks used so far and thus are not captured by current models. Examples from conversations (...) are presented to demonstrate that speakers often try to manage the accessibility of a problematic referent to an addressee by presenting a context for it as well as a referring expression, even at the cost of syntactic orthodoxy. We also present examples demonstrating that partners negotiate as to what representation is good enough for present purposes and whether that has been achieved. While strategies may vary as to explicitness, we believe these negotiations underlie all formulations of referring expressions. (shrink)

The multitude of training models and curricula for the specialty of clinical neuropsychology around the world has led to organized activities to develop a framework of core competencies to ensure sufficient expertise among entry-level professionals in the field. The Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists’ Associations is currently working toward developing a specialty certification in clinical neuropsychology to establish a cross-national standard against which to measure levels of equivalency and uniformity in competence and service provision (...) among professionals in the field. Through structured interviews with experts from 28 European countries, we explored potential areas of core competency. Specifically, questions pertained to the perceived importance of a series of foundational, functional, and other competencies, as well as current training standards and practices, and optimal standards. Our findings revealed considerable agreement on academic and clinical training, despite varied actual training requirements currently, with fewer respondents relegating importance to training in teaching, supervision, and research, and even fewer to skills related to management, administration, and advocacy. European expert clinical neuropsychologists were in agreement with previous studies regarding the importance of sound theoretical and clinical training but management, administrative, and advocacy skills were not central to their perspective of a competent specialist in clinical neuropsychology. Establishing a specialty certificate in clinical neuropsychology based on core competencies may enable mobility of clinical neuropsychologists across Europe, and, perhaps, provide an impetus for countries with limited criteria to reconsider their training requirements and harmonize their standards with others. (shrink)

Although international research is increasing in volume and importance, there remains a dearth of knowledge on similarities and differences in “national human research ethics”, that is, national ethical guidelines, Institutional Review Boards, and research stakeholder’ ethical attitudes and behaviors. We begin to address this situation by reporting upon our experiences in conducting a multinational study into the mental health of children who had a parent/carer in prison. The study was conducted in 4 countries: Germany, Great Britain, Romania, and Sweden. Data (...) on NHREs were gathered via a questionnaire survey, two ethics-related seminars, and ongoing contact between members of the research consortium. There was correspondence but even more so divergence between countries in the availability of NEGs and IRBs and in researcher’ EABs. Differences in NHREs have implications particularly in terms of harmonization but also for ethical philosophy and practice and for research integrity. (shrink)

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Medical students’ concerns during clinical clerkships may not always be addressed with mentors who work under significant time constraints. This study examined 3rd year students’ survey responses regarding patient encounters to elucidate what may be hidden aspects of their learning environment. We analyzed results to an 18-item survey completed during a required ethics and professionalism course in third-year medicine clerkships over a period of 18 months. The survey covered types of concerns elicited by patient encounters, interactions with mentors about concerns, (...) perceptions of mentors, and level of moral distress. We also examined results of a 7-item evaluation of small group discussions during the study period. 1210 surveys and 195 evaluations constituted the study samples. Students’ concerns related primarily to ethics (36.4%, n = 441) and quality of care (34.5%, n = 418). Concerns had not been raised with a mentor in 535 (44.2%) instances. Students experienced moral distress in connection with 35.4% (n = 324) of cases; this was particularly common when a concern applied to a mentor. Higher levels of moral distress were associated with a lower likelihood of wishing to emulate the mentor (r = -0.27, p <.001). Two thirds of students, 66.9% (n = 107), stated that small group discussions where concerns were discussed lowered their stress levels. We suggest that clinical mentors be made aware of students’ learning needs and that structured discussions be available for students to articulate concerns with peers and facilitators in efforts to uncover elements of the hidden curriculum with the goal of optimizing students’ well-being, learning and professional development. (shrink)

BackgroundAn increasing number of studies utilize intracranial electrophysiology in human subjects to advance basic neuroscience knowledge. However, the use of neurosurgical patients as human research subjects raises important ethical considerations, particularly regarding informed consent and undue influence, as well as subjects’ motivations for participation. Yet a thorough empirical examination of these issues in a participant population has been lacking. The present study therefore aimed to empirically investigate ethical concerns regarding informed consent and voluntariness in Parkinson’s disease patients undergoing deep brain (...) stimulator (DBS) placement who participated in an intraoperative neuroscience study.MethodsTwo semi-structured 30-minute interviews were conducted preoperatively and postoperatively via telephone. Interviews assessed participants’ motivations for participation in the parent intraoperative study, recall of information presented during the informed consent process, and participants’ postoperative reflections on the research study.ResultsTwenty-two participants (mean age = 60.9) completed preoperative interviews at a mean of 7.8 days following informed consent and a mean of 5.2 days prior to DBS surgery. Twenty participants completed postoperative interviews at a mean of 5 weeks following surgery. All participants cited altruism or advancing medical science as “very important” or “important” in their decision to participate in the study. Only 22.7% (n = 5) correctly recalled one of the two risks of the study. Correct recall of other aspects of the informed consent was poor (36.4% for study purpose; 50.0% for study protocol; 36.4% for study benefits). All correctly understood that the study would not confer a direct therapeutic benefit to them.ConclusionEven though research coordinators were properly trained and the informed consent was administered according to protocol, participants demonstrated poor retention of study information. While intraoperative studies that aim to advance neuroscience knowledge represent a unique opportunity to gain fundamental scientific knowledge, improved standards for the informed consent process can help facilitate their ethical implementation. (shrink)

Person‐specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self‐determination method with people with various long‐term health conditions. It explains the mechanisms of mobilizing relational capacity by including person‐specific evidence in shared decision‐making. Person‐specific self‐insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self‐management challenges. This step paved the way for sharing these insights and (...) challenges in a relationship with a supportive health professional, who could then rely on person‐specific evidence instead of assumptions or a narrow disease perspective for shared decision‐making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person‐specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self‐insights in daily life with other people, decreasing loneliness they experienced in self‐management. Relational capacity, the core of the theory, is mobilized in both people with long‐term health conditions and healthcare professionals. Further research on person‐specific evidence and relational capacity in healthcare is recommended. (shrink)

Physical activity and sedentary behaviour have been linked to the mental health of children and adolescents, yet the timing of behaviours may play a role in this relationship and clarifying this could inform interventions. We explored cross-sectional associations of PA and SED in varying time segments throughout the school day with the mental health of school-aged children and adolescents from rural Northeastern Ontario, Canada. A total of 161 students wore accelerometers for 8 days and completed a self-report survey. Mental health (...) was measured using the Strengths and Difficulties Questionnaire. Accelerometer-measured SED, light PA, and moderate and vigorous PA were estimated in the time-segments before school, school time, after school, and evenings. Associations were tested with multilevel linear regressions while adjusting for confounding factors. Students spent 72.6 min in MVPA, 209.0 min in LPA, and 621.0 min in SED per day. Daily SED was associated with less conduct problems. Evening LPA was inversely associated with hyperactivity, while SED was associated with hyperactivity and with peer problems before school, and during school. No associations were observed for MVPA, emotional symptoms, or prosocial behaviour. In conclusion, displacing SED with LPA in some specific periods of the day may benefit the mental health of students; taking this into account could strengthen interventions. (shrink)

The prevalence and negative impact of brain disorders are increasing. Clinical Neuropsychology is a specialty dedicated to understanding brain-behavior relationships, applying such knowledge to the assessment of cognitive, affective, and behavioral functioning associated with brain disorders, and designing and implementing effective treatments. The need for services goes beyond neurological diseases and has increased in areas of neurodevelopmental and psychiatric conditions, among others. In Europe, a great deal of variability exists in the education and training of Clinical Neuropsychologists. Training models include (...) master’s programs, continuing education courses, doctoral programs, and/or post-doctoral specialization depending on the country, with no common framework of requirements, although patients’ needs demand equal competencies across Europe. In the past five years, the Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists’ Association has conducted a series of surveys and interviews with experts in the field representing 30 European countries. The information, along with information from the existing literature, is used in presenting an overview of current and relevant topics related to policy and guidelines in the training and competencies in Clinical Neuropsychology. An option for the way forward is the EuroPsy Specialist Certificate which is currently offered in Work- and Organizational psychology and Psychotherapy. It builds upon the Basic Certificate and complements national standards without overriding them. General principles can be found that can set the basis for a common, solid, and comprehensive specialty education/training, sharpening the Neuropsychologists’ competencies across Europe. The requirements in Clinical Neuropsychology should be comparable to those for the existing specialty areas in the EuroPsy model. Despite the perceived challenges, developing a Specialist Certificate appears a step forward for the development of Clinical Neuropsychology. Recommendations are proposed towards a shared framework of competencies by the means of a common level of education/training for the professionals in Europe. Benchmarking training standards and competencies across Europe has the potential of providing protection against unqualified and ethically questionable practice, creating transparency, raising the general European standard, and promoting mobility of both Clinical Neuropsychologists and patients in Europe, for the benefit of the professional field and the population. (shrink)

Emotion regulation (i.e. either up- or down-regulating affective responses to emotional stimuli) has been shown to modulate long-term emotional memory formation. Further, research has demonstrated that the emotional aspects of scenes are preferentially remembered relative to neutral aspects (known as the emotional memory trade-off effect). This trade-off is often enhanced when sleep follows learning, compared to an equivalent period of time spent awake. However, the interactive effects of sleep and emotion regulation on emotional memory are poorly understood. We presented 87 (...) participants with pictures of neutral or negative objects on neutral backgrounds paired with instructions to either increase or decrease their emotional response by altering personal relevance, or to passively view the stimuli. Following a 12 h period of sleep or wakefulness, participants were tested for their memory of objects and backgrounds separately. Although we replicated the emotional memory trade-off effect, no differences in the magnitude of the trade-off effect were observed between regulation conditions. Sleep improved all aspects of memory, but it did not preferentially benefit memory for emotional components of scenes. Irrespective of a period of sleep or wake following encoding, findings suggest emotion regulation during encoding did not influence memory for emotional items at a 12-hour delay. (shrink)

"My energies for near a lifetime have been used almost entirely to win such prominence as I could in outdoor photography."--H. H. Bennett Henry Hamilton Bennett became a celebrated photographer in the half-century following the American Civil War. Bennett is admired for his superb depictions of dramatic landscapes of the Dells of the Wisconsin River and also for his many technical innovations in photography, including a stop-action shutter and a revolving solar printing house that is now housed at the Smithsonian (...) Institution. With his instantaneous shutter, he gained recognition for his striking images of moving subjects, such as lumber raftsmen shooting the river rapids and his son Ashley leaping in midair from a bluff to the craggy pillar of Stand Rock. Less well-known are Bennett's splendid urban photographs of nineteenth-century Chicago, Milwaukee, and St. Paul. This engaging biography of H. H. Bennett tells his life story, illustrated throughout with his remarkable photographs, some of them rarely viewed before. It draws on the photographer's own letters and journals, along with other family documents, to portray the sweep of his career and personal life. An important figure in the history of photography, he also contributed to the growth of American tourism: his nationally distributed stereoscopic views of Dells rock formations and his portraits of local Ho-Chunk Indians played a significant role in creating the Wisconsin Dells as the popular tourist destination it is today. Despite personal challenges--a crippling Civil War injury, the death of his first wife, and continual financial worries--Bennett produced an extensive portfolio that captures the midwestern culture of his time. He accepted commissions in the 1890s to document Chicago's modern skyscrapers, grand residences of Milwaukee's entrepreneurs and sailing ships in its harbor, enormous scenic panoramas along the routes of Wisconsin railroads, and sparkling ice palaces lit by fireworks at the St. Paul Winter Carnival. Finalist, Midwest Regional Interest, Midwest Book Awards. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

This article is about the relationship between reading, trauma and responsive literary caregiving in Britain during the First World War. Its analysis of two little-known documents describing the history of the War Library, begun by Helen Mary Gaskell in 1914, exposes a gap in the scholarship of war-time reading; generates a new narrative of "how," "when," and "why" books went to war; and foregrounds gender in its analysis of the historiography. The Library of Congress's T. W. Koch discovered Gaskell's ground-breaking (...) work in 1917 and reported its successes to the American Library Association. The British Times also covered Gaskell's library, yet researchers working on reading during the war have routinely neglected her distinct model and method, skewing the research base on war-time reading and its association with trauma and caregiving. In the article's second half, a literary case study of a popular war novel demonstrates the extent of the "bitter cry for books." The success of Gaskell's intervention is examined alongside H. G. Wells's representation of textual healing. Reading is shown to offer sick, traumatized and recovering combatants emotional and psychological caregiving in ways that she could not always have predicted and that are not visible in the literary/historical record. (shrink)

In an essay examining Hannah Arendt's approach to public memory, rhetorical scholar Stephen H. Browne notes that "to remember is thus not simply to turn backward; it is itself a type of action that steadies us in the face of an unknown and unpredictable future" (2004, 60). The act of remembering connects the rememberer to both the past and the future. As scholars such as Benedict Anderson, John Bodnar, and John Gillis have pointed out, remembering also connects human beings to (...) their contemporaries and "imagined communities" by establishing a common narrative and space for identification. In many cases, action itself provides the material from which memories are formed—an individual from the past betrayed his .. (shrink)

Kant scholars have rarely addressed the centuries-old tradition of casuistry and the concept of conscience in Kant’s writings. This book offers a detailed exploration of the period from Pascal’s Provincial Letters to Kant’s critique of probabilism and discusses his proposal of a (new) casuistry as part of an moral education. *** -/- Die Debatte um Kasuistik und Probabilismus zählt zu den wichtigsten Themen der Moraltheologie und Moralphilosophie der frühen Neuzeit. In der enormen Verbreitung der Literatur über die Gewissensfälle (casus conscientiae) (...) und in der großen Resonanz der Lehre von den wahrscheinlichen Meinungen (opiniones probabiles) in der ersten Hälfte des 17. Jahrhunderts findet sich ein wirkungsmächtiges Modell für die Analyse des moralischen Handelns, in welchem Universalität des Gebots und Kontingenz der Handlung, Notwendigkeit der Norm und individuelle Freiheit miteinander versöhnt werden. Dennoch erregt dieses Modell heftige Kritik, die in Pascals berühmtem Angriff in den Briefen in die Provinz (1656–1657) gipfelt. So beginnt für die Kasuistik und den Probabilismus eine lange Krise, welche die Entstehung der modernen Moralphilosophie und den Siegeszug des kantischen Paradigmas ankündigt. Die Krise von Kasuistik und Probabilismus fällt zusammen mit einer einsetzenden rigoristischen Reaktion der christlichen Moraltheologie sowohl katholischer als auch protestantischer Prägung,welche die moralischen und spekulativen Folgen eines Rückgriffs auf Gewissensfälle und wahrscheinliche Meinungen als inakzeptabel ablehnt. Die Ablehnung geht aber weiter und dringt bis in den Kern der philosophischen Reflexion vor: Die rigoristische Reaktion gegen Kasuistik und Probabilismus entzündet sich im moralphilosophischen Denken Kants als Folge seiner umfassenden kritischen Revision der Grundbegriffe der Moralphilosophie sowie insbesondere seiner Neubestimmung des Verhältnisses von Gewissen und praktischem Urteil. Dem Grundsatz des Probabilismus setzt Kant das Kriterium der moralischen Gewißheit („quod dubitas, ne feceris!“) entgegen, das er als „Postulat des Gewissens“ bezeichnet (RGV 6:185.23–186.9).Und die Kasuistik wird als eine „Critic der Handlungen nach Sophistic“ abgestempelt, als eine „Uebung, um nach der Sophistic das Gewissen zu hintergehen oder es zu chicaniren, insofern man es in Irrthum zu setzen denkt“ (V-MS/Vigil 27:620.2–5). Dennoch weist Kant den kasuistischen Fragen eine herausragende Stellung in der Tugendlehre zu und legt der Kasuistik im Rahmen der ethischen Methodenlehre, also im Hinblick auf pädagogische Anwendungen, letztlich eine positive Funktion bei. Vermutlich ist Kants Angriff auf Kasuistik und Probabilismus durch den Einfluss Pascals philosophisch vermittelt. Kants Verhältnis zu Pascal und, allgemeiner, zu dem historischen Hintergrund, welchem dieser angehört, sind gleichwohl noch erstaunlich wenig erforscht: Trotz der wiederholten (stillschweigenden oder sogar ausdrücklichen) Hinweise an wichtigen Stellen in Kants Schriften richtet die Kant-Forschung ihre Aufmerksamkeit nur selten auf die Jahrhunderte währende Tradition der Kasuistik und den Begriff des Gewissens, der in ihrem Rahmen ausgearbeitet wird. Aus dieser langen Geschichte wird in diesem Band insbesondere der Zeitraum „von Pascal bis Kant“ eingehend untersucht, d.h. der noch wenig erkundete Zeitabschnitt von der beißenden Polemik von Pascals Briefe in die Provinz bis zu Kants eigener Kritik des Probabilismus und seinem Entwurf einer (neuen) Kasuistik als Teil der ethischen Methodenlehre. (shrink)

IntroductionDignity therapy is brief psychotherapy targeting psychological and existential suffering among patients with a life-limiting illness. Studies have been conducted on the use of DT by healthcare professionals. In Italy, the current legislation defines that any form of psychotherapy may be performed exclusively by psychotherapists. Consequently, this intervention is unlikely to be used by other healthcare professionals. Herein, we will describe a training on DT not as a psychotherapy intervention but as a narrative intervention for non-psychotherapists health care professionals. Finally, (...) we will explore the potential enablers/barriers as experienced by palliative care physicians and nurses.MethodsThe study was conducted in the Psycho-Oncology Unit within the Cancer Research Hospital of Reggio Emilia. It consisted of an exploratory qualitative case study. Data were collected employing observations and interview data and thematically analyzed.ResultsThe training was attended by six physicians and ten nurses and took place during two-afternoon sessions for 10 h. Two participants put their training into practice and administered DT under the supervision of a psychotherapist. Data analysis highlighted five overarching themes relating to the training experience and direct use of DT, namely, time required, psychological skills, patient’s disease awareness, patient’s life history, and distinguishing DT from Advance Care Planning.ConclusionPalliative care professionals found DT to be a valuable non-pharmacological hospital-based intervention to address the person beyond the patient and his clinical conditions. In our experience, considering that in Italy, psychotherapy is an intervention that psychotherapists can only perform, it can help organize different training on DT for psychotherapists and other healthcare professionals. (shrink)