Spirituality in Physical Health and Aging

A variety of research has documented the association between various measures of religion/spirituality and physical health outcomes. The purpose of this paper is to review the literature on this topic. The paper also discusses the mechanisms that are thought to underlie the associations found in the literature. Further, the paper presents several avenues along which future research might proceed in order to advance our understanding of these issues. The paper concludes by making a case for the need for empirical examinations of these issues in countries other than the United States. Particular focus is paid here to religion among older adults in Japan.     

Examining the Ethics of Clinical Use of Unproven Interventions Outside of Clinical Trials During the Ebola Epidemic

The recent Ebola outbreak in West Africa began in the spring of 2014 and has since caused the deaths of over 6,000 people. Since there are no approved treatments or prevention modalities specifically targeted at Ebola Virus Disease (EVD), debate has focused on whether unproven interventions should be offered to Ebola patients outside of clinical trials. Those engaged in the debate have responded rapidly to a complex and evolving crisis, however, and this debate has not provided much opportunity for in-depth analysis. Additionally, the existing literature on access to unproven therapies has focused on contexts like HIV/AIDS and oncology, which are very different than the Ebola epidemic. In this paper, we examine the ethical issues surrounding access to unproven therapies in the context of the recent Ebola outbreak to yield new insights about this controversial and unsettled issue. We argue first that, in this context, the interests of patients in obtaining access to unproven therapies are not fully aligned with the interests of their providers and drug developers. Second, we focus on the resource constraints facing providers, funders, and patients and conclude that they often counsel against the use of unproven interventions against EVD.     

Witnesses to Reality: Working Psychodynamically With Survivors of Terror 1

As generations of young men and women return from combat scarred not only physically but also psychologically by their experiences, as civil wars and genocide proliferate and refugees seek sanctuary in America from persecution in their native countries, even while others are held in violation of their international human rights by the United States government, this paper asks what role psychoanalysts can play in working with those who have survived violence and terror as adults. Offering a relational formulation of adult onset trauma, the author reviews some of the difficulties inherent in being called upon to bear witness to destructive social forces. The paper concludes with the case of a man who has been detained in Guantanamo Bay for the last 6 years.     

Standards,Harmonization and Cultural Differences: Examining the Implementation of a European Stem Cell Clinical Trial

ABSTRACT

A complex set of European regulations aims to facilitate regenerative medicine, harmonizing good clinical and manufacturing standards and streamlining ethical approval procedures. The sociology of standardization has elaborated some of the effects of regulation but little is known about how such implementation works in practice across institutions and countries in regenerative medicine. The effects of transnational harmonization of clinical trial conduct are complex. A long-term ethnographic study alongside a multinational clinical trial finds a range of obstacles. Harmonization standardizes at one level, but implementing the standards brings to the fore new layers of difference between countries. Europe-wide harmonization of regulations currently disadvantages low-cost clinician-lead research in comparison to industry-sponsored clinical trials. Moreover, harmonized standards must be aligned with the cultural variations in everyday practice across European countries. Each clinical team must find its own way of bridging harmonized compulsory practice with how things are done where they are, respecting expectations from both patients and the local hospital ethics committee. Established ways of working must further be adapted to a range of institutional and cultural conventions that affect the clinical trial such as insurance practices and understandings of patient autonomy. An additional finding is that the specific practical roles of team members in the trial affect their evaluation of the importance of these challenges. Our findings lead to conclusions of wider significance for the sociology of standards concerning how regulation works and for medical sociology about how trial funding and research directions in stem cell medicine intersect.     

Measurement of Trust in Salesperson–Customer Relationships in Direct Selling

No readily available scales exist that are appropriate to the measurement of trust in direct selling. This paper presents a conceptualization of trust that focuses on its nature and presents it as an affect—that is, a combination of attitudes and emotions. To develop a scale that reflects this approach, a two-country study is conducted looking at the perceptions of buyers regarding the trust they place in direct selling salespeople. Three distinct measures of trust and two related measures, based on scales developed for use in contexts other than direct selling, are utilized. The measurement properties of all five are shown to be adequate; however, differences are apparent in their robustness and in the pattern of responses in the two countries. Moreover, one measure (Trust 3) clearly is inferior to the other measures. The paper concludes with a discussion of the effectiveness of these measures of trust and suggestions for future refinements to them.     

Oversight framework over oocyte procurement for somatic cell nuclear transfer: comparative analysis of the Hwang Woo Suk case under South Korean bioethics law and U.S. guidelines for human embryonic stem cell research

We examine whether the current regulatory regime instituted in South Korea and the United States would have prevented Hwang’s potential transgressions in oocyte procurement for somatic cell nuclear transfer, we compare the general aspects and oversight framework of the Bioethics and Biosafety Act in South Korea and the US National Academies’ Guidelines for Human Embryonic Stem Cell Research, and apply the relevant provisions and recommendations to each transgression. We conclude that the Act would institute centralized oversight under governmental auspices while the Guidelines recommend politically-independent, decentralized oversight bodies including a special review body for human embryonic stem cell research at an institutional level and that the Guidelines would have provided more vigorous protection for the women who had undergone oocyte procurement for Hwang’s research than the Act. We also suggest additional regulations to protect those who provide oocytes for research in South Korea.     

Human embryonic stem cell research and the discarded embryo argument

Many who believe that human embryos have moral status are convinced that their use in human embryonic stem cell (hESC) research can be morally justified as long as they are discarded embryos left over from fertility treatments. This is one reason why this view about discarded embryos has played such a prominent role in the debate over publicly funding hESC research in the United States and other countries. Many believe that this view offers the best chance of a compromise between the different sides in this debate. This paper focuses on what seems to be the most plausible argument for this view about discarded embryos. It shows that this argument is unsound regardless of how one understands the claim that embryos have moral status. It also discusses the implications of this conclusion for attempts to use this argument as a basis for public policy.

The gap between law and ethics in human embryonic stem cell research: Overcoming the effect of U.S. Federal policy on research advances and public benefit

Key ethical issues arise in association with the conduct of stem cell research by research institutions in the United States. These ethical issues, summarized in detail, receive no adequate translation into federal laws or regulations, also described in this article. U.S. Federal policy takes a passive approach to these ethical issues, translating them simply into limitations on taxpayer funding, and foregoes scientific and ethical leadership while protecting intellectual property interests through a laissez faire approach to stem cell patents and licenses. Those patents and licenses, far from being scientifically and ethically neutral in effect, virtually prohibit commercially sponsored research that could otherwise be a realistic alternative to the federal funding gap. The lack of federal funding and related data-sharing principles, combined with the effect of U.S. patent policy, the lack of key agency guidance, and the proliferation of divergent state laws arising from the lack of Federal leadership, significantly impede ethical stem cell research in the United States, without coherently supporting any consensus ethical vision. Research institutions must themselves implement steps, described in the article, to integrate addressing ethical review with the many legal compliance issues U.S. federal and state laws create. The opinions expressed in this article are the author’s own, and are not necessarily the opinions of others, including Children’s Hospital Boston. Portions of earlier versions of this article were previously published by the American Bar Association and the New York State Bar Association.     

“Who Cares for the Children?” Lessons from a Global Perspective of Child Care Policy

We present the argument that the meaning of child care and the policies that address it are explicitly linked with national ideologies, work force participation, economic success, and child outcomes. The relationship between family and child care policies is cyclical in nature, with a nation’s ideology and vision of family often driving child care policies, while child care policies in turn drive and support a nation’s ideology. We examine the interrelatedness of child care policy and national ideologies of family in selected industrialized countries. Specifically, this paper first defines child care policy and discusses the national ideological frameworks that provide the impetus for child care policy formation and implementation. Second, the paper explores current child care policies and their connection to the historical and political context of several countries within, including France, Germany, Japan, South Korea, Belgium, the Nordic countries, and the United States. Lastly, recommendations are offered for the future of child care policy development with specific recommendations for child care policy development in the United States.     

处于生存极限的低出生体重儿该如何决策救治

我国极低及超低出生体重儿的出生比例已接近发达国家。但因为经济、文化、技术及社会保障制度等原因,相当多的患儿得不到合理救治。这与发达国家相比有很大差距。让医护人员做到合理评估和告知,适时放弃治疗,完善社会保障制度,加强社会舆论监督和教育,加快相关制度、法规的建立等措施有望改变这一现状。     

Getting the ethics right regarding research in the emergency setting: lessons from the PolyHeme study

Research in emergency settings (RES) has become a major public issue with urgent policy implications. Significant attention has focused recently on RES in response to the trial of PolyHeme, a synthetic blood substitute, in trauma victims in hemorrhagic shock. Unfortunately, the discussion of the PolyHeme trial in the popular and scholarly press leaves important questions unanswered. This paper articulates three important lessons from the PolyHeme trial that have significant policy implications. First, the RES regulations should be re-visited, particularly the requirement that existing treatments be unproven or unsatisfactory in order for research to be acceptable without consent. Second, further conceptual and empirical scholarship is needed to accomplish the goal of effectively involving communities. Third, a more subtle analysis is needed regarding how to balance the needs of maintaining public trust and protecting confidential trade information in the context of RES.     

Foreign Qualification Recognition Regimes for Internationally Trained Professionals: the Case of Pharmacists

The paper aims to bridge the literatures on “immigration policy” and “sociology of professions” by offering an institutionalist perspective that focuses on the nature of foreign qualification recognition (FQR) processes and their impact on internationally trained workers’ access to employment in 11 immigrant-receiving countries—France, Germany, Netherlands, Austria, Sweden, Denmark, Finland, Canada, United Kingdom, Australia, and New Zealand. It analyzes professional regulations and immigrant selection systems and puts forward four FQR regimes—“readily accessible,” “segmented,” “moderately restrictive,” and “highly restrictive.” The central focus of the article is on FQR regimes for pharmacists since professional regulations are not uniform across all professions and jurisdictions. It would thus be more suitable to clarify country clusters for each profession. This conceptual tool, however, can also be utilized to enhance our understanding about other professions.     

人类胚胎干细胞的伦理学应用

人类胚胎干细胞研究和使用面临很多问题,并且大部分已经进行了广泛的讨论,但目前仍有一些问题很少进行讨论。对这些问题的讨论将有助于更好地研究人类胚胎干细胞的使用问题,这些问题是：（1）干细胞研究与社会政策,各个国家有关的政策制定并不一致,除了禁止人的生殖性克隆的国际性公约外,国际性准则在胚胎研究的也没有提供明确的规定;（2）欧洲有些国家在相关的问题的立法一致性上存在着许多问题,有些甚至是相互预报的;（3）干细胞研究应用的预防原则的适宜性问题已引起人们的争论;（4）有利及避免浪费原则在干细胞研究中的应用。     

干细胞治疗糖尿病及外周血管病变研究进展

本文综述干细胞移植治疗糖尿病及外周血管病变研究进展,各国学者在该领域的经验及现状新途径等。关于干细胞移植治疗糖尿病的临床有效性及安全性等方面,各国学者仍然存在争议。总结目前临床应用研究中所存在的相关问题及经验教训,各国学者在开展后续临床研究时,应该避免重要的方案参数之间存在明显差异。更值得一提的是,干细胞移植的长期安全性尚待评估,其潜在的致瘤风险已受到关注。近期,中华医学会糖尿病学分会撰写了《中华医学会糖尿病学分会关于干细胞治疗糖尿病的立场声明》和《中华医学会糖尿病学分会关于干细胞治疗糖尿病外周血管病变的立场声明》,就是希望能够为阻止当前临床医生和患者在认识上和就医行为上的混乱局面发挥作用,使我国的干细胞临床研究和应用在健康的轨道上发展。     

Developing effective social support: Team building and the social support process

Abstract

Team members who provide each other with several types of social support (e.g., listening support, reality confirmation support, and task appreciation support) offer each other the opportunity to increase their physical and emotional well-being. Also, teams that employ strategies to enhance their social support as part of a team-building intervention are more likely to build a working, achieving, successful organization, one with effective communication and a shared commitment to team goals and a team vision of success. This article presents a rationale for enhancing the development of team social support, describes the social support process and a measurement tool based on the characteristics of that process, outlines strategies for maintaining and enhancing student-athletes' social support, and concludes with comments regarding intervention evaluation.     

Ethics, regulation, and biomedical research

Controversy has surrounded the institutions that facilitate discussion and regulation of American biomedical research for years. Recent challenges to the legitimacy of the President's Council on Bioethics have been focused on stem cell research. These arguments represent an opportunity to reconsider the legislation under which stem cell research is regulated, as well as to consider preexisting bodies like the Recombinant DNA Advisory Committee and National Bioethics Advisory Commission. This paper proposes a Federal Life Sciences Policy Commission, a novel commission with advisory and regulatory powers that would benefit from the positive and negative lessons learned under the legislation that currently shapes the formation and institutional characteristics of advisory bodies in the United States. The Federal Life Sciences Policy Commission would have institutional independence not present in previous advisory bodies, while maintaining the tradition of broad societal representation and thoughtful discourse that has developed in the United States.     

Psychologists versus psychologists: evaluating the claims of psychologists who publicly criticize their profession

Since the 1990s, 7 psychologists have written books for a public audience expressing great dissatisfaction with mental health practitioners. These critics represent 4 English-speaking countries: Australia, Canada, the United Kingdom, and the United States. Those psychologists make 3 basic arguments: (a) any improvements attributed to psychotherapy are due to placebo effect, (b) psychological assessments have little value, and (c) clinicians do not meet the legal standards to qualify as experts in a court of law. The present author examines these arguments and concludes that these concerns are unfounded. The exception is that several forensic psychologists had been using tests that were invalid for legal purposes, but this situation has shown gradual improvement in the past 15 years.     

Empowerment or Intrusion? The Input and Output Legitimacy of Introductory Programs for Recent Immigrants

Recent changes in the social policy regimes of western European countries have raised questions about the normative legitimacy of policy measures. Welfare states may face difficult dilemmas when efficient social policy measures clash with principles of the liberal state, like equal treatment and individual autonomy. Is output legitimacy achieved at the expense of the input legitimacy dimensions of individual autonomy and human dignity? In this paper, a standard for evaluating the normative legitimacy of social policy interventions is proposed, and subsequently applied on the concrete example of the Norwegian introductory programs for immigrants. The paper concludes that activation measures in some of its implementations may actually represent fewer threats to input legitimacy than does the alternative regime of unconditional social assistance.     

Ethical issues and approaches in stem cell research: from international insights to a proposal

In recent years and months, human stem cell research has dominated many scientists' interests, the media, public debate, and social policy. This paper aims to consider, first, the major scientific data on stem cell research that are available. Second, I reflect on them by examining how they shaped policies in Europe and the United States. I also point to current changes in policy-making concerning the creation of ad hoc committees to address this novel issue and how, in a few instances, different ethical positions are part of the documents produced. In other words, diverse approaches are not solved but kept in tension. Finally, I suggest that the current state of research on human stem cell will benefit from an ethics of risk.