Knowing When to Say Goodbye: Final Exit and Suicide in the Elderly

The publication of Derek Humphry's Final Exit in 1991 caused a large uproar. Although designed as a suicide manual for terminally ill persons, there has been considerable fear that the book's methods might be used by others, such as nonterminal elderly individuals who have made a “rational” decision to end their lives. This piece, a short story about an elderly couple that commits double suicide, explores rational suicide by using fiction, as opposed to a standard bioethical approach. Fiction does not provide answers, but rather highlights the ambiguities surrounding elder suicide, and reminds us to evaluate this issue in the context of individual life experiences.     

Knowing What To Do,When, and How: An Integrative Approach to the Use of Psychoanalytic Play Therapy with Children Affected by Cancer

This article delineates a comprehensive approach to play therapy in work with children with cancer. It considers different psychological needs experienced by the patient in connection with significant moments related to cancer treatment and the psychological tasks it involves. Different therapeutic aims are presented, and the therapeutic components related to each are described in detail. The therapeutic aims approached by play therapy are reality testing and ego strengthening, unveiling and working through of unconscious conflicts related to disease, and defense maturation. Therapeutic components leading to the attainment of those aims include the provision of realistic information about diagnosis and treatment by means of play, the use of play as a space for containment, the detection and interpretation of unconscious anxieties and defenses within play, and the exploration and trial of adaptive defenses in the face of illness-related anxiety. Implications of this approach in terms of the precision and flexibility of therapeutic actions and the diversity of roles played by the therapist are discussed.     

When Knowing Becomes Remembering: Individual Differences in Susceptibility to Suggestion

In two experiments, the authors explored factors that might influence a person's tendency to make source-monitoring errors about autobiographical memories. In the first experiment, undergraduates retrieved a memory from childhood (a) that was known about but not remembered, (b) that was remembered, or (c) for which they were unsure of their memory's source. After writing down the memory, experimental groups listened to a guided visualization tape and answered questions about the event—interventions designed to help them focus on details of their memory. Controls also retrieved and wrote down a memory; however, instead of visualizing the memory, they were instructed to conduct a visual search task. Results indicated that guided visualization led participants to rate known memories closer to remembered events. A second experiment examined individual difference variables that might be related to this know-to-remember shift. Results indicated that extraversion, external locus of control, a memory that conveyed fear, and overall affective content predicted this rating. The applicability of these findings to the psychotherapy process is discussed.     

John Keown: Euthanasia,ethics and public policy: an argument against legalisation, 2nd edition

Theoretical Medicine and Bioethics -     

Self-Control: A Function of Knowing When and How to Exercise Restraint

ABSTRACT— To successfully pursue a goal in the face of temptation, an individual must first identify that she faces a self-control conflict. Only then will the individual exercise self-control to promote goal pursuit over indulging in temptation. We propose a new model that distinguishes between the problems of conflict identification and those of conflict resolution. We then review research on the factors that influence conflict identification and those that determine conflict resolution.     

Seeing What We Know, Knowing What We See: Challenging the Limits of Visual Acuity

Ageism has resulted in overstated expectations regarding the inevitable deterioration in human capabilities, such as visual perception, with age (Rowe and Kahn in Science, 237, 143?C149, 1987; Grant in Health and Social Work, 21, 9?C15, 1996). Human visual perception, however, is of a largely constructive nature, evidenced in the complementary interactions between top-down inputs (e.g., expectations) and bottom-up stimuli (Engel et al. in National Review of Neuroscience, 2(10), 704?C716, 2001; Miller and Cohen in, Annual Review of Neuroscience, 24, 167-202, 2001). Based on this constructive nature, we hypothesized that visual perception may be better than is typically expected. In three experiments, we demonstrated the malleability of visual acuity using a conditioning procedure involving manipulations in bottom-up stimuli. Experimental groups read a book excerpt with one letter in decreased font size, while the control groups read the same book excerpt with all letters in the same font size. Experiment 1 (N?=?112) examined whether visual acuity could be enhanced for a specific letter. Experiment 2 (N?=?70) assessed whether visual acuity could be enhanced for a non-conditioned letter, while Experiment 3 (N?=?108) evaluated whether the visual conditioning effects would transfer to all non-conditioned letters. Visual acuity for experimental groups was significantly better than that in the control groups, speaking to the general malleability of our visual sense.     

Disclosure of Divorce Plans to Children: What the Children Have to Say

Divorce has become a common experience for children. One part of the process that children of divorcing parents experience is the time when they are informed of their parents' approaching separation or divorce. In this study, 20 adults from eight families who had experienced the divorce of their parents when they were younger were interviewed using a guided interview format. At least two siblings from each family except one was interviewed. Qualitative analyses of data revealed interesting themes around the questions of how the participants were told about the impending separation or divorce, who told them, whether or not siblings were present, how they reacted to the news, and how they would have preferred being told.     

Living Danger: On Not Knowing What We Know

This paper contextualizes the struggle around the American Psychological Association's ethical standards regarding psychologists' participation in abusive interrogations of detainees by examining the psychological and political meanings of living in a society in which the state assumes the right to torture. To highlight the implications of authoritarian trends in America's post-9/11 political culture, I offer an interdisciplinary psychoanalytic analysis of the extreme social situation of the Argentine Dirty War, in which torture was used by the military government not as a tactic to make detainees talk but as a strategy to silence an entire population. I explore the defense mechanism of disavowal and its use by both perpetrators and victims in ways that contributed to sustaining authoritarian rule in Argentina. I suggest that it is within the legitimate arena of psychoanalysis to consider the psychological meanings of patients' experience in the larger social order. I argue for a psychoanalytic project that does not disavow the centrality of social reality in the formation of subjectivity and for a clinical model that provides a potential space in which the subject can develop a critical psyche able to co-construct a more democratic political as well as personal life.     

Visioning Family-Centered Care in Genetics: What Parents and Providers Have to Say

The purpose of this multisite exploratory research study involving focus groups of consumers and service providers was to generate stakeholder input for a statewide strategic plan for genetic services in the southwestern region of the United States. This article describes the qualitative methods by which the data were collected and summarizes major themes in participants’ perceptions about genetic services. It also describes processes related to obtaining genetic services and characteristics of an ideal service delivery system for children affected by genetic disorders and the families that care for them. Implications for practice and policy are also reviewed.     

Knowing How to Talk About What Cannot Be Said: Objectivity and Epistemic Locatedness

I take it that A. W. Moore is right when he said that ‘Wittgenstein was right: some things cannot be put into words. Moreover, some things that cannot be put into words are of the utmost philosophical importance’. There is, however, a constant threat of self-stultification whenever an attempt is made to put the ineffable into words. As Pamela Sue Anderson notes in Re-visioning gender in philosophy of religion: reason, love, and epistemic locatedness, certain recent approaches to ineffability—including Moore’s approach—attempt to find a ‘third way’ of engaging with it, which displaces the traditional dichotomy between the effable and the ineffable, that is, between what can be said and what cannot be said. In this way, they seek to overcome the threat of self-stultification mentioned above. Still, one important challenge to this kind of approach, which Moore addresses, is, as he puts it, ‘to show how it is possible’ to talk about the ineffable ‘without belying its very ineffability’. His solution to the problem of the ineffable takes the notion of ‘knowing how’ to play a central role, and is formulated in accordance with his commitments to truth and objectivity. A further important challenge to the kind of approach to the ineffable Moore proposes concerns the issue of objectivity. In Re-visioning gender in philosophy of religion, Anderson draws attention to our epistemic locatedness, which brings in questions concerning, for example, gender and culture. Pursuing this view, the challenge is to show ineffable insight without ignoring our epistemic locatedness and, in particular, the role of gender in the conceptualisation and imagery through which we seek to come to terms with the ineffable. My paper deals with these challenges. By engaging with Moore’s and Anderson’s discussions of the ineffable, I examine how it is possible to talk philosophically about the ineffable, without breaking a commitment to enlarged or objective thinking, and without ignoring the epistemic locatedness of thinking.     

Fairness in Knowing: Science Communication and Epistemic Justice

Science communication, as a field and as a practice, is fundamentally about knowledge distribution; it is about the access to, and the sharing of knowledge. All distribution (science communication included) brings with it issues of ethics and justice. Indeed, whether science communicators acknowledge it or not, they get to decide both which knowledge is shared (by choosing which topic is communicated), and who gets access to this knowledge (by choosing which audience it is presented to). As a result, the decisions of science communicators have important implications for epistemic justice: how knowledge is distributed fairly and equitably. This paper presents an overview of issues related to epistemic justice for science communication, and argues that there are two quite distinct ways in which science communicators can be just (or unjust) in the way they distribute knowledge. Both of these paths will be considered before concluding that, at least on one of these accounts, science communication as a field and as a practice is fundamentally epistemically unjust. Possible ways to redress this injustice are suggested.