Death: the final stage of confusion

The sensitive case presentation by Barbara Springer Edwards and Winston M. Ueno, concerning a patient's desire to be sedated and disconnected from a respirator, furnishes much material for discussion. One issue: When a patient refuses treatment, what are the limits of the health-care provider's obligation to persuade the patient to accept or continue with treatment? I say "limits" advisedly, for the obligation has both a floor (the least that one must attempt) and a ceiling (beyond which efforts to persuade become medical harassment).... Another point concerns the language we all use to describe the experiences of patients. My wife, Barbara, rails at how doctors use the terms "distress" and "discomfort" -- a usage that, she points out, has infected her husband as well. She is right to rail. Someone who calls the suffocation caused by disconnecting a respirator "distressing" or "uncomfortable" will call the Gulf War a "spat."... The main issue this discussion by Edwards and Ueno raises for me, though, is that of the manner and meaning of dying.     

Conflict of Interest and the CREATE-X Trial in the New England Journal of Medicine

There is an increasing emphasis on clear disclosure of conflict of interest in medical communities, following repeated scientific frauds in clinical trials. However, incomplete COI statements continue to be prevalent in the medical community, as appears to have occurred in the Capecitabine for Residual Cancer as Adjuvant Therapy (CREATE-X) trial, which was recently published in the New England Journal of Medicine. The authors of the article did not clearly report the roles of the Japan Breast Cancer Research Group, a sponsor and funder of the study, although a majority of the Japanese authors served in important positions in the organization. Furthermore, the conflict of interest related to Chugai Pharmaceutical Company, a Japanese distributor of capecitabine, was not correctly disclosed. More transparent statements of conflict of interest and clarification of sponsors and funders’ roles, as well as rigorous review by academic journals are required to fairly interpret the findings of clinical trials, including and beyond the single case of the CREATE-X trial.     

Permanently locked-in syndrome in the neurologically impaired neonate: report of a case of Werdnig-Hoffmann disease.

Echenberg, a physician and the chairman of a PEC (perinatal ethics committee) recounts a difficult case of an infant with congenital Werdnig-Hoffman disease, which is characterized by a severe, early-onset form of spinal muscular atrophy, secondary to progressive neurologic degeneration. The two-and-one-half-month-old girl was paralyzed and respirator dependent, but apparently mentally intact and aware. Her parents and other family members tried to avoid serious involvement in the case. The physicians caring for her were resigned to the futility of further treatment, but uncertain how to proceed. The infant's nurses, many of whom had bonded with the child, were strongly divided as to what course of action would be in her best interests, and who should make decisions about continuation or termination of life support. Echenberg summarizes the PEC meeting which was convened about this case, and reviews the issues involved.     

A discussion of some moral issues in nutrition and feeding

In this essay we review a number of values and conflicts involved in human nutrition in order to clarify the sources of resistance to accepting a pump-fed patient on the part of nursing home nurses. The case illustrates the complexities of our feelings and values in the area of intrusion showing the need for continued reflection upon and revision of our intuitive reactions. The case also displays conflict resolution.     

Incest and professional boundaries: Confidentiality versus mandatory reporting

The mandatory reporting of an incest case by a mental health professional, sets in motion a chain of events which raise conflict for all involved. Typically, attorneys, the courts, health service providers, as well as primary treatment team become involved. This article discusses some of the relevant dilemmas that are raised by the personal and professional mandatory report of incest.     

Mediation in Health Care Settings: Some Theoretical and Practical Concepts

Selected topics are discussed that may be relevant to psychologists in medical mediation and bioethical consultations, such as family conflict and DNR (do not resuscitate) orders. The premise is that psychologists will be more involved in these disputes than ever before. This article includes some relevant theoretical issues and practical procedures for conducting mediation disputes in health care settings.     

浅议生物医学研究中不同主体的利益冲突

作为医学伦理学研究的重要内容,生物医学研究中的利益冲突问题日益受到公众、研究机构和管理部门的关注。探讨生物医学活动中研究者、研究机构、学术期刊三种不同主体利益冲突的表现、危害及其特点,以期有针对性地促进人们对该领域利益冲突问题的认识。     

工作记忆更新任务中的认知优势效应

目的：采用N-back范式,探讨熟练双语者与非熟练双语者之间工作记忆更新能力的差异,以验证双语优势效应是否存在于工作记忆更新任务中。方法：采用数字型2-back任务,两因素混合实验设计。自变量分别为被试间变量(熟练双语者与非熟练双语者）和被试内变量（低难度任务组和高难度任务组）,因变量为2-back任务中目标刺激、非目标刺激、诱惑刺激和非诱惑刺激的准确率和反应时。结果：熟练双语者与非熟练双语者在低难度的2-back任务（一般的2-back任务）中,目标刺激和非目标刺激的准确率和反应时上没有差异;在高难度任务组（有冲突的2-back任务）中,熟练双语者在非目标刺激、诱惑刺激和非诱惑刺激的准确率显著高于非熟练双语者。结论：工作记忆更新中的“双语优势效应”更容易体现在高执行功能需求的条件下。     

Conflicts with Friends: A Multiplex View of Friendship and Conflict and Its Association with Performance in Teams

Drawing on conservation of resources theory, multiplex social networks research, and the emerging conflict involvement perspective, the purpose of this study is to develop and test a multiplex view of conflict that explicitly accounts for the nature of the social relationships between those involved in intrateam conflict and how these multiplex relationships differentially impact team performance. Data were collected from 120 teams engaged in a 4-month business simulation. Relationship conflicts occurring among team members who are friends have a negative impact on team performance, whereas those occurring between non-friends have a positive impact on team performance. Although we also find non-friend task conflicts to be beneficial for team performance, friend task conflicts have no impact on team performance. This study highlights the dark side of workplace friendships and admonishes managers to pay close attention not only to conflicts among employees, but also to the relational closeness of those involved in conflict. The current study provides empirical support for the emerging conflict involvement perspective by explicitly assessing the number of individuals involved in conflict as well as the type of relationships between them. We also extend research on multiplex relationships from the individual to the team level of analysis. Finally, we respond to calls for studies of multiplexity that include both positive and negative relationships.     

Embolie gazeuse cérébrale lors d’une séance d’hémodialyse : aspects médico-légaux : à propos d’une affaire judiciaire

Air embolism is a serious iatrogenic event, concerning many invasive medical therapies. It is a rare but life-threatening adverse event. We report a case of a cerebral air embolism occurring during a renal replacement therapy. We report the case of a court case analyzed in the Department of Legal Medicine of Farhat Hached University Hospital in Sousse, Tunisia, related to a cerebral gas embolism occurring during a session of renal replacement therapy. Then we discuss the medical liability of the medical team involved in this act. Through a draft organic law (law No. 41/2019 on patients’ rights and medical liability), Tunisian jurisprudence aims at resolving legal claims in the field of medical liability by providing more opportunities for an amicable solution and by guaranteeing an adequate and quick compensation of the damage suffered.     

Disability or end-of-life? Competing narratives in bioethics

Bioethics, and indeed much ethicalwriting generally, makes its point throughnarratives. The religious parable no less thanthe medical teaching case uses a simple storyto describe appropriate action or theapplication of a critical principle. Whilepowerful, the telling story has limits. In thispaper the authors describe a simple teachingcase on ``end-of-life' decision making that wasill received by its audience. The authors ill-receivedexample, involving the disconnection ofventilation in a patient with ALS (Lou Gherig'sDisease) was critiqued by audience members withlong-term experience as ventilation users. Inthis case, the supposedly simple narrative ofthe presenters conflicted with the lifehistories of the audience. The lessons of thisstory, and the conflict that resulted, speakcritically to the limits of simple teachingcases as well as the strengths of narrativeanalysis as a tool for the exploration ofbioethical case histories. This revised version was published online in June 2006 with corrections to the Cover Date.     

Ethical issues and the family doctor

Issues recognized as having ethical or moral components are becoming increasingly common, for society in general, the health care system and for general practitioner/family physicians in particular. Some of the peculiar problems for GP's relate to the provision of continuing, comprehensive, primary medical care to large numbers of individuals who provide extensive potential for conflict between all the involved elements: patients, physicians, families, consultants and societal attitudes. There is a need for more formal education programs.     

More conflict does not trigger more adjustment of cognitive control for subsequent events: A study of the bivalency effect

Encountering a conflict triggers an adjustment of cognitive control. This adjustment of cognitive control can even affect subsequent performance. The purpose of the present study was to determine whether more conflict triggers more adjustment of cognitive control for subsequent performance. To this end, we focussed on the bivalency effect, that is, the adjustment of cognitive control following the conflict induced by bivalent stimuli (i.e., stimuli with relevant features for two tasks). In two experiments, we tested whether the amount of conflict triggered by bivalent stimuli affected the bivalency effect. Bivalent stimuli were either compatible (i.e., affording one response) or incompatible (i.e., affording two different responses). Thus, compatible bivalent stimuli involved a task conflict, whereas incompatible bivalent stimuli involved a task and a response conflict. The results showed that the bivalency effect was not affected by this manipulation. This indicates that more conflict does not trigger more adjustment of cognitive control for subsequent performance. Therefore, only the occurrence of conflict – not its amount – is determinant for cognitive control.     

Predecision conflict and different patterns of postdecision attractiveness restructuring: empirical illustrations from an important real-life decision

This study presents different postdecision consolidation patterns following decisions made under value conflicts. The different patterns were illustrated by case studies of real-life decisions concerning university programs. There were five program alternatives each of which branched into a different professional area. These decisions were very important to the students. The subjects were followed during a year, from a couple of months before they made their choice of program and during several months after the start of the programs. Different postdecision strategies for consolidating a prior decision were derived from Differentiation and Consolidation Theory (Svenson, 1992). The strategies involved the following postdecision attractiveness restructuring patterns. (1) Reversing an attractiveness disadvantage into an advantage on a conflict attribute, (2) Compensating for a disadvantage through increase of an advantage of another attribute, (3) Reversing disadvantage on a conflict and decreasing advantage on non-conflict attribute(s), and (4) Increasing advantage for chosen alternative on all attributes. In addition, (5) downgrading of importance of the conflict attribute or a complete elimination of this attribute is also a possible way of consolidating the prior decision. The results illustrated the above consolidation patterns. A comparison with subjects who made the same decisions but with no value conflict indicated that postdecision consolidation was largely driven by value conflicts at the time of decision in conjunction with the outcome of the decision.     

剖析患者投诉

患者投 是患者就医过程中与医务人员或医疗单位的利益发生的表现形式,着重剖析了因医疗费用、服务质量、医疗质量等引起的投诉,分析了投诉的目的及管理投诉单位的反应,并从几个方面探讨了如何对待投诉,减少投诉、避免投诉。     

医护人员对患者权利的保护情况调查分析

采用现场问卷方式调查统计结果表明:大部分医护人员了解患者的相应权利,对患者权利具有一定的保护意识,但部分患者权利保护不足,存在易发生医患纠纷隐患,需要引起临床医护人员的重视,不断加强法制观念教育.     

从手术签字审视医疗活动中道德与法律之冲突

手术签字不应成为实施手术的必要条件,手术治疗及其他医疗活动中道德与法律之冲突有其产生的理论和现实根源,其实质是利益冲突。合情不合法与合法不合情是道德与法律冲突的两种具体情形。单纯的道德谴责或责任追究无助于,中突的解决,完善法律、提升道德、调适利益是避免及减少冲突的有效途径。     

消费时代的医学人文价值：—兼谈医学中科学和人文的对话与冲突

针对消费时代医患关系的现状重提医学人文价值凸显的话题,将对诊断与治疗两个环节剖析了医学人文在医疗生活中的切入点,价值内涵与现实冲突。深入分析了医学人文旨归与科学建构之间的差异、冲突、并为医学人文走向医学、医疗、医院提供了一些有益的见解。     

Effective behaviors to de-escalate organizational conflicts in the process of escalation

The goal of the present study was to determine what behaviors negotiators can use to help to quell an escalating conflict. In doing so, we formed a sample of professionals who took on the role of negotiator when we provoked an organizational conflict between a superior and subordinate that escalates due to the intervention of research confederates. Trained judges analyzed the negotiators' behaviors that most effectively mitigated the intensity of the conflict in which they were involved. The results demonstrate that the behaviors most effective at de-escalating an escalating conflict are problem-solving and accommodation, especially when said conflict has escalated considerably. Similarly, jointly employing problem-solving and direct fighting behaviors also seems to help de-escalate conflict. The results do not, however, consistently support using a forceful behavioral strategy to de-escalate a conflict in the early stages of escalation.