The Dream of Consensus: Finding Common Ground in a Bioethical Context

Consensus is the holy grail of bioethics, the lynch pin of the assumption that well informed, well intentioned people may reach generally acceptable positions on ethically contentious issues. It has been especially important in bioethics, where advancing technology has assured an increasing field of complex medical dilemmas. This paper results on the use of a multicriterion decision making system (MCDM) analyzing group process in an attempt to better define hospital policy. In a pilot program at The Hospital for Sick Children, Toronto, a series of small scale focus groups was constituted to examine criteria defining organ transplant eligibility. Criteria were organized hierarchically using the Analytic Hierarchy Process, an MCDM approach, and the resulting data was analyzed using Expert Choice 9.0, software designed to facilitate AHP analysis. Qualitative and quantitative analysis map barriers to practical consensus in a way not previously possible.     

An expert consensus on the most effective components of cognitive behavioural therapy for adults with depression: a modified Delphi study

ABSTRACT

Designing new approaches to delivering cognitive behavioural therapy (CBT) requires an understanding of the key components. This study aimed to establish an expert consensus on the effective components of CBT for depressed adults. An international panel of 120 CBT experts was invited to participate in a modified Delphi study. Thirty-two experts participated in round 1; 21 also provided data in round 2. In round 1, experts rated the effectiveness of 35 content and process components. A priori rules identified components carried forward to round 2, in which experts re-rated items and final consensus items were identified. Consensus was achieved for nine content components (ensuring understanding; developing and maintaining a good therapeutic alliance; explaining the rationale for CBT; eliciting feedback; identifying and challenging avoidant behaviour; activity monitoring; undertaking an initial assessment; relapse prevention methods; homework assignments); and three process components (ensuring therapist competence; scheduling sessions flexibly; scheduling sessions for 45–60 mins). Five of the twelve components identified were generic therapeutic competences rather than specific CBT items. There was less agreement about the effectiveness of cognitive components of CBT. This is an important first step in the development of novel approaches to delivering CBT that may increase access to treatment for patients.     

临床护理人员的护理伦理知信行素养调查研究——以某三甲医院为例

为了解临床护理人员的护理伦理知识、信念、行为等素养的现状、存在的主要问题及其主要影响因素,问卷调查了某三级甲等医院的1147名护理人员,同时对16名资深护理人员和护理工作管理者进行深入访谈。调查结果显示,尽管多数护理人员在工作实践中能正确践行护理伦理行为,但护理人员的护理伦理知识欠缺,护理伦理教育有待加强;部分护理人员的基本护理（医学）伦理理念尚未建立;“重技术轻人文”的护理理念仍然是影响护理伦理践行的主要因素。临床护理人员普遍有接受有关护理伦理知识和技能培训的需求和愿望。

     

How Christian Norms Can Have an Impact on Bioethics in a Pluralist and Democratic Europe: A Scandinavian Perspective

This article assesses the similarity and difference betweenthe Western European style of doing bioethics and the Scandinavianone. First, it reviews the introductory article by the editor,C. Delkeskamp-Hayes in the first issue of Christian Bioethics(2008), devoted to the possibility of a specifically Christianbioethics in Europe. Second, it analyses bioethics debates inScandinavian today. In light of Delkeskamp-Hayes' article, themain similarity is that both regions are facing secularizationas a threat to basic Christian values, for example, to the Christianview of the sanctity and dignity of the human life. But theScandinavian tends to reduce Christian bioethics to Luther'sconcept of the worldly kingdom, supposed to foster a dialoguebetween Christians and non-Christians on controversial ethicalissues. Despite the positive value of the dialogue, this strategyrenders Christian ethics powerless. Third, from an evangelicaltheological standpoint, it proposes some strategies for enhancingthe influence of Christian commitments on bioethical laws andpolicies.     

The case of Peter: reflections on applied ethics in a neonatal intensive care unit

The case of Peter is reflected upon in order to highlight some of the moral theorising that could be brought to bear in the process of providing palliative care for sick neonates. The situation will be discussed using the theoretical lenses of deontological and virtue ethics. Nursing practice is considered as engaged moral reasoning where the nurse brings his/her beliefs, knowledge and experience into the situation and engages in reflexivity to provide appropriate ongoing patient care. The care should be provided in culturally sensitive manner and tailored to the needs of the newborn and their family. Nurses should initiate early consultations with colleagues, medical staff and families to address concerns about patient well-being in order to enhance the well-being of patients and families and to improve the work environment making it more conducive to care.     

Sexual orientation and HIV risk among youth in South Africa: a brief report

This study investigated the prevalence of homosexual orientation and HIV risk in a population-based survey among youth in South Africa. A cross-sectional population-based household survey was conducted using a multi-stage stratified cluster sampling approach. The total sample included 1859 sexually experienced youth, aged 18–24, from four provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). Results indicate that 128 (4.9%) had had a homosexual experience. In a multivariate analysis, peer pressure and, for men, having been circumcised as an adult were associated with having had a homosexual experience. Having had a homosexual experience increased, but not significantly, HIV risk and HIV positive status.     

The WPA position paper on spirituality and religion in psychiatry: a North American perspective

ABSTRACT

The WPA position statement is a clear challenge for psychiatrists to recognize how religion/spirituality (R/S) is relevant to their work. North American psychiatry has shown progress related to each principle articulated in the statement, especially in the areas of research and scholarship. However, most advances are yet to be widely implemented or coordinated, so that the statement offers valuable encouragement and direction in moving forward.     

Withstanding Persecution as a Corroboration of Legitimacy in the New Testament: Reflections on the Resulting Ethical and Hermeneutical Quandary

Abstract : Assertions of standing, authority, and power claimed on the basis of withstanding persecution play a prominent and heretofore under‐appreciated role in much of the New Testament literature. Yet deriving legitimacy from persecution presents an interpretive quandary not unlike those inherited from biblical passages that condone slavery or unhealthy attitudes toward women and men. Reflection on how we construe ourselves in relation to suffering is an agendum inadequately realized in the New Testament that commends itself for twenty‐first century ethics and theology.     

Integrating psychological research on girls with feminist activism: a model for building a liberation psychology in the United States

A liberation psychology is needed to bridge the gap between psychology's focus on individual distress and broad social forces that foster such distress. We offer a model for bridging this gap by focusing on a specific area of psychology (psychological research on girls) and a specific social movement (feminist activism). Psychological research on girls and feminist activism share the common goal of improving the lives of girls and women. However, both have fallen short of this goal. This is due, in part, to the weaknesses associated with each endeavor and to the fact that the complementary strengths of each have remained isolated from the other. In this paper, we propose a common language and shared framework to integrate psychological research with feminist activism. First, we review the basic strengths and weaknesses associated with psychological research and feminist activism, with a particular focus on how they are distinct from one another. Second, we provide a taxonomic framework for integrating these two areas on the basis of the stress paradigm, with specific examples provided from our recent reviews of the literature and our own empirical work with adolescent girls. Finally, we conclude with recommendations for future work needed to integrate psychological research on girls with feminist activism toward the goal of building a liberation psychology in the United States.     

Determining Risk in Pediatric Research with No Prospect of Direct Benefit: Time for a National Consensus on the Interpretation of Federal Regulations

United States federal regulations for pediatric research with no prospect of direct benefit restrict institutional review board (IRB) approval to procedures presenting: 1) no more than “minimal risk” (§ 45CFR46.404); or 2) no more than a “minor increase over minimal risk” if the research is commensurate with the subjects' previous or expected experiences and intended to gain vitally important information about the child's disorder or condition (§ 45CFR46.406) (DHHS 2001). During the 25 years since their adoption, these regulations have helped IRBs balance subject protections with the pursuit of scientific knowledge to advance children's welfare. At the same time, inconsistency in IRB application of these regulations to pediatric protocols has been widespread, in part because of the ambiguity of the regulatory language. During the past decade, three federally-charged committees have addressed these ambiguities: 1) the National Human Research Protections Advisory Committee (NHRPAC) (Washington, DC), 2) the Institute of Medicine (IOM) Committee on the Ethical Conduct of Clinical Research Involving Children (Washington, DC); and 3) the United States Department of Health and Human Services Secretary's Advisory Committee for Human Research Protections (SACHRP) (Washington, DC). The committees have reached similar conclusions on interpretation of language within regulations § § 45CFR46.404 and 406; these conclusions are remarkably consistent with recent international recommendations and those of the original National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1977) National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1977. Report and recommendations: Research involving children, Washington, DC: U.S. Government Printing Office.  [Google Scholar] report from which current regulations are based. Drawing on the committees' public reports, this article identifies the ethical issues posed by ambiguities in regulatory language, summarizes the committees' deliberations, and calls for a national consensus on recommended criteria.     

The role of working hours,work environment and physical leisure activity on the need for recovery following a day's work among UK white-water raft guides: A within-subjects multilevel approach

BackgroundWhite-water raft guides are a growing workforce of the outdoor sector but little is known about how the working environment, workload and physical leisure activity impacts on the need for occupational recovery (the desire to replenish internal resources and recuperate in the time immediately following work) of those working in this physically demanding occupation.MethodsLongitudinal data were collected across an eight month working season at three month intervals. Multilevel analyses tested the within-subject associations between work environment, hours worked and physical leisure activity had on the need for recovery.ResultsWorking longer across the working season and participating in more physical leisure activity were directly associated with a lower need for occupational recovery. Furthermore, working on natural rivers significantly reduced the need for recovery experienced compared to work on man-made courses. This was regardless of the number of hours of worked in these environments.DiscussionPhysical leisure activity may provide a distraction from work, allowing employees to replenish their physical and psychological energy, thus protecting themselves against work-related fatigue. The findings also expand upon the previous literature identifying that working in a natural environment reduces the risk of experiencing work-related fatigue.     

Perceptions of alcohol risk among people on antiretroviral treatment in South Africa: a qualitative study

This study explored perceptions of alcohol abuse risk among people on antiretroviral treatment (ART) who self-identified as alcohol users. Twenty six people receiving ART from an out-patient setting were interviewed on their alcohol abuse risk perception. Data were thematically analysed. Findings suggest participants developed routines to drink alcohol around the times they took their antiretroviral medications to reduce adverse impact. They also reported alcohol abuse risk reduction strategies such as reducing alcohol use because of the event of an HIV positive diagnosis and/or getting on antiretroviral treatment, and alcohol use reduction following health education or counselling by health care staff. These findings suggest a need for alcohol interventions tailored to ART patients.     

Short report: The impact of measurement conditions on the validity of self-assessment in a selection setting

Two experimental studies investigated the impact of format and instructions on the validity of SAs, using participants applying for junior management positions in a public sector organization. In Study 1 (607 participants) self-assessments (SAs) were valid when applicants rated overall competencies or the same competencies broken down into discrete elements, but not when providing behavioural evidence prior to rating competencies. The effect of social comparison instructions was also explored but found to have no impact on validity. Study 2 used a subset of 193 candidates from the previous study who attended the next stage of the selection process. Consistent with predictions it was found that unbalanced, positively toned scales were more valid than conventional scales, and highest validities were achieved when used with instructions requesting a realistic SA of strengths and weaknesses. Interestingly, gender differences were found in both studies. These findings are discussed in terms of their implications for both research and practice.     

Impact of educational intervention on willingness-to-pay for suicide prevention: a quasi-experimental study among university students in Japan

Many individuals show negative attitudes toward the use of taxes for suicide prevention. Activities that enhance knowledge and awareness of suicide and suicide prevention may increase willingness to pay (WTP) for suicide prevention. WTP is the amount that a consumer will pay for a product or service. The present study examined the influence of educational activities on enhancing knowledge and awareness of suicide and its prevention on WTP. We conducted a quasi-experimental study to examine the influence of lectures on suicide by comparing the amount of change in WTP between two groups over the same period: an intervention group (n = 92) comprising students who participated in the lectures and a control group (n = 128) comprising general university students recruited through an Internet-based survey. A t-test showed that the amount of change was significantly larger in the intervention group (t (152.31) = 2.25, p = .026). Ordinal logistic regression analysis showed that increased WTP was significantly correlated with an annual household income of JPY 4–6 million or higher. It may be appropriate to conclude that participation in lectures about suicide is effective in increasing WTP for suicide prevention.     

The effect of security-related stress on dyadic closeness among Jews and Arabs in Israel: a daily diary study

An important aspect of Israeli life is its continuous state of conflict with the neighboring Palestinian people and Arab countries. Given that security-related stress is so intensely experienced by all Israeli residents, we examined the effects of daily fluctuations in security-related stress on dyadic closeness among Jewish and Arab couples. Time sampling approach was used to study repeated sequences of associations between stress and dyadic closeness. Data were collected from 188 Jewish and 93 Arab couples by means of daily diaries. Hierarchical multivariate linear modeling was used to analyze the data. The findings indicate that stress results in increasing distance between intimate partners, but the effect varies with the level of marital quality and socioethnic affiliation.     

Performance-based and parent ratings of attention in children treated for a brain tumor: The significance of radiation therapy and tumor location on outcome

Children are at increased risk for cognitive difficulties following the diagnosis and treatment of a brain tumor. Radiation therapy (RT) and tumor location are commonly-cited predictors of neurocognitive functioning. Disruptions to foundational neurocognitive processes such as attention, working memory, and processing speed underlie declines on measures of general intellectual functioning. While several studies have examined visual sustained attention in pediatric brain tumor patients, auditory sustained attention has yet to be examined. This study employs a longitudinal design to examine performance-based and parent ratings of attention in children undergoing surgical resection of a brain tumor (n = 29) and treated with (n = 11) or without (n = 18) RT at 6.79 months post-surgery (baseline) and then again at 30.56 months post-surgery (follow-up). The measures include an auditory continuous performance test (CPT) and parent ratings of attention and hyperactivity on a behavior rating scale. Ultimately, children treated with and without RT performed similarly on performance-based and parent ratings of attention. However, the performance on the auditory CPT differed according to tumor location, with children with infratentorial tumors committing more inattention and inhibitory control errors compared to children with supratentorial tumors. Parent ratings did not differ according to tumor location, and parent ratings and auditory sustained attention performance are not significantly correlated. The findings are interpreted in the context of neurocognitive and brain development.     

To rebuild lives: a longitudinal study of the influences of the Holocaust on relationships among three generations of women in one family

The current article presents an analysis of the life stories of three generations of women within a family headed by a Holocaust survivor. Its uniqueness lies in its double analysis of the stories told by these women, with an interval of 12 years between telling. The first series of interviews were conducted in the early 1990s within the framework of a pioneering study in which, for the first time, three generations in each of 20 families were interviewed and their narratives analyzed. The current analyses are based on the perspective that, through life narratives, it is possible to view the transformations of relationships over time and that these transformations in relationships are central to personal development. We will examine the relationships of the women in these three generations, both with significant others and with each other. We will trace processes of development and changes in these relationships over the 12 years. Finally, we will discuss the social and methodological implications of our study.