Across the divide: Religious objections to brain death

This article reviews the evolution of the medical-legal definition of brain death, as well as the normative debate surrounding this reconceptualization. It offers a clinical approach to address religious objections to brain death, which prefers negotiation over confrontation when families and practicitioners must discern the boundaries between life and death.He also serves as physician-ethicist-in-residence at the Hospital Chaplaincy in New York City. An earlier draft of this essay was presented to the Metropolitan New York Ethics Committee Network at the New York Academy of Medicine on 16 November 1994.     

Addressing the brain drain: A partial cosmopolitanism approach

This paper joins the thorny debates on the “brain drain”. It first examines some of the core issues and debates around international migration and the asymmetry in the arguments that defend the right to restrict entry but are critical of any attempts to rein in exit. It then argues that the empirical evidence on this issue is contingent on multiple factors, which weakens the case for universal recommendations. Instead, the paper lays out a form of “partial cosmopolitanism” that attempts to balance an individual’s freedom to exit with the larger social good in two distinctive ways: first, by allowing some grains of sand in the wheels of skilled migration flows through contingent contracts in higher education; and second, enhanced temporary migration that encourages greater international mobility but with temporal curbs. The paper concludes by suggesting that in an era of international migration, welfare considerations need to account for both people within territorially bounded countries and territorially unbounded nations.     

The economics and philosophy of the brain drain: A critical perspective from the periphery

The paper provides a critical perspective on recent contributions to the economics literature, and associated philosophical arguments, that downplay negative effects of skilled migration on developing countries. The assertion that such migration incentivises investment in human capital is shown to rely on shaky theoretical foundations and weak empirical evidence. The associated economic literature suggesting a net positive effect of brain drain is at odds with literatures on the positive effects of human capital and education on economic growth. The manner in which net effects are determined also demonstrates that such contributions are utilitarian in nature. Identifying those who are the worst affected by brain drain, as well as the possible decision of a citizen placed behind the veil of ignorance, supports the view that opposing barriers to brain drain is inconsistent with a Rawlsian social welfare function. The undermining of institutions by skilled emigration is a fundamental consideration neglected by the economics literature without justification and, again, contradicts literatures on growth and institutions within economics. The economic theory of education can also be shown to support the view that depriving governments of the power to limit migration undermines states’ ability to resolve market failures. A number of other issues are identified that deserve greater consideration, including reflexivity in research on brain drain, the political economy of skilled migration and the philosophical status of nation-states. Despite unreliable econometric evidence, there is sufficient basis and justification to act. The paper concludes by briefly sketching possible actions under different degrees of international cooperation.     

The ethics and politics of the brain drain: A communal alternative to liberal perspectives

In Debating Brain Drain, Gillian Brock and Michael Blake both draw on a liberal moral-political foundation to address the issue, but they come to different conclusions about it. Despite the commonly held value of free and equal persons having a dignity that grounds human rights, Brock concludes that many medical professionals who leave a developing country soon after having received training there are wrong to do so (if they do not provide compensation) and that the state may place some limits on their ability to exit, whereas Blake infers that there is neither any wrongdoing on their part, nor rightful restrictions placed on them. In this article, rather than sort out which has the better interpretation of what liberalism entails, I consider the medical brain drain in the light of an alternative normative framework, one informed by ideals of communion salient in the sub-Saharan moral tradition. I argue that a principle of prizing communal relationships more naturally entails Brock’s conclusions than does her appeal to liberalism.     

Taking up the slack: The duties of source state citizens in the brain drain crisis1

This paper proposes two shifts in our approach to the brain drain crisis. First, it argues for a collective view. Since the moral wrong of the brain drain is inherently collective, we can best understand our consequent duties through a collective lens. Second, the paper argues that we ought to explore explicitly the duties of citizens of source states. These citizens systematically bear the burdens of labour migration, giving us good reason to search for normative guidelines for how best to understand and distribute these burdens. Drawing on these two shifts, the paper argues that the obligations of citizens of source states are best understood as individual shares of a collective duty to uphold the functioning of their state. The content of this duty is deeply shaped by background injustice and so ought to be understood as a duty to “take up the slack”. As such, individuals’ shares are differentiated to respect the diversity of individual circumstance and, where formal policy is required, it ought to be democratically determined.     

The persistence of attention to emotion: brain potentials during and after picture presentation

Emotional stimuli have been shown to elicit increased perceptual processing and attentional allocation. The late positive potential (LPP) is a sustained P300-like component of the event-related potential that is enhanced after the presentation of pleasant and unpleasant pictures as compared with neutral pictures. In this study, the LPP was measured using dense array electroencephalograph both before and after pleasant, neutral, and unpleasant images to examine the time course of attentional allocation toward emotional stimuli. Results from 17 participants confirmed that the LPP was larger after emotional than neutral images and that this effect persisted for 800 ms after pleasant picture offset and at least 1,000 ms after unpleasant picture offset. The persistence of increased attention after unpleasant compared to pleasant stimuli is consistent with the existence of a negativity bias. Overall, these results indicate that attentional capture of emotion continues well beyond picture presentation and that this can be measured with the LPP. Implications and directions for future research are discussed.     

Just responses to problems associated with the brain drain: Identity,community, and obligation in an unjust world

In this essay, which forms part of a symposium on the brain drain, I respond to the arguments of several critics. I defend my proposals concerning how to address problems associated with high levels of skilled migration, especially in the face of concerns about identity, community and obligation in an unjust world.     

Negotiating Identity: Three Events that Weaken the Maternal Identity of Addicted Law-Breaking Women

This qualitative study aimed to comprehend how mothers experienced and built their maternal identity throughout their lives. Thirty-eight semi-structured interviews were conducted with drug-using and law-breaking mothers. Results showed that three events were significant for participants: pregnancies, loss of custody, and incarceration. As each event challenged their maternal identity, they questioned their substance use and their criminal involvement. Our results suggest that these events represent key moments to encourage their growing awareness and to foster changes in their deviant lifestyle. We conclude this article by discussing interventions possible for each of these important moments in these mothers’ lives.     

Quantum entanglement and nonideal measurements: A critique of Margenau's objections to the projection postulate

I defend the projection postulate against two of Margenau's criticisms. One involves two types of nonideal measurements, measurements that disturb and measurements that annihilate. Such measurements cannot be characterized using the original version of the projection postulate. This is one of the most interesting and powerful objections to the projection postulate since most realistic measurements are nonideal, in Margenau's sense. I show that a straightforward generalization of the projection postulate is capable of handling the more realistic kinds of measurements considered by Margenau. His other objection involves the EPR (Einstein-Podolsky-Rosen) situation. He suggests that there is a significant potential for violations of the no-superluminalsignals requirement of the special theory of relativity, if projections occur in this situation and others like it. He also suggests that what is paradoxical about this situation disappears if the projection postulate is rejected. I show that it is not possible to use measurements on pairs of spatially-separated systems whose states are entangled to transmit information superluminally, and generalize this result to include nonideal measurements. I also show that EPR's dilemma does not really depend on the projection postulate.I would like to thank three anonymous referees, two from Synthese and one from Foundations of Physics, for their critical comments on preliminary versions of this essay, and for bringing to my attention several articles concerning quantum mechanics and the impossibility of faster-than-light communication.     

Family therapy: the rest of the picture

The specialist literature on family therapy naturally tends to focus only on the special features of what is a much larger body of skills and knowledge. To redress the balance this paper outlines the rest of the picture in various ways. About 90 separable component parts of family therapy are described. Some implications of this analysis are identified.     

Claremont Purpose Scale: A Measure that Assesses the Three Dimensions of Purpose among Adolescents

The 12-item Claremont Purpose Scale (CPS) was designed for use with adolescents, and it gauges all three dimensions of the purpose construct, including goal-directedness, personal meaning, and a beyond-the-self orientation. Repeated administration reveals promising psychometric properties. For instance, the CPS demonstrates excellent internal consistency (α = .916?.935) and convergent validity. In exploratory and confirmatory factor analyses, items fell onto the three dimensions, and the measure accounted for variance on indicators of a beyond-the-self orientation above and beyond the PIL. In addition to discussing the measure’s creation and validation, suggested uses of the CPS are also addressed.     

The Christian physician in the non-Christian institution: objections of conscience and physician value neutrality.

Christian physicians are in danger of losing the right of conscientious objection in situations they deem immoral. The erosion of this right is bolstered by the doctrine of "physician value neutrality" (PVN) which may be an impetus for the push to require physicians to refer for procedures they find immoral. It is only a small step from referral to compelling performance of these same procedures. If no one particular value is more morally correct than any other (a foundational PVN premise) and a physician ought to be value neutral, than conscientious objection to morally objectionable actions becomes a thing of the past. However, the argument for PVN fails. Therefore, Christian physicians should state their values openly, which would allow patients the ability to choose like-minded physicians. Some possible responses to this erosion of conscientious objection include, disengagement from non-Christian institutions, the formation of distinctly Christian medical institutions and political action. However, for the Christian the initial focus should be on a life of holiness which requires each of us to avoid evil.     

The brain mechanism that reduces the vividness of negative imagery

The present study attempts to locate brain regions that are related to vividness control, a hypothesized mechanism that reduces the vividness of negative imagery by controlling memory retrieval and emotion processing. The results showed that BOLD response in the left posterior cingulate gyrus in the negative imagery condition, in which activation of vividness control mechanisms was considered to be strong, was greater than that in the positive imagery condition, in which the activation of control mechanisms was considered to be weak. Moreover, the activation of this region negatively correlated with the subjective vividness of negative imagery. These results support the idea that the posterior cingulate gyrus may be involved in the suppression of imagery generation. Several previous studies have suggested that the posterior cingulate cortex is involved in both memory and emotion processing. Therefore, the current results indicate that the posterior cingulate gyrus may function as the vividness control mechanism.     

Personality and psychopathology: working toward the bigger picture

There are systematic and meaningful links among normal and abnormal personality traits and Axis I and II constructs from the DSM. Nevertheless, much research in this area focuses on pairs of constructs (e.g., the link between personality traits and a specific Axis I disorder), rather than on the broader multivariate structure of the personality-psychopathology domain. We underscore the need for this broader perspective, a perspective that would transcend largely artificial boundaries between current constructs (e.g., normal and abnormal personality). We outline our approach to research from this perspective and we emphasize the internalizing (mood and anxiety) and externalizing (substance use and antisocial behavior) spectra as promising foci for initial research on the joint structure of personality and psychopathology.