Value of "suture bones" in the diagnosis of minor brain damage in early childhood

In a sample of 278 children with normal intelligence and behaviour disorders the x-rays of the craniums were analysed especially on the aspect of suture bones. They were related to the clinical total diagnosis "Minimal Brain Damage". Statistically significant relations between the appearance of suture-bones and other cranium anomalies as well as between clinical total diagnosis "MBD" were to be found. So the results by D. Müller on the clinical value of suture-bones are supported.     

"仁"的多元伦理阐释

在"仁学"的创立发展过程中,形成了几种比较系统的理论倾向,主要包括:心理主义的解释倾向;形而上学方向、人与人的伦理关系阐释.这些阐释方向基本上规定了对"仁"进行现代理论构建和实践阐释的空间.     

Realist ethical naturalism for ethical non-naturalists

It is common in metaethics today to draw a distinction between “naturalist” and “non-naturalist” versions of moral realism, where the former view maintains that moral properties are natural properties, while the latter view maintains that they are non-natural properties instead. The nature of the disagreement here can be understood in different ways, but the most common way is to understand it as a metaphysical disagreement. In particular, the disagreement here is about the reducibility of moral properties, where the “naturalists” maintain that moral properties are in some way reducible to the lower-level natural properties on which they supervene, while the “non-naturalists” maintain that moral properties are sui generis and robustly irreducible. In this paper I present a novel version of realist ethical naturalism—a view that I call Emergentist Ethical Naturalism—that reveals this common way of understanding the distinction between naturalism and non-naturalism to be flawed by combining a commitment to ethical naturalism with a commitment to the sui generis and robustly irreducible nature of moral properties that typically defines non-naturalism. Then, after presenting the theory and addressing a few worries that one might have about it, I show how it offers some novel, emergence-based responses to the various supervenience challenges that plague moral realism and thereby gives the ethical naturalist a robustly non-reductive option for dealing with these challenges.     

A survey of genetic counselors' strategies for addressing ethical and professional challenges in practice

There is limited research about ethical and professional dilemmas that genetic counselors encounter in their practice and their strategies for addressing them. In this study, 454 genetic counselors rated the frequency with which they encounter each of 16 ethical/professional challenges identified and categorized previously (McCarthy Veach P, Bartels DM, LeRoy BS (2001) J Genet Couns 10(2):97–119). Over 40% indicated these issues occurred frequently: patient emotions, diversity, financial constraints, uncertainty, and colleague error. Two hundred and fifty-five respondents provided personal anecdotes describing exceptionally challenging situations and recommended strategies for addressing them. Most of their anecdotes involved informed consent, value conflicts, confidentiality, colleague error, withholding information, and resource allocation. The most frequently recommended strategies were further discussion with patient, consultation with other professionals, and referral to other health sources. Thirty-five respondents were unable to/did not offer strategies. Respondent demographics were not related to frequency of issues, type of anecdote, or recommended strategies. Practice, policy, and research implications are discussed.     

Future directions in genetic counseling: practical and ethical considerations

The accelerated discovery of gene mutations that lead to increased risk of disease has led to the rapid development of predictive genetic tests. These tests improve the accuracy of assigning risk, but at a time when intervention or prevention strategies are largely unproved. In coming years, however, data will become increasingly available to guide treatment of genetic diseases. Eventually genetic testing will be performed for common diseases as well as for rare genetic conditions. This will challenge genetic counseling practice. The ethical principles that now guide this practice take into account the personal nature of test decision making, the need to respect individual self-determination, and the importance of client confidentiality. Certain of these principles may have to be modified as genetic testing becomes more widespread in order to meet the changing needs of clients and society. This paper offers recommendations to ensure that genetic counselors will take a leading role in the future delivery of ethical genetic services.     

Prenatal diagnosis, personal identity, and disability

A fascinating criticism of abortion occasioned by prenatal diagnosis of potentially disabling traits is that the complex test-and-abortion sends a morally disparaging message to people living with disabilities. I have argued that available versions of this "expressivist" argument are inadequate on two grounds. The most fundamental is that, considered as a practice, abortions prompted by prenatal testing are not semantically well-behaved enough to send any particular message; they do not function as signs in a rule-governed symbol system. Further, even granting, for the sake of argument, the expressive power of testing and aborting, it would not be possible, contra the argument's proponents, to distinguish between abortions undertaken because of beliefs about the disabling conditions the fetus might face as a child and abortions undertaken for many other possible reasons -- e.g., because of the poverty the fetus would face or the increase in family size that the birth of a new child would occasion. Here, I respond to criticisms of those arguments, and propose and defend another: the expressivist argument cannot, in general, distinguish successfully between abortion and therapy as modalities for responding to disabilities.     

"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home

Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.     

"Phronesis" on tour: cultural adaptability of Aristotelian ethical notions.

How might bioethics take account of cultural diversity? Can practical wisdom of an Aristotelian sort be applied across cultures? After showing that practical wisdom involves both intellectual cleverness and moral virtue, it is argued that both these components have universality. Hence practical wisdom must be universal as well. Hellenic ethical thought neither depended on outdated theoretical notions nor limited itself to the Greek world, but was in fact developed with constant awareness of cultural differences, so it arguably works as well in other times and places when formulated. Even the eudaemonistic setting for practical wisdom is unproblematic.     

When adolescents "mismanage" their chronic medical conditions: an ethical exploration

Many adolescent patients with chronic medical conditions do not manage their illnesses very closely and often put themselves at risk for serious health complications. Setting aside cases of nonadherence that are due to practical difficulties involving the implementation of a management plan, a deeply problematic question remains. How should health care providers respond to adolescent patients who express a conscious and value-driven decision to pursue other goals and interests that are incompatible with their doctors' recommended directives? Using two guiding ethical principles, the "relevant difference principle" and the "principle of noninterference," as well as available empirical data on adolescent decision making and risk perception, the paper concludes that most adolescents ages 14 and older should be allowed to make self-determining decisions regarding the management of their chronic medical conditions.     

Down to cases: the ethical value of "non-scientificity" in dyadic psychoanalysis

The efficacy of the dyadic psychoanalytic method cannot be verified empirically, due to the impossibility of counterfactuals, controls, or double-blind experiments, although inventive psychoanalytic researchers have established validation methodologies for analyzing groups of case studies, outcomes, and even theoretical precepts. The unavailability of complete empirical validation for the most basic method of the discipline of psychoanalysis, or of its fundamental "report of findings"--the case study--means that the field's scientific rationale must be supplemented with public reasoning of another sort. Fortunately, the very conditions of uncertainty that make it impossible to falsify the findings of dyadic psychoanalysis lend it its ethical force by compelling its participants to confront the basic human dilemmas of freedom, meaning, and judgment, the ethical horizon of human affairs. One substantial value of psychoanalysis, then, is its capacity for generating "ethical knowledge" of the sort adumbrated by Aristotle's conception of practical knowledge (phronesis). Case studies written for a lay audience to highlight these basic dilemmas can demonstrate that psychoanalysis produces crucial knowledge, specific to individuals, for living a healthy and satisfying life.     

Forbidden knowledge. A case study with commentaries exploring ethical issues and genetic research

This case is part of a series of case studies used as an exercise within a program on research ethics education. The case involves research on genetic birth defects in a culturally distinct, closed religious community in which elders speak for the community. The case raises ethical issues of informed consent in such a setting; of collaboration with the community; of conflicts between the researchers' responsibilities to the community as a whole and to individual subjects; of the impact of the researcher's findings on the practices and values of the community and issues regarding how the researchers share findings with subjects and how the findings are stored.