Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

Estimating time to contact and impact velocity when catching an accelerating object with the hand

To catch a moving object with the hand requires precise coordination between visual information about the target's motion and the muscle activity necessary to prepare for the impact. A key question remains open as to if and how a human observer uses velocity and acceleration information when controlling muscles in anticipation of impact. Participants were asked to catch the moving end of a swinging counterweighted pendulum, and resulting muscle activities in the arm were measured. The authors also simulated muscle activities that would be produced according to different tuning strategies. By comparing data with simulations, the authors provide evidence that human observers use online information about velocity but not acceleration when preparing for impact.     

Tuned for the future: Intentions are only accessible when a retrieval opportunity is near

The intention-superiority effect describes faster reaction times for stimuli related to an intention than for more neutral material during the retention interval. Some authors have interpreted the effect in terms of a more persistent activation of intention-related material. However, typically participants are instructed to realize the intention immediately after completing the task in which reaction times are assessed (e.g., a recognition task) in order to yield the intention-superiority effect. Thus, the reaction-time task is also associated with a retrieval context. We tested whether the proximity of a retrieval opportunity affects the intention-superiority effect by manipulating whether or not a recognition task indicated a retrieval opportunity. We observed an intention-superiority effect only if the task itself was a meaningful cue for a near retrieval opportunity. This finding indicates that even short-term-delayed intentions flexibly become more or less accessible, depending on the proximity of a retrieval opportunity. We further demonstrated that the intention-superiority effect is not restricted to motor tasks, but is also found for monitoring tasks when the task realization has personally relevant consequences (replicating Schult & Steffens, Memory & Cognition, 39, 1487–1495, 2011).     

Problems with prioritization: exploring ethical solutions to inequalities in HIV care

Enormous gaps between HIV burden and health care availability in low-income countries raise severe ethical problems. This article analyzes four HIV-priority dilemmas with interest across contexts and health systems. We explore principled distributive conflicts and use the Atkinson index to make explicit trade-offs between health maximization and equality in health. We find that societies need a relatively low aversion to inequality to favor treatment for children, even with large weights assigned to extending the lives of adults: higher inequality aversion is needed to share resources equally between high-cost and low-cost treatment; higher inequality aversion is needed to favor treatment rather than prevention, and the highest inequality aversion is needed to favor sharing treatment between urban and rural regions rather than urban provision of treatment. This type of ethical sensitivity analysis may clarify the ethics of health policy choice.     

The ethical issue of competence in working with the suicidal patient

In this article, I discuss the ethical need for competence in the assessment and management of the suicidal patient, and further suggest that this specific competence be considered a routine element in professional psychological practice. I also argue that this particular competence necessitates adequate training in working with this high-risk population, as well as the need for every clinician to personally evaluate her or his own technical and personal competencies to work with suicidal patients before beginning independent practice activities in clinical situations wherein he or she may be called on to evaluate or treat a suicidal patient. This article concludes with a discussion of specific ethical dilemmas (e.g., the issue of confidentiality), and a list of suggestions for specific competencies in working with the suicidal patient is provided.     

Characterizing the level of risk in pediatric research: an ethical examination of the federal regulations

Federal regulations require that the level of risk posed by pediatric research be classified as "minimal," "greater than minimal," or "a minor increase over minimal" Interpretation of the meaning of the levels has produced a significant literature exploring the ethical basis for making these determinations. This article examines the ethical basis of a variety of approaches proposed in the literature for classifying pediatric research risk. These approaches strive to take into account how society decides which risks are routinely accepted for children outside of research. It is concluded that ways of classifying risk should compare research risks to normal risks for children without special disability and take into account the concerns of the research subject's community.     

Imagining ethical globalization: The contributions of a care ethic

Approaches to global ethics have drawn on a number of diverse theoretical traditions, such as Kantianism and utilitarianism. While emerging frameworks contribute to a growing awareness of and interest in ethics within a global society, the values that they prioritize are not adequate for realizing a just, equitable and fair system of global governance. This article considers the possibilities of an alternative ethic—a feminist ethic of care—and explores how it can bear on present circumstances, including global inequity and injustice. This care ethic has been put forward as a viable normative approach to politics and policy. Little attention, however, has been paid to the potential of a care ethic within the globalization and ethics debate. This article illustrates how the values and corresponding principles of care, grounded in relationships and responsibilities, are essential to responding adequately to the current challenges of globalization. By examining the relevance of care in this context, the article seeks to broaden dominant ethical worldviews and contribute to the articulation of normative tools for examining globalization while at the same time avoiding the trappings of conventional universality—the abstract and a priori thinking typically associated with conceptions of global ethics.     

The inner speech of behavioral regulation: Intentions and task performance strengthen when you talk to yourself as a You

People often talk to themselves using the first‐person pronoun (I), but they also talk to themselves as if they are speaking to someone else, using the second‐person pronoun (You). Yet, the relative behavioral control achieved by I and You self‐talk remains unknown. The current research was designed to examine the potential behavioral advantage of using You in self‐talk and the role of attitudes in this process. Three experiments compared the effects of I and You self‐talk on problem solving performance and behavioral intentions. Experiment 1 revealed that giving self‐advice about a hypothetical social situation using You yielded better anagram task performance than using I. Experiment 2 showed that using You self‐talk in preparation for an anagram task enhanced anagram performance and intentions to work on anagrams more than I self‐talk, and that these effects were mediated by participants' attitudes toward the task. Experiment 3 extended these findings to exercise intentions and highlighted the role of attitudes in this effect. Altogether, the current research showed that second‐person self‐talk strengthens both actual behavior performance and prospective behavioral intentions more than first‐person self‐talk. Copyright © 2014 John Wiley & Sons, Ltd.     

Pastoral hermeneutics and the challenge of a global economy: care to the living human Web

The author discusses the relationship between a pastoral hermeneutics and the current social context as determined by international communication and globalization. He explores the influence of telecommunications on the human quest for meaning and the implication of this for pastoral care and counseling. A paradigm shift is proposed in terms of care to the living human web. A pastoral assessment which interprets the undergirding philosophy and belief system of globalization and its influence on human dignity is suggested; and a pastoral ministry which takes up its prophetic task and voices the needs of people in terms of a "globalization from below" is explicated.     

Where and when to look: Sequential effects at the millisecond level

Attention, Perception, & Psychophysics - Learning and imitating a complex motor action requires to visually follow complex movements, but conscious perception seems too slow for such tasks....     

The findings of the Dartmouth Atlas Project: a challenge to clinical and ethical excellence in end-of-life care

The Dartmouth Institute for Health Policy and Clinical Practice Atlas Project found "staggering variations" in the quality and quantity of end-of-life care provided to Medicare patients with severe chronic illness across the United States. Particularly concerning is the finding that more care is provided to patients who live in "high-supply" areas, irrespective of the effectiveness of care, and that more care often equaled inappropriate care that increased patients' suffering at the end of life. Patients in "lower supply" areas typically received better, more appropriate levels of care and reported higher levels of satisfaction with the care they received.     

Doing as they would do: How the perceived ethical preferences of third-party beneficiaries impact ethical decision-making

Although unethical behavior often benefits third-parties not directly complicit in the misconduct, not all beneficiaries welcome these ill-gotten benefits. We investigate whether actors consider the ethical preferences of potential beneficiaries or rely solely on their own ethical predispositions when making decisions that affect others. Three studies demonstrate that the perceived ethical preferences of these beneficiaries can substantially influence the likelihood that actors behave unethically on their behalves. These studies show that actors consider the ethical preferences of beneficiaries only when their own ethical disposition is outcome-based.     

Why and when peer prediction is superior to self-prediction: the weight given to future aspiration versus past achievement

Peer predictions of future behavior and achievement are often more accurate than those furnished by the self. Although both self- and peer predictions correlate equally with future outcomes, peers tend to avoid the degree of overoptimism so often seen in self-predictions. In 3 studies, the authors tested whether this differential accuracy arises because people give more weight to past behavior when predicting others, but emphasize agentic information, in particular data about their aspiration level, when predicting the self. Studies 1 and 3 showed that the exact same participants rated past behavior more diagnostic of future performance when predicting another person but viewed aspiration-level data as more valuable when someone else was trying to predict them. In Studies 2 and 3 (predicting an upcoming exam score and performance in a lab task, respectively), participants gave greater weight in self-predictions to aspiration-level data than did a yoked peer, who instead gave greater weight to evidence of past achievement. This differential weighting explained why peer predictions tended to be less optimistic and, thus, more accurate. Discussion centers on strategies for predicting future behavior and why people may remain ignorant of their own incompetence despite feedback.     

员工伦理型领导原型对伦理型领导有效性的影响：员工崇敬感的中介作用

基于工作场所中具体积极情绪的理论模型和内隐领导理论, 探究了伦理型领导对员工工作绩效的影响机制, 具体是检验了崇敬感的中介作用和员工伦理型领导原型的调节作用。通过对一项问卷调查研究(193份上下级配对数据)和两个情境实验获得的实证数据进行统计分析, 结果表明: 伦理型领导能够正向影响员工的崇敬感; 崇敬感能够中介伦理型领导对组织公民行为的积极作用, 但对任务绩效的中介效应并不显著; 此外, 员工的伦理型领导原型会强化伦理型领导与员工崇敬感之间的正向关系, 即相比于拥有低伦理型领导原型的员工, 拥有高伦理型领导原型的员工更容易对伦理型领导产生崇敬感; 崇敬感能够中介伦理型领导与员工伦理型领导原型的交互作用对组织公民行为的影响。