Divorce and Death: A Case Study for Health Psychology

Marital separation and divorce are associated with increased risk for early death, and the magnitude of this association rivals that of many well‐established public health factors. In the case of divorce, however, the mechanisms explaining precisely why and how some people are at risk for early death remain unclear. This paper reviews what is known about the association between divorce and risk for all‐cause mortality, then discusses four emerging themes: the biological intermediaries linking divorce to pathophysiology and disease onset, moving beyond the statistical mean, focusing research on the diathesis‐stress model, and studying how opportunity foreclosures may place people on a trajectory toward poor distal health outcomes. These ideas are grounded in a set of public lay commentaries about the association between divorce and death; in this way, the paper seeks to integrate current research ideas with how the general public thinks about divorce and its correlates. Although this paper focuses on divorce, many of the emerging themes are applicable to the study of psychosocial stress and health more generally. Therefore, the study of divorce and death provides a good case study for health psychology and considers new questions that can be pursued in a variety of research areas.     

Defining the vital condition for organ donation

The issue of organ donation and of how the donor pool can or should be increased is one with significant practical, ethical and logistic implications. Here we comment on an article advocating a paradigm change in the so-called "dead donor rule". Such change would involve the societal and legal abandonment of the above rule and the introduction of mandated choice. In this commentary, we review some of the problems associated with the proposed changes as well as the problems associated with the current model. We emphasize the continuing problems with the definition of death and the physiological process of dying; we discuss the difficulties associated with a dichotomous view of death; we review the difficulties with non-beating heart donation and emphasize the current limitations of society's understanding of these complex issues. We conclude that public education remains the best approach and that such education should not be merely promotion of a particular ideology but honest debate of what is socially and morally acceptable and appropriate given the changes in vital organ support technology and the need to respect patient autonomy.     

Public health, public trust and lobbying

Each year, infection with Human Papillomavirus (HPV) leads to millions of abnormal Pap smears and thousands of cases of cervical cancer in the US. Throughout the developing world, where Pap smears are less common, HPV is a leading cause of cancer death among women. So when the international pharmaceutical giant Merck developed a vaccine that could prevent infection with several key strains of HPV, the public health community was anxious to celebrate a major advance. But then marketing and lobbying got in the way. Merck chose to pursue an aggressive lobbying campaign, trying to make its new vaccine mandatory for young girls. The campaign stoked public mistrust about how vaccines come to be mandated, and now it's not just Merck's public image that has taken a hit. The public health community has also been affected. What is the lesson to be learned from this story? Public health communication relies on public trust.     

突发公共事件中公众的补偿性控制

补偿性控制理论指出,当面临控制感的缺乏时,个体会表现出一种需求秩序的倾向,即努力寻求客观世界的秩序,对于具有秩序性、确定性、可预测性的物理或抽象事物表现出偏好与需求,这种表现被称为补偿性控制。基于突发公共事件常会引发人们控制感暂时的下降,补偿性控制理论的视角可以用来解释个体在突发公共事件中的一系列典型心理反应。如阴谋论信念、谣言传播、道德争论和非理性囤积,都可以从补偿性控制与秩序需求的角度来加以理解。未来研究可以更多考虑从补偿性控制的角度探讨突发公共事件中的公众心理反应,并基于此视角加强理论深化、研究细化和实践干预。     

The ‘redefinition of death’ debate: Western concepts and western bioethics

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. Ms. Jones is an intensive care clinical nursing specialist. Dr. Kessel is a public health physician and medical ethicist.     

Medium-chain acyl CoA dehydrogenase deficiency: Its relationship to SIDS and the impact on genetic counseling

Sudden infant death syndrome (SIDS) is defined as the sudden and unexpected death of an apparently healthy infant under 1 year of age. Routine autopsies often provide few clues as to the cause of death and rarely include a biochemical evaluation. Genetic counseling for SIDS can be difficult as recurrence risks vary depending on the age at death and the number of deaths which have occurred in the family. Biochemical disorders may account for up to 5% of SIDS. Of the metabolic disorders known to be involved in SIDS, the most commonly found is medium-chain acyl CoA dehydrogenase deficiency (MCAD). MCAD is an autosomal recessive disorder of fatty acid oxidation which accounts for up to 1% of SIDS. For some families, the addition of a postmortem biochemical investigation can identify an unsuspected metabolic disorder as the cause of death. Once the diagnosis is established, accurate genetic counseling can then be provided. Metabolic testing of the surviving siblings of victims of sudden death, and the subsequent identification of those due to MCAD can prevent the tragedy of recurrent SIDS in some families. In addition, screening the survivors of an acute life threatening event (ALTE) may also prevent a recurrence.     

Japan's dilemma with the definition of death

Japan is unusual among industrialized countries in its reluctance to use brain criteria to determine death and harvest transplant organs. This results from public distrust of the medical profession due to an earlier incident, and from concern that technological interventions will threaten religious and cultural traditions surrounding death and dying. Public acceptance is growing, however, as medical professional groups and universities develop brain criteria, and as pressure from patients who could benefit from a transplant, as well as from foreign countries, increases.     

RELIGIOUS REASONS AND POLITICAL ARGUMENTATION

In Evangelium Vitae Pope John Paul II calls for a renewal of culture to combat the culture of death. He criticizes various aspects of a pluralistic, liberal society—a type of society that he claims is based on moral relativism and a view of democracy that becomes a substitute for moral law. He maintains that such a view trivializes moral choice. In this essay I argue that John Rawls's notion of a liberal society as an overlapping consensus of comprehensive doctrines can avoid relativism while allowing for reasonable debate among opposed positions. While Rawls maintains that comprehensive doctrines, including religions, should employ a form of public reason that is not a unique feature of any one comprehensive doctrine, I argue that this requirement is too strong. One is often justified in appealing to features of comprehensive doctrines other than one's own, features that are unique to the doctrines themselves. Such an appeal does not pretend to be neutral as public reason would seem to be. In the final section of the paper I discuss some suggestions made by the Pope regarding actions in civil society that are independent of debates about legal change and suggest some ways in which they might contribute to desired cultural transformation.     

A Noneist Account of the Doctrine of Creatio ex Nihilo

I spell out a problem with the doctrine of creatio ex nihilo: that, contra the doctrine, it is not possible to efficiently cause something from nothing. This is because an efficient cause requires a material cause in order to have an effect. The material cause supplies the potency that the efficient cause actualises. Because nothingness has no potencies, there is nothing for an efficient cause to actualise. I show that this objection presupposes that the theory of noneism (the proposition that some things do not exist) is false. I postulate that the universe (i.e. the created order) is a non-existent item and so there is no problem with the claim that it was efficiently caused to come from nothing – the universe has no being anyway. After rehearsing the rather strong reasons in favour of the truth of noneism, I deal with two objections that are peculiar to my claim that the universe lacks reality: that creation possesses characteristics that are sufficient to render it existent and that a non-existent object has its properties independent of divine fiat. I show that there are sensible replies to both objections. With regard to the first I show that the possession of such characteristics at most shows that the universe has an ontological status that is equivalent to some reference point. With regard to the second I argue that the Characterisation Principle (i.e. in some world – not necessarily the actual world – an object has the properties that it is characterised as having) entails that non-existent objects possess their properties in virtue of some existent entity and that the only plausible candidate for such an entity is a divine mind of some sort.     

The dead donor rule: how much does the public care...and how much should we care?

In this brief commentary, we reflect on the recent study by Siminoff, Burant, and Youngner of public attitudes toward "brain death" and organ donation, focusing on the implications of their findings for the rules governing from whom organs can be obtained. Although the data suggest that many seem to view "brain death" as "as good as death" rather than "dead" (calling the dead donor rule into question), we find that the study most clearly demonstrates that understanding an individual's definition of death is neither a straightforward task nor a good predictor of views about donation. Reflecting on the implications for ongoing debates over the dead donor rule, we suggest that perhaps it is not a change in policy that is warranted, but rather a change in the priorities that have garnered such intense focus on this issue within the field of bioethics.     

Mistakes as a social construct: an historical approach.

The Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in November 1999. The report focused public attention on the errors that occur within the medical system that cause death and harm to patients. It outlined a series of changes for health care that are aimed at reducing these errors by 50 percent over the next five years.This paper examines the problem of medical mistakes historically. It documents how legal, scientific, and medical trends during the years 1890-1934 intersected to effect the reporting of mistakes in the subspecialty of neurosurgery. At the start of this timeframe, mistakes were reported openly in journal articles as an educational tool. By its end, however, mistakes had gone "underground" and were buried amid a more objective, scientific reporting system. Using this historical perspective as a baseline, the paper concludes by re-examining the IOM's suggestions for change and comments on what they mean for the culture of medicine.     

The Marikana Violence in South Africa: A Brief Psychodynamic Extrapolation

This study applies psychoanalytic concepts in making sense of the individual, group and collective factors that may have contributed towards the Marikana violence. Speculatively, individual factors might include the death instinct, repetition compulsion, and intra-psychic splitting. Related group dynamics such as identification with the aggressor, group and projective identification might be relevant as would the collective psychological influences of history of oppression, severe trans-generational traumatisation, and mystical cultural interpretations in a divided society. Further public truth, reconciliation and forgiveness processes in addition to other integrative forms of healing are proposed.     

Creative Prisoners: Do They Exist?

One frequently suggested motive for creative work is awareness of mortality. This article reviews some suggestions about ways in which death might serve as such a motive, and also proposes other motives. It is hypothesized that death might provide both a drive that initiatives creative activity, and also incentives that finished products try to achieve, As well, its specific role and importance probably changes with age.     

The Present State and Future of Symbolic-Experiential Family Therapy: A Post-Modern Analysis

Symbolic-experiential family therapy (SEFT) is facing an important phase in its development. With the death of Carl Whitaker, it is not certain in which direction SEFT will be headed. This paper describes some of the challenges that SEFT presently faces and what can be done to surmount them. It is proposed that SEFT theorists and therapists concentrate on the post-modern components of the theory. By moving in a post-modern, constructionist direction, SEFT will be developing with a current trend in family therapy, allowing SEFT to continue as an important family therapy model.     

The Contested Publics of the UK GM Controversy: A Tale of Entanglement and Purification

Ten years ago the UK held one of the largest, most complex and politically charged exercises in the turn towards public engagement in the governance of the biosciences. Called ‘GM Nation’ this experiment arose as an attempt to mediate public concerns in the run-up to a government decision on whether to allow some varieties of GM crops to be commercially cultivated in the UK. Formed to mediate a controversy, ‘GM Nation’ itself became a focus of controversy, with claims that many of its public participants were already engaged in the GM issue and were thus not representative of a general public. In this way, the category of the public became a contested category, with at least two different versions of the public featuring in the GM controversy. Particularly important was the contrast between engaged or issue publics that emerged entangled in and increasingly familiar with the objects and issues of the controversy, and a general public, identified through its distance and disengagement from the GM issue. These different forms of public were articulated through different modes of engagement ranging from engaged publics found in hybrid forums such as local village meetings, to versions of the general public brought into being in some of the closed parts of ‘GM Nation’. Throughout all this, a wider public institutional architecture, improvised to govern the controversy, became the site of complex boundary work that attempted to separate science from politics, a feature that conditioned how these different versions of public would be articulated and received.     

脑死亡判定的伦理学及实践中的几个问题

脑死亡是临床实践中的常见问题,随着当代医学科学的发展,经过临床严格的判定程序,患者脑死亡即生物学死亡已经成为科学标准,但由于我国在脑死亡立法、公众认知以及医生的各种心理考量,在我国开展脑死亡的判定还存在许多障碍。我们结合自己在判定患者脑死亡后的医患心理变化,以及存在的一些问题,期望引起更多的医学、法学和社会学家关注,使得临床医生对脑死亡的判定,顺应科学发展又能符合患者及其家属的最大利益。     

Christian Engagement with Public Bioethics in Britain: The Case of Human Admixed Embryos

This paper offers an assessment of the prospects for Christianengagement with public bioethical debates in a contemporaryBritish context. One recent example, the debate provoked byproposed legislation for research involving human admixed embryos,is examined briefly. It is argued that this debate has someproblematic features that are characteristic of public ethicaldebates in this context. Next, a proposal is offered as to howsuch bioethical questions may be approached from within a Christiantheological tradition (specifically, a Reformed Protestant tradition).This proposed approach makes use of four "diagnostic questions"to assess whether technological proposals and practices suchas the creation of human admixed embryos can be consistent withthe distinctive Christian narrative of creation, sin, salvationthrough Christ, and promised future hope. The final sectionoffers some reflections on how Christians and churches mightengage, on the basis of this theological approach, with publicethical debates such as the one about admixed embryos.     

凋亡--一个令人困惑的名称

就"细胞凋亡"这个热点名称进行探讨,从凋亡的起因及定义、由凋亡定义引起的哲学思考及就定义所做的建议进行分别论述.凋亡最初提出的是一种形态学特点,描述与坏死相对应的细胞解体的主动过程,之后大多数文章把凋亡定义为程序性的细胞死亡,并逐步演绎把死亡之前的细胞内生化变化称为凋亡.由此引起凋亡判断标准的混乱,并产生相关的药理学问题.细胞凋亡的实际情况与人类冠以的定义产生矛盾,其根本原因是真正实体与人为定义概念的哲学思维的混淆.提出应用直接描述真正实体的名称较凋亡更为可取.     

华生关怀理论在慢性病患者护理中的应用探索

随着我国经济的发展,人群中疾病谱和死因谱发生了重大变化。以心脑血管疾病、恶性肿瘤为代表的慢性病已成为严重威胁人们健康的公共卫生问题。慢性病的主要特点是病程长,迁延不愈,反复发作,它对人的共同影响有：身体功能、心理、社会生活等的影响。护理理论家华生提出关怀护理理论,关怀必须是护理人员结合科学与人文知识在与患者的互动关系中按照关怀的10个要素来完成,目标是帮助患者达到身体、心理及心灵更高程度的协调。本文介绍了关怀理论的主要内容、慢性病的特点,并通过实际病例应用阐述了关怀理论在慢性病患者临床护理中的应用。