Resistance and adherence to the norms of genetic counseling

Genetic counseling for women of advanced maternal age who are considering prenatal testing continues to be based on a principle of nondirectiveness. We interviewed 11 genetic counseling students and four counselors about how they experience and manage, in practice, the tensions between the ideology of nondirectiveness and the acknowledged reality that one can never be truly nondirective. We found that our respondents creatively resolve this tension—simultaneously resisting and adhering to the values of nondirectiveness and information-giving—in individual and situation-specific ways. This resolution is facilitated by the extent to which information given to counselees is fluid, mobile and context-dependent, but these very features of information also have critical implications for both the norms and the practice of genetic counseling.     

Yes,Virginia, Lemons are Yellow

This paper discusses a number of themes and arguments in The Quest for Reality: Stroud's distinction between philosophical and ordinary questions about reality; the similarity he finds between the view that coloris unreal and the view that it is subjective; his argument against thesecondary quality theory; his argument against the error theory; and the disappointing conclusion of the book.     

From <Emphasis Type="Italic">Pintele Yid to Racenjude</Emphasis>: Chaim Zhitlovsky and racial conceptions of Jewishness

The Russian Jewish intellectual, Chaim Zhitlovsky (1865–1943), a leading architect of secular Jewish culture and thought, was a central figure in the progressive Jewish intelligentsia of the late nineteenth and early twentieth century. In an essay written in 1927, Yidn un Yiddishkayt (Jews and Jewishness), he sought to define the secular essence of what he calls Yiddishkayt. This essay is not the first in Zhitlovskys long publicistic career in which he searches for new, secular definitions of Jewish identity and culture. But this essay differs, since it is marked by Zhitlovskys use of contemporary social scientific notions of race and racial traits to conceptualize what he believes constitutes Jewishness in a non-religious context, along with his adoption of the mystical Jewish concept of the pintele yid, the theory of an innate Jewishness embodied by a Jewish spark. Zhitlovskys desire to craft a truly secular theory of Jewish identity led him ironically to accept models of Jewish identity at odds with his stated larger vision. In turning to contemporary racial theory, as well as long nurtured mystical models of Yiddishkayt, Zhitlovsky reveals the wide range of ideological discourses that led him to innovative and controversial notions of modern Jewish identity.     

Development of the Critical Elements of Genetic Evaluation and Genetic Counseling for Genetic Professionals and Perinatologists in Washington State

We present a method for the development of consensus documents describing the components of genetic evaluation and genetic counseling for various diagnoses. These documents were developed to encourage consistency among genetic professionals in Washington State. Other possible uses of these documents are to provide information regarding genetic evaluations for health care practitioners and payers, and to assist in quality assurance and genetic training programs. A working group of six genetic professionals developed two templates for the critical elements of genetic evaluation and genetic counseling, for clinical (nonprenatal) and prenatal patients. The working group then completed prototype templates for several specific genetic disorders. The templates and prototypes were sent to interested genetic professionals and perinatologists who submitted a total of 76 draft critical elements (CE's) to the working group. At two statewide meetings, participating practitioners modified and unanimously approved the CE templates, then unanimously approved the 21 draft CEs that had been finalized in small group discussions. Approved CE's were distributed to genetic professionals and perinatologists within the state.     

What Predicts the Use of Genetic Counseling Services After the Birth of a Child with Down Syndrome?

In the state of Victoria, Australia, a government funded genetic counseling service exists to meet the needs of families. An audit showed that many families do not use this service after the birth of a child with a genetic problem. To investigate this we surveyed families of children born with Down syndrome over 2 years in Victoria. Questionnaires were completed by 74 mothers, of whom only 18 had received genetic counseling between the birth and the time of the study (mean 3.5 years). Of those not receiving genetic counseling, 71% said they were not offered or had not heard of it. Mothers who had genetic counseling were younger than those who had not, and were more likely to have attended University. Those who had genetic counseling indicated less satisfaction with care at the diagnosis and were more likely to perceive their child as unwell at birth than those who were aware of genetic counseling but did not have it. Of those who did not have genetic counseling, over half were unclear about what it is, although 74% agreed with the statement genetic counseling is most useful when planning to have another child. Of those who had heard of genetic counseling, 73% said they were not sure how it could help. Many families with children with Down syndrome are not aware of the existence or functions of genetic counseling. With greater awareness, some may still choose not to have genetic counseling, but others enunciated needs that could be met by this service if it were offered to them.     

Issues in Pastoral Care and Counseling for the Fourth Quarter of Life

Issues and risks for pastoral care and counseling from the perspective of old age (here, ages 75 to 100) include identification of old age as a problem and its association with death in a death-denying culture. Two elements are fundamental: existential experiential deficits between the old and their younger caregivers (e.g., age cohort experiences, health status, gender, culture, privilege, etc.); and boundary issues that push the old, and pastoral care, to the edge of experience, where choices must be made between creativity and negativity (e.g., moving to dependent living, disability, etc.). Loss of doing (versus being) as a viable option is a major edge experience. The resulting sense of emptiness carries with it the potential for a sacramental awareness in which absence of doing becomes an outward and visible sign of an inward and spiritual grace.     

The Hard Issues of Life

In pastoral counseling, the practitioner and client face the most difficult human problems. An authentic encounter and subsequent connection with one's fundamental Being often occurs, creating a direct existential knowing of what is. Because there are no directions or steps in a protocol to follow in this process, it is helpful for the client to reframe his/her existential search for Being as a Rite of Passage, comprising three distinct, but not separate stages—the separation phase, the initiation phase, and the return or integration phase. Such a process permits the individual a realization of what is through his/her own life circumstances, as a meaningful progression of spiritual growth.decorated Vietnam combat veteran and a marriage, family, and child counselor specializing in treatment of PTSD     

Threat to Parental Role: A Possible Mechanism of Altered Self-Concept Related to Carrier Knowledge

Researchers and clinicians have suggested that learning one is a carrier for a genetic disorder has the potential to alter self-concept. Concerns about self-concept have influenced the development of policies regarding the availability of carrier testing for minors and the informed-consent process. A literature review identified three mechanisms through which self-concept has been proposed to be affected: altered perception of genetic identity, diminished social identity, and an altered perception of health. This paper presents a conceptual framework developed from identity theory and the self's response to threat to propose a fourth mechanism: threat to the parental role. Clarification of the role of self-concept, the threat to self-concept related to carrier knowledge, and coping behaviors activated in response to this threat would help to target appropriate genetic counseling interventions.     

Lay understanding of genetic disease: A British study of families attending a genetic counseling service

Although lay people know that various diseases can be inherited, the idea that unhealthy life styles are the crucial cause of ill health has been promoted by health education policy in the United Kingdom. However, a new paradigm seems to be developing. The medical profession is increasingly using genetics to explain ill health, and people are being referred to geneticists for information and counseling. Lay conceptions of genetic disease emerged during this qualitative study of the process of genetic counseling. The results reported in this paper suggest that many lay people lack knowledge of genetics and inheritance, and that there is considerable stigma attached to genetic disease. Misconceptions and fears may not always be recognized or resolved during the process of genetic counseling. The implications of such misunderstandings and beliefs are considered in this paper.     

Theological and Biblical Interpretations of Current Movements and Emerging Paradigms Within Bereavement Studies

Among the predominant themes in the last few years of bereavement studies have been those around disenfranchised grief, masculine grief, spirituality and grief, and the movement from medical/hierarchical models of grief work/counseling to a more non-hierarchical model that emerges internally, inherently, and intrinsically within the bereaved. In the latter model the grief counselor becomes a facilitator or, as Alan Wolfelt noted at the Chicago ADEC conference, a companioning presence. The intent of this article is to take this conversation into the realm of theology, and/or biblical theology. The following offers theological analysis of what is already good clinical theory. Integrating theories from anthropology and theology, this article will explore the concepts of voice, etic and emic theory, and incarnational theology as they relate to emerging patterns in bereavement studies. It will also relate a model of the Kingdom of God to disenfranchised grief, as well as offer support for the theory of masculine grief from biblical sources and complementary fields of study.     

Objectively reliable subjective probabilities

Subjective Bayesians typically find the following objection difficult to answer: some joint probability measures lead to intuitively irrational inductive behavior, even in the long run. Yet well-motivated ways to restrict the set of reasonable prior joint measures have not been forthcoming. In this paper I propose a way to restrict the set of prior joint probability measures in particular inductive settings. My proposal is the following: where there exists some successful inductive method for getting to the truth in some situation, we ought to employ a (joint) probability measure that is inductively successful in that situation, if such a measure exists. In order to do show that the restriction is possible to meet in a broad class of cases, I prove a Bayesian Completeness Theorem, which says that for any solvable inductive problem of a certain broad type, there exist probability measures that a Bayesian could use to solve the problem. I then briefly compare the merits of my proposal with two other well-known proposals for constraining the class of admissible subjective probability measures, the leave the door ajar condition and the maximize entropy condition.The author owes special thanks to Kevin Kelly, for a number of helpful ideas for the proof of the Bayesian Completeness Theorem, as well as other aspects of the paper. Thanks also to Clark Glymour for some helpful suggestions for improvement of an earlier draft. Part of the work leading to this paper was funded by a Summer Research Grant from the University Research Institute of the University of Texas at Austin.     

Formalization of the basic concepts of animal ecology

Summary Formal definitions of the following concepts of animal ecology are given: environment, niche, locality, local population, natural population, community, ecosystem. Five primitive (undefined) notions are used including animal, offspring and habitat, the latter in the sense of Charles Elton. The defining equations for the environment of one animal are first given, then niche (in the Elton sense) is formally defined in terms of the environment. The fifth primitve notion habitat is then introduced in order to define the remaining concepts.     

Maturing Religious Experience and the Postmodern Self

Past attempts to define mature religion have been rooted in a modernist theological anthropology which assumes an atomistic, universal, rational, and stable human self. Yet postmodernists resist universal statements about humanity and understand the self as an ever-changing social construct. This paper suggests a theological anthropology more adequate to the postmodern world, examines maturing religious experience from this perspective, and considers ways pastoral care/counseling can nurture healthy, integrative, and maturing Christian faith in postmodern culture.     

Exploitation via labour power in Marx

Marx's account of capitalist exploitation is undermined by inter-related confusions surrounding the notion of labour power. These confusions relate to [i] what labour power is, [ii] what happens to labour power in the labour market, and [iii] what the epistemic status of labour power is (the issue of appearance and reality). The central theses of the paper are [a] that property ownership is the wrong model for understanding the exploitation of labour, and [b] that the concept of exploitation is linked more fruitfully to a conception of distributive injustice than to Marx's theory of surplus value.     

All That Glitters Is Not Gold: Bad Forgiveness in Counseling and Preaching

A 3 R's of Forgiveness model is presented in which forgiveness is seen as a complex therapeutic process involving both situational and personal variables. Forgivers are seen to utilize the cognitive processes of dialectical reasoning and reframing, modulated by the emotional experiences of empathy, guilt, and shame. Personality style and self-esteem significantly influence the process as well. Distinctions are maintained among various kinds of forgiveness. Divine forgiveness, seen as a partial component of a spiritual encounter with one's God, may be a valid experience for people of faith, but is not something that psychologists are equipped to experimentally analyze. Interpersonal and intrapsychic varieties of forgiveness are more accessible to therapists and deserve empirical investigation. Important differences are highlighted between conjunctive forgiveness (where the third R in the forgiveness sequence is reconciliation) and disjunctive forgiveness )where the third R is release). Pastors are reminded that, depending on the circumstances, forgiveness can be either good or bad.     

The pastor as enabler

Out of a personal struggle to understand and help a chronically ill friend the writer evolves a view of the pastor as enabler. The definition of enable, the role of the enabler, and the problems which prevent many from being enabled, are discussed. These definitions are illuminated by the Biblical perspective of Elihu in the book ofJob. The pastor who sees himself as enabler is able to bring perspective, clarity, empathy, compassion, and concrete help to the person in need.Chaplain Rusnak is a graduate of The Luthern School of Theology at Chicago.     

"Solar love": Nietzsche,Merleau-Ponty and the fortunes of perception

Both Nietzsche and Merleau-Ponty repudiate the mirror view of perception and embrace what Nietzsche refers to as solar love or creative perception. I argue that Merleau-Ponty thinks of this type of perception primarily in terms of convergence and Nietzsche in terms of divergence. I then show how, contrary to their own emphases, Merleau-Ponty's notion of flesh and Nietzsche's idea of chaos suggest that convergence and divergence are abstractions from an ontologically prior realm of hybrid perceptions. In this realm, each perception is shot through with the others, simultaneously inside and outside one another. The creative tension among these perceptions continually produces new perspectives or voices, that is, a realm whose very being is metamorphosis. Moreover, this realm of hybrid perceptions suggests a political principle that might prove attractive for communities in an age of diversity and cultural hybridity.     

Moral Responsibility, Determinism, and the Ability to do Otherwise

In his classic paper, The Principle of Alternate Possibilities, Harry Frankfurt presented counterexamples to the principle named in his title: A person is morally responsible for what he has done only if he could have done otherwise. He went on to argue that the falsity of the Principle of Alternate Possibilities (PAP) implied that the debate between the compatibilists and the incompatibilists (as regards determinism and the ability to do otherwise) did not have the significance that both parties had attributed to it -- since moral responsibility could exist even if no one was able to do otherwise. I have argued that even if PAP is false, there are other principles that imply that moral responsibility entails the ability to do otherwise, and that these principles are immune to Frankfurt-style counterexamples. Frankfurt has attempted to show that my arguments for this conclusion fail. This paper is a rejoinder to that reply; I argue that he has failed to show this.     

“Paramount reality” in Schutz and Gurwitsch

Conclusion Both Schutz and Gurwitsch describe reality as having a manifold character: Schutz speaks of multiple realities and Gurwitsch of orders of existence. Both hold that one realm of reality has a privileged status compared to the others: common everyday experience. However, in spite of this apparent convergence in their views, a closer reading of their various works reveal the important difference in what they understand under common everyday experience.For Schutz, it is the world of social action, characterized by him as paramount reality because of the constitutive processes of the experiences of time, space, sociality and meaning involved in action. For Gurwitsch, the realm of common everyday experience represents the counterpart and the origin of the constructed realm of science: therein lies its status of paramount reality. But what it really refers to is not ordinary experience, as most of his statements suggest, but pre-predicative experience, wherefrom the categories of the natural sciences, namely space and time, originate. Gurwitsch speaks of this pre-predicative experience, which he also calls primordial experience, as being essentially perceptual experience. However, he limits perceptual experience to sensory perception, leaving out the symbolic, social and action-related components of perception and becomes thus inconsistent with his adherence to the dismissal of the constancy hypothesis in his field theory of consciousness. The dismissal of the constancy hypothesis implies the recognition of the appresentational structures involving symbols, action and Others as inherent components of every perception. Schutz disagrees with Gurwitsch's reduction of the life-world Erlebnisse to sensory perception and this issue becomes the core of their debate on the phenomenon of paramount reality.     

Power,Freedom, and Individuality: Foucault and Sexual Difference

This paper offers a detailed account of Foucaults ethical and political notion of individuality as presented in his late work, and discusses its relationship to the feminist project of the theory of sexual difference. I argue that Foucaults elaboration of the classical ethos of care for the self opens the way for regarding the I-woman as an ethical, political and aesthetic self-creation. However, it has significant limitations that cannot be ignored. I elaborate on two aspects of Foucaults avoidance of sexual difference as a relevant category for an account of political and ethical individuality, which thus implicitly associates individual agency with men. I argue that Foucault implicitly assumes the existence of an ontological desire to become engaged in political self-creation. However, the ethical position of self-knowledge and desire should be understood as a contingent option that depends on material and historical conditions for its realization. Hence, I argue that a feminist reworking of Foucaults notion of political individuality should add a substantial ethical condition to the imperative of self-knowledge and self-creation – making possible the desiring woman subject.