Middlesex: A Pastoral Theological Reading

This article, written for the Group for New Directions in Pastoral Theology’s conference on the theme of “Emotion, Mood, and Temperament,” focuses on Middlesex, a Pulitzer Prize-winning novel by Jeffrey Eugenides, Professor of Creative Writing in the Lewis Center for the Arts at Princeton University. The novel, set in 20th century America and written as a fictional memoir, is a coming-of-age story of Cal/Calliope, a man with an intersex condition caused by 5-alpha-reductase deficiency. The mission statement of the Intersex Society of North America (ISNA) states that the organization is “devoted to systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female.” This essay employs the resources of pastoral theology to assist in the project of ending shame regarding intersex conditions by offering a pastoral theological reading of Middlesex. As such, this essay is an example of the discipline of pastoral theology being employed in the field of medical humanities in particular and the field of clinical humanities more broadly, and it also serves as an example as to how one might offer a pastoral theological reading of a novel.     

The professional ethics course

A professional ethics program was recently developed and implemented as a comparative values course at the University of Puget Sound. This article is a report ontheprogram, “Professional Ethics fora Technological Era.”The program consists of two courses: “Ethics for a Technological Era,” and “Values: Conflict and Compromise.” The first course emphasizes skills necessary for ethical decision making. The second course follows through with an opportunity to apply these skills to a major social policy program. This article discusses the approach to ethics, and participation, and the theoretical approach, including role modeling, speakers, and reading and discussion material, for “Professional Ethics in a Technological Era.”     

A report on the development and prospects of Medical Psychology in the Federal Republic of Germany

For eight years Medical Psychology has been an integral part of medical pre-examination as well as of research and teaching in the Federal Republic of Germany, and a great deal of psychological knowledge is taught to the medical student under this heading. Besides mere theory the medical student is supposed to acquire behavior based on psychological findings which will be important to him in medical practice. Nevertheless, students often complain that teaching is too far from reality, due to the fact that Medical Psychology is part of the first, more theoretical, period of medical eduction, even though one of the main objects of this new field is the analysis of the interaction between patient and physician.     

Rethinking Medical Humanities

This paper questions different conceptions of Medical Humanities in order to provide a clearer understanding of what they are and why they matter. Building upon former attempts, we defend a conception of Medical Humanities as a humanistic problem-based approach to medicine aiming at influencing its nature and practice. In particular, we discuss three main conceptual issues regarding the overall nature of this discipline: (i) a problem-driven approach to Medical Humanities; (ii) the need for an integration of Medical Humanities into medicine; (iii) the methodological requirements that could render Medical Humanities an effective framework for medical decision-making.     

See me,hear me: Using film in health-care classes

This essay argues that film deserves a place within the medical humanities curriculum and demonstrates effective strategies for employing it within medical ethics and humanities classrooms. Part One of the article emphasizes how and why medical ethics teachers can utilize documentary and fictional films, such as “Thomas Szasz and the Myth of Mental Illness,” “The Deadly Deception,”Whose Life Is It Anyway? and “Voices From the Front” in their courses. Such films encourage students to move beyond abstract debates and confront the human pain inherent in all ethical dilemmas. Part Two focuses on documentary and fiction film in the medical humanities classroom. In this section, the author details how to incorporates films, such asThe Doctor, The Waterdance andHospital, into the humanities classroom, juxtaposing them with various literary works, such asOther Women's Children, Borrowed Time, andCeremony. Part Three of the essay presents a detailed discussion ofThe Elephant Man andFrankenstein, illustrating how visual and literary texts compliment each other within the humanities classroom. Overall, the author demonstrates how films function as engaging and complex visual texts providing unique insights in the particularities of American health care and, as such, can become valuable components within medical ethics and humanities classrooms.     

NLSDBA: The National Longitudinal surveys on compact disk

The National Longitudinal Survey of Labor Market Experience of Youth (NLSY) is an ongoing study of 12,686 young men and women who were aged 14 to 21 as of January 1, 1979. Over the years, the respondents have answered a wide variety of over 26,000 questions about their work experience, military experience, training, schooling, family background, marital status, income and assets, health, fertility, child care, and drug and alcohol abuse. The data from the survey are available on CD-ROM. This paper briefly describes the data set and how it may be accessed.     

Personal computer software for teaching differential psychodiagnostics

The third edition of theDiagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980), outlines for the student what symptoms to consider when attempting to arrive at an accurate differential diagnosis of eight broad psychiatric categories. This paper describes a program developed to instruct a medical or graduate student in the science of such decision making.     

Reflections of a reluctant clinical ethicist: Ethics consultation and the collapse of critical distance

The obvious appeal and growing momentum of clinical ethics in academic medical centers should not blind us to a potential danger: the collapse of critical distance. The very integration into the clinical milieu and the processes of clinical decision making, that clinical ethics claims as its greatest success, carries the seeds of a dilution of ethics' critical stance toward medicine and medical education. The purpose of this paper is to suggest how this might occur, and what potential contributions of ethics to medicine might be sacrificed as a result. Medical sociology will be used for comparison. Sociologists have found that they may function either as students and critics of established medical practices and educational philosophies, or as collaborative participants in them — but rarely both. It may be that professional ethics is most effective when it plays the role of stranger rather than insider, and is continually able to question the most basic assumptions and values of the enterprise with which it is associated. As with medical sociology, ethics and humanities must ask to what extent their desire for acceptance in the clinic requires their acceptance of the clinic: specifically, acceptance of basic assumptions about optimal ways of organizing medical education, socializing physicians-in-training, providing care, and even of defining medical ethics itself. The paper concludes by recommending that ethics reassert its strangeness in the medical milieu even as it assumes a more prominent role within the medical center.     

The influence of gender on the frequency of pain and sedative medication administered to postoperative patients

This study examines whether the frequency of pain and sedative medication administered to postoperative coronary artery bypass graft (CABG) patients differs according to patient gender. It was hypothesized that nurses medicate patients with pain medication more frequently if they are men than if they are women. It was also hypothesized that nurses medicate female patients with sedative medication more frequently than male patients. The hypotheses in this study were based on a review of the literature indicating that health care professionals hold stereotypic views of women as emotionally labile and more apt to exaggerate complaints of pain than men. The medication records of 30 male and 30 female patients between 44–71 years of age, who had undergone recent CABG surgery, were evaluated in this study. Male and female patients were matched on the basis of age, number of grafts completed in surgery, and location of graft donor sites. All data were obtained through the use of medical records to allow for control of patients' current and past medical history. The frequency of pain and sedative medication administered to these patients from 12 hours postop to 72 hours postop was compared. The results revealed that male patients were administered pain medication significantly more frequently than female patients, and that female patients were administered sedative medication significantly more frequently than male patients. Also, patients 61 years or younger received pain medication significantly more frequently than those patients 62 years and over.     

The Effect of Genetic Counseling for Adult Offspring of Patients with Type 2 Diabetes on Attitudes Toward Diabetes and its Heredity: A Randomized Controlled Trial

The aim of this study is to investigate the effect of diabetes genetic counseling on attitudes toward diabetes and its heredity in relatives of type 2 diabetes patients. This study was an unmasked, randomized controlled trial at a medical check-up center in Japan. Subjects in this study are healthy adults between 30 and 60 years of age who have a family history of type 2 diabetes in their first degree relatives. Participants in the intervention group received a brief genetic counseling session for approximately 10 min. Genetic counseling was structured based on the Health Belief Model. Both intervention and control groups received a booklet for general diabetes prevention. Risk perception and recognition of diabetes, and attitude towards its prevention were measured at baseline, 1 week and 1 year after genetic counseling. Participants who received genetic counseling showed significantly higher recognition about their sense of control over diabetes onset than control group both at 1 week and 1 year after the session. On the other hand, anxiety about diabetes did not change significantly. The findings show that genetic counseling for diabetes at a medical check center helped adults with diabetes family history understand they are able to exert control over the onset of their disease through lifestyle modification.     

Supererogation in an Ethics of Care

Most philosophers who advance an ethics of care do not claim that their theories are meant to account for all of morality, or that they can, or should, replace the traditional Western philosophical approaches to moral theory. However, one care ethicist, Michael Slote, holds that his theory can be used to understand all of individual and political morality. Moreover, while Kantianism, utilitarianism, and both ancient and contemporary Aristotelian ethics are all uncomfortable with supererogation and are typically committed to assumptions that rule out the possibility of someone acting beyond the call of duty, Slote claims that the way in which his theory accommodates supererogation constitutes a real advantage over other approaches to ethics. My aim in this paper is to cast doubt on the truth of this claim by showing that Slote’s theory has considerable difficulty accommodating supererogation.     

The Environmental Ethics of Fan Ruiping’s Revisionist Confucianism

Fan Ruiping is engaged in a wide-ranging project to reconstruct Confucianism for the contemporary period. It includes his sustained attack on John Rawls’ theory of distributive justice, various Chinese policies and practices on the delivery of health and elder care, and global business ethics. This paper describes his revised Confucian understanding of environmental morality under the metaphor of nature as garden and man as gardener. I argue the current state of this effort is in need of a more robust appropriation of Chinese sources and a greater attention to comparative analogues using the garden metaphor. I conclude with some suggestions that might advance this specific aspect of his project.     

Dying: A universal human experience?

This paper explores the question, “Is there a universal psychological experience suffered by all dying persons?” a question to which the popular theory of Kübler-Ross presupposes an affirmative answer. Our answer takes three steps: first, a comparison between the Kübler-Ross model of dying and that of the late medievalBook of the Craft of Dying centered upon the five Kübler-Ross “stages”; second, a philosophical critique of the terms of this comparison; and third, a revised look at the alleged similarities between the two models, providing a deeper look at the moral and spiritual assumptions behind each.     

Stability and Change of ODD,CD and ADHD Diagnosis in Referred Preschool Children

Longitudinal studies have shown that preschool children’s diagnosis of Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are likely to persist into school age. However, limited attention has been paid to instability of diagnosis. The aim of the present study, therefore, was to investigate both stability and change of ODD, CD and ADHD diagnosis in children aged 3.5–5.5 years. For diagnosing these disorders, a semi-structured diagnostic parent interview, i.e., the Kiddie-Disruptive Behavior Disorder Schedule (K-DBDS), was used at the first assessment and at follow-up assessments (9 and 18 months). Five diagnostic stability groups (chronic, partial remission, full remission, new onset, no diagnosis) were compared with regard to impairment and number of symptoms. Participants were referred preschool children with externalizing behavioral problems (N?=?193; 83 % male) and typically developing (TD) children (N?=?58; 71 % male). Follow-up assessments allowed to distinguish children belonging to the chronic group of ODD, CD or ADHD from those belonging to one of the remission groups. In addition, there was a substantial number of children with a new onset diagnosis. In conclusion, as a complement to studies showing stability of ODD, CD and ADHD diagnosis into school age, present findings point to changes of diagnosis in the preschool and early school period. Diagnostic reassessments therefore are needed in this age group.     

Impact of Sluggish Cognitive Tempo and Attention-Deficit/Hyperactivity Disorder Symptoms on Adults’ Quality of Life

The symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) have been linked to dysfunction in numerous life domains for both children and adults. As such, it is likely that individuals with these and other related symptoms (e.g., sluggish cognitive tempo, SCT) may also experience impaired quality of life. The current study examines the association between ADHD and SCT symptoms and quality of life (QOL) in a community sample of adults. Quality of life data collected from 983 participants (M age = 45.6 years) were analyzed primarily through a series of hierarchical multiple regressions employing SCT and ADHD symptom clusters, demographic, and anxiety and depression scale variables as predictors. Results generally supported the hypothesis that ADHD and SCT symptoms would negatively associate with QOL. Amongst the indicators, inattention and SCT emerged as the strongest predictors of low QOL. These findings underscore the negative impact of ADHD symptoms in adulthood, the independent contribution of SCT, and the importance of considering QOL in prospective research and intervention.     

The Role of the Humanities and Social Sciences in Nanotechnology Research and Development

The experience with genetically modified foods has been prominent in motivating science, industry and regulatory bodies to address the social and ethical dimensions of nanotechnology. The overall objective is to gain the general public’s acceptance of nanotechnology in order not to provoke a consumer boycott as it happened with genetically modified foods. It is stated implicitly in reports on nanotechnology research and development that this acceptance depends on the public’s confidence in the technology and that the confidence is created on the basis of information, education, openness and debate about scientific and technological developments. Hence, it is assumed that informing and educating the public will create trust, which will consequently lead to an acceptance of nanotechnology. Thus, the humanities and social sciences are seen as tools to achieve public acceptance. In this paper, the author argues that this is a narrow apprehension of the role of the humanities and social sciences. The humanities and social sciences have a critical function asking fundamental questions and informing the public about these reflections. This may lead to scepticism, however, the motivation for addressing the social and ethical dimensions of nanotechnology should not be public acceptance but informed judgement. The author illustrates this critical function by discussing the role, motivation and contribution of ethics as an example. Lastly, the author shows that a possible strategy for incorporating the humanities and the social sciences into nanotechnology research and development is Real-Time Technology Assessment, where the purpose is to integrate natural science and engineering investigations with ethical, legal and social science from the outset.