Discourse on medicine: meditative and calculative approaches to ethics from an international perspective

Heidegger’s two modes of thinking, calculative and meditative, were used as the thematic basis for this qualitative study of physicians from seven countries (Canada, China, India, Ireland, Japan, Korea, & Thailand). Focus groups were conducted in each country with 69 physicians who cared for the elderly. Results suggest that physicians perceived ethical issues primarily through the lens of calculative thinking (76%) with emphasis on economic concerns. Meditative responses represented 24% of the statements and were mostly generated by Canadian physicians whose patients typically were not faced with economic barriers to treatment due to Canada’s universal health care system.     

Performance enhancement,elite athletes and anti doping governance: comparing human guinea pigs in pharmaceutical research and professional sports

In light of the World Anti Doping Agency’s 2013 Code Revision process, we critically explore the applicability of two of three criteria used to determine whether a method or substance should be considered for their Prohibited List, namely its (potential) performance enhancing effects and its (potential) risk to the health of the athlete. To do so, we compare two communities of human guinea pigs: (i) individuals who make a living out of serial participation in Phase 1 pharmacology trials; and (ii) elite athletes who engage in what is effectively ‘unregulated clinical research’ by using untested prohibited or non-prohibited performance enhancing substances and methods, alone or in combination. Our comparison sheds light on norms of research ethics that these practices exacerbate with respect to the concepts of multiplicity, visibility, and consistency. We argue for the need to establish a proper governance framework to increase the accountability of these unregulated research practices in order to protect the human guinea pigs in elite sports contexts, and to establish reasonable grounds for the performance enhancing effects, and the risks to the health of the athlete, of the methods and substances that might justify their inclusion on the Prohibited List.     

The phenomenological-existential comprehension of chronic pain: going beyond the standing healthcare models

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain.     

Informed consent in the psychosis prodrome: ethical,procedural and cultural considerations

Research focused on the prodromal period prior to the onset of psychosis is essential for the further development of strategies for early detection, early intervention, and disease pre-emption. Such efforts necessarily require the enrollment of individuals who are at risk of psychosis but have not yet developed a psychotic illness into research and treatment protocols. This work is becoming increasingly internationalized, which warrants special consideration of cultural differences in conceptualization of mental illness and international differences in health care practices and rights regarding research participation. The process of identifying and requesting informed consent from individuals at elevated risk for psychosis requires thoughtful communication about illness risk and often involves the participation of family members. Empirical studies of risk reasoning and decisional capacity in young people and individuals with psychosis suggest that most individuals who are at-risk for psychosis can adequately provide informed consent; however ongoing improvements to tools and procedures are important to ensure that this work proceeds with maximal consideration of relevant ethical issues. This review provides a discussion of these issues in the context of international research efforts.     

Assessment of perception of morphed facial expressions using the Emotion Recognition Task: Normative data from healthy participants aged 8–75

The ability to recognize and label emotional facial expressions is an important aspect of social cognition. However, existing paradigms to examine this ability present only static facial expressions, suffer from ceiling effects or have limited or no norms. A computerized test, the Emotion Recognition Task (ERT), was developed to overcome these difficulties. In this study, we examined the effects of age, sex, and intellectual ability on emotion perception using the ERT. In this test, emotional facial expressions are presented as morphs gradually expressing one of the six basic emotions from neutral to four levels of intensity (40%, 60%, 80%, and 100%). The task was administered in 373 healthy participants aged 8–75. In children aged 8–17, only small developmental effects were found for the emotions anger and happiness, in contrast to adults who showed age‐related decline on anger, fear, happiness, and sadness. Sex differences were present predominantly in the adult participants. IQ only minimally affected the perception of disgust in the children, while years of education were correlated with all emotions but surprise and disgust in the adult participants. A regression‐based approach was adopted to present age‐ and education‐ or IQ‐adjusted normative data for use in clinical practice. Previous studies using the ERT have demonstrated selective impairments on specific emotions in a variety of psychiatric, neurologic, or neurodegenerative patient groups, making the ERT a valuable addition to existing paradigms for the assessment of emotion perception.     

Has the sanctity of life law ‘gone too far’?: analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not ‘gone too far’

The medical profession consistently strives to uphold patient empowerment, equality and safety. It is ironic that now, at a time where advances in technology and knowledge have given us an increased capacity to preserve and prolong life, we find ourselves increasingly asking questions about the value of the lives we are saving. A recent editorial by Professor Raanan Gillon questions the emphasis that English law places on the sanctity of life doctrine. In what was described by Reverend Nick Donnelly as a “manifesto for killing patients”, Professor Gillon argues that the sanctity of life law has gone too far because of its disregard for distributive justice and an incompetent person’s previously declared autonomy. This review begins by outlining the stance of the sanctity of life doctrine on decisions about administering, withholding and withdrawing life-prolonging treatment. Using this as a foundation for a rebuttal, a proposal is made that Professor Gillon’s assertions do not take the following into account:

1. 1)
   A sanctity of life law does not exist since English Common Law infringes the sanctity doctrine by tolerating quality of life judgements and a doctor’s intention to hasten death when withdrawing life-prolonging treatment.
    
2. 2)
   Even if a true sanctity of life law did exist:

   1. a)
      The sanctity of life doctrine allows for resource considerations in the wider analysis of benefits and burdens.
       
   2. b)
      The sanctity of life doctrine yields to a competent person’s autonomous decision.
       
    

This review attempts to demonstrate that at present, and with the legal precedent that restricts it, a sanctity of life law cannot go too far.     

Older Workers with Disabilities: Job Satisfaction Differences in the Public and Private Sectors in Europe

This study analyzes the differences in job satisfaction of older European people (aged 50-64), with or without disabilities, who are employed in either the public or the private sector. Using the data taken from the Survey of Health, Ageing and Retirement in Europe (SHARE) for the years 2004, 2007 and 2011, job satisfaction equations are estimated for workers from both the public and private sectors, with panel data techniques that include variables related to the worker's degree of disability (nondisabled, non-limited disabled, and limited disabled), among others. The results show that the disabled workers who are limited in their everyday activities are less satisfied in both the public and private sectors than those who are non-disabled and non-limited. In addition, the levels of job satisfaction for non-limited disabled people are higher than their non-disabled counterparts but only in the public sector. From a point of view of public policies, it is necessary to design and undertake measures and actions that would contribute to improving the levels of job satisfaction of older workers with disabilities, especially among those who are limited in their everyday activities.     

Memory Acts: A Theory for the Study of Collective Memory in Everyday Life

History abounds in everyday life: It is in the discourse of the politician who makes a patriotic use of World War II, in the epic movie of medieval inspiration, in the latest museum opening in town, or in the magnet on your fridge that makes a humoristic use of advertisement posters from the 1950s. What tools can help us understand how history is used in these contexts, and with what purposes? And, more importantly perhaps, how to understand the effects these uses have on us? To answer these questions, this article proposes a framework to study the uses of collective memory in everyday life. After a short review of the history of collective memory, the concept of memory act is outlined, based on three theoretical traditions: James's pragmatism, Austin's speech acts, and Mead's social acts. They are used to argue that everyday uses of collective memory are better understood as intersubjective and discursive acts that are part of larger activities. Finally, some of the consequences of this theory are discussed.