The right to practice medicine without repercussions: ethical issues in times of political strife

ABSTRACT: This commentary examines the incursion on the neutrality of medical personnel now taking place as part of the human rights crises in Bahrain and Syria, and the ethical dilemmas which these incursions place not only in front of physicians practicing in those nations, but in front of the international community as a whole.In Bahrain, physicians have recently received harsh prison terms, apparently for treating demonstrators who clashed with government forces. In Syria, physicians are under the same political pressure to avoid treating political demonstrators or to act as informants against their own patients, turning them in to government authorities. This pressure has been severe, to the point that some physicians have become complicit in the abuse of patients who were also political demonstrators.This paper posits that physicians in certain countries in the Middle East during the "Arab Spring," specifically Syria and Bahrain, are being used as both political pawns and political weapons in clear violation of Geneva Convention and World Medical Association guidelines, and that this puts them into the most extreme sort of "dual loyalty" dilemma. They are being forced to choose between their own safety and well-being and that of their patients -- a negative sum scenario wherein there is no optimal choice. As such, an international call for a United Nations inquiry must be made in order to protect the neutrality of medical care and personnel during times of armed conflict.     

The absence of cruelty is not the presence of humanness: physicians and the death penalty in the United States

The death penalty by lethal injection is a legal punishment in the United States. Sodium Thiopental, once used in the death penalty cocktail, is no longer available for use in the United States as a consequence of this association. Anesthesiologists possess knowledge of Sodium Thiopental and possible chemical alternatives. Further, lethal injection has the look and feel of a medical act thereby encouraging physician participation and comment. Concern has been raised that the death penalty by lethal injection, is cruel. Physicians are ethically directed to prevent cruelty within the doctor-patient relationship and ethically prohibited from participation in any component of the death penalty. The US Supreme Court ruled that the death penalty is not cruel per se and is not in conflict with the 8th amendment of the US constitution. If the death penalty is not cruel, it requires no further refinement. If, on the other hand, the death penalty is in fact cruel, physicians have no mandate outside of the doctor patient relationship to reduce cruelty. Any intervention in the name of cruelty reduction, in the setting of lethal injection, does not lead to a more humane form of punishment. If physicians contend that the death penalty can be botched, they wrongly direct that it can be improved. The death penalty cocktail, as a method to reduce suffering during execution, is an unverifiable claim. At best, anesthetics produce an outward appearance of calmness only and do not address suffering as a consequence of the anticipation of death on the part of the condemned.     

Konzeption zum Umgang mit rückfallgef?hrdeten Sexualstraft?tern (KURS NRW)

The concept of the management of sexual offenders at risk for recidivism in Northrhine-Wesfalia (Konzeption zumUmgang mitrückfallgef?hrdetenSexualstraft?tern in Nordrhein-Westfalen, KURS NRW) came into effect on February 1, 2010 with a joint circular of the Ministries of Justice, Health and the Interior. Thereby Northrhine-Westfalia has created a systematic for monitoring sexual offenders at risk for recidivism, comparable to those already or in the meantime developed in other federal states in Germany. This article initially describes the procedural nature underlying the KURS concept, regarding mutual information routing and collaboration between the parties involved, i.e. justice, hospital order treatment, police and if necessary others as well. In addition, the framework in which KURS is ingrained, will be shown. Based on case reports this article will finally explain how actions and reactions will be specified in case conferences. Within the systematic KURS it is important that all participants reach all relevant information expeditiously, thus being able to react within their own jurisdiction. When planning actions it is essential to carefully consider the individual case parameters. Within the case conferences it remains a strength of the KURS concept that different perspectives of the case and the offender are bundled together. Ideally this and the case-specific actions will help to avoid similar offences to those committed previously.     

Modesty and style in Islamic attire: Refashioning Muslim garments in a Western context

My ethnographic fieldwork conducted with female converts to Islam in France and in Quebec (Canada) shows that, for these women, being Muslim does not necessarily mean wearing clothes with ‘oriental’ designs. Rather, they are starting their own clothing companies so as to produce distinct Muslim-Western fashions that they promote through the Internet. By interpreting Islam in a context where Muslims are a minority religious group, converts construct alternative religious and social representations of Muslim identity that accord with their feminist interpretation of the Qu’ran while simultaneously incorporating the Western background within which they were socialized. In this regard, the strategies that they develop for wearing the veil and for integrating into their environment (family, workplace, etc.) make it clear that fashion, religion and politics are interacting in multiple, creative ways. In this paper, I look at how new Muslim feminist subjectivities are produced and realized through habits of dress, resulting in new representations of the body. I explore this issue by considering dress and hairstyle strategies developed by Muslim converts, in order to examine new perspectives on the place of gender in religion as it relates to particular social contexts.     

Music training enhances the rapid plasticity of P3a/P3b event-related brain potentials for unattended and attended target sounds

Neurocognitive studies have shown that extensive musical training enhances P3a and P3b event-related potentials for infrequent target sounds, which reflects stronger attention switching and stimulus evaluation in musicians than in nonmusicians. However, it is unknown whether the short-term plasticity of P3a and P3b responses is also enhanced in musicians. We compared the short-term plasticity of P3a and P3b responses to infrequent target sounds in musicians and nonmusicians during auditory perceptual learning tasks. Target sounds, deviating in location, pitch, and duration with three difficulty levels, were interspersed among frequently presented standard sounds in an oddball paradigm. We found that during passive exposure to sounds, musicians had habituation of the P3a, while nonmusicians showed enhancement of the P3a between blocks. Between active tasks, P3b amplitudes for duration deviants were reduced (habituated) in musicians only, and showed a more posterior scalp topography for habituation when compared to P3bs of nonmusicians. In both groups, the P3a and P3b latencies were shortened for deviating sounds. Also, musicians were better than nonmusicians at discriminating target deviants. Regardless of musical training, better discrimination was associated with higher working memory capacity. We concluded that music training enhances short-term P3a/P3b plasticity, indicating training-induced changes in attentional skills.     

Sustained attention, attentional selectivity, and attentional capacity across the lifespan

Changes in sustained attention, attentional selectivity, and attentional capacity were examined in a sample of 113 participants between the ages of 12 and 75. To measure sustained attention, we employed the sustained-attention-to-response task (Robertson, Manly, Andrade, Baddeley, & Yiend, Neuropsychologia 35:747?C58, 1997), a short continuous-performance test designed to capture fluctuations in sustained attention. To measure attentional selectivity and capacity, we employed a paradigm based on the theory of visual attention (Bundesen, Psychological Review 97:523?C547, 1990), which enabled the estimation of parameters related to attentional selection, perceptual threshold, visual short-term memory capacity, and processing capacity. We found evidence of age-related decline in each of the measured variables, but the declines varied markedly in terms of magnitude and lifespan trajectory. Variables relating to attentional capacity showed declines of very large effect sizes, while variables relating to attentional selectivity and sustained attention showed declines of medium to large effect sizes, suggesting that attentional control is relatively preserved in older adults. The variables relating to sustained attention followed a U-shaped, curvilinear trend, and the variables relating to attentional selectivity and capacity showed linear decline from early adulthood, providing further support for the differentiation of attentional functions.     

Magnitude of force perception errors during static contractions of the knee extensors in healthy young and elderly individuals

The accuracy of force perception during muscular contraction has not been studied extensively, despite its importance in rehabilitation and training. The purpose of this study was to quantify the errors made by healthy young and elderly individuals in their perceptions of force produced at the knee. Four different tasks were used to evaluate the perception of force and the effect of a sensory-motor reference and simultaneous contraction on the accuracy of perception. The absolute errors were similar between groups, with values of 11.9% to 16.3%, depending on the task. The raw perception errors were greater for high levels of force (>50% of the maximal voluntary contraction, or MVC), indicating an overestimation of the forces produced for both groups. At 70% MVC, the sensory-motor reference reduced raw perception errors, and the simultaneous contraction improved the accuracy of force production. Healthy young and elderly individuals had about the same capacity to judge the muscular force of their knee extensors. Therapists involved in the training of active?elderly?individuals should be aware that the accuracy of force perception is not perfect and that these clients have the same ability as young individuals to perceive their knee extension strength.     

When emotional valence modulates audiovisual integration

We constantly integrate the information that is available to our various senses. The extent to which the mechanisms of multisensory integration are subject to the influences of attention, emotion, and/or motivation is currently unknown. The ??ventriloquist effect?? is widely assumed to be an automatic crossmodal phenomenon, shifting the perceived location of an auditory stimulus toward a concurrently presented visual stimulus. In the present study, we examined whether audiovisual binding, as indicated by the magnitude of the ventriloquist effect, is influenced by threatening auditory stimuli presented prior to the ventriloquist experiment. Syllables spoken in a fearful voice were presented from one of eight loudspeakers, while syllables spoken in a neutral voice were presented from the other seven locations. Subsequently, participants had to localize pure tones while trying to ignore concurrent visual stimuli (both the auditory and the visual stimuli here were emotionally neutral). A reliable ventriloquist effect was observed. The emotional stimulus manipulation resulted in a reduction of the magnitude of the subsequently measured ventriloquist effect in both hemifields, as compared to a control group exposed to a similar attention-capturing, but nonemotional, manipulation. These results suggest that the emotional system is capable of influencing multisensory binding processes that have heretofore been considered automatic.     

Perceiving performer identity and intended expression intensity in point-light displays of dance

This study investigated agent and expression intensity recognition in point-light displays depicting dancing performances. In a first session, participants danced with two different expression intensities to music, solo or in dyads. In a subsequent session, they watched point-light displays of 1–5-s duration, depicting their own, their partner’s or another participant’s recorded actions, and were asked to identify the agent (self vs. partner vs. stranger) and the intended expression intensity (expressive vs. inexpressive) of the performer. The results indicate that performer identity and expression intensity could be discerned reliably from displays as short as 1 s. The accuracy in judgment increased with exposure duration and, for performer identification, with higher expression intensity. Judgment accuracy in agent and expression intensity recognition tasks correlated with self-report empathy indices. Accuracy correlated also with confidence in judgment, but only in the intensity recognition task. The results are discussed in relation to perceptual and neural mechanisms underlying action and intention recognition.