Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

Attachment and the management of empathic accuracy in relationship-threatening situations

The current studies tested how attachment orientations are related to empathic accuracy (i.e., the accuracy with which one infers a partner's private thoughts and feelings) during attachment-relevant discussions. In Study 1, married couples were videotaped discussing a severe or a less severe relationship issue that involved intimacy or jealousy. In Study 2, dating couples were videotaped trying to resolve a relationship conflict. Consistent with the revised empathic accuracy model, highly avoidant individuals were less empathically accurate in both studies. Relative to less anxious persons, highly anxious individuals were more empathically accurate when discussing intimacy issues that posed a potential threat to their relationship (in Study 1) and when they were rated as more distressed when discussing a relationship conflict (in Study 2). The findings are discussed in terms of how highly anxious and highly avoidant people differentially manage empathic accuracy to regulate negative affect and facilitate their interpersonal goals.     

For the greater goods? Ownership rights and utilitarian moral judgment

People often judge it unacceptable to directly harm a person, even when this is necessary to produce an overall positive outcome, such as saving five other lives. We demonstrate that similar judgments arise when people consider damage to owned objects. In two experiments, participants considered dilemmas where saving five inanimate objects required destroying one. Participants judged this unacceptable when it required violating another’s ownership rights, but not otherwise. They also judged that sacrificing another’s object was less acceptable as a means than as a side-effect; judgments did not depend on whether property damage involved personal force. These findings inform theories of moral decision-making. They show that utilitarian judgment can be decreased without physical harm to persons, and without personal force. The findings also show that the distinction between means and side-effects influences the acceptability of damaging objects, and that ownership impacts utilitarian moral judgment.     

The Beneficial Role of Spiritual Counseling in Heart Failure Patients

To ascertain the beneficial role of spiritual counseling in patients with chronic heart failure. This is a pilot study evaluating the effects of adjunct spiritual counseling on quality of life (QoL) outcomes in patients with heart failure. Patients were assigned to “religious” or “non-religious” counseling services based strictly on their personal preferences and subsequently administered standardized QoL questionnaires. A member of the chaplaincy or in-house volunteer organization visited the patient either daily or once every 2 days throughout the duration of their hospitalization. All patients completed questionnaires at baseline, at 2 weeks, and at 3 months. Each of the questionnaires was totaled, with higher scores representing positive response, except for one survey measure where lower scores represent improvement (QIDS-SR16). Twenty-three patients (n = 23, age 57 ± 11, 11 (48 %) male, 12 (52 %) female, mean duration of hospital stay 20 ± 15 days) completed the study. Total mean scores were assessed on admission, at 2 weeks and at 3 months. For all patients in the study, the mean QIDS-SR16 scores were 8.5 (n = 23, SD = 3.3) versus 6.3 (n = 18, SD = 3.5) versus 7.3 (n = 7, SD = 2.6). Mean FACIT-Sp-Ex (version 4) scores were 71.1 (n = 23, SD = 15.1) versus 74.7 (n = 18, SD = 20.9) versus 81.4 (n = 7, SD = 8.8). The mean MSAS scores were 2.0 (n = 21, SD = 0.6) versus 1.8 (n = 15, SD = 0.7) versus 2.5 (n = 4, SD = 0.7). Mean QoL Enjoyment and Satisfaction scores were 47.2 % (n = 23, SD = 15.0 %) versus 53.6 % (n = 18, SD = 16.4 %) versus 72.42 % (n = 7, SD = 22 %). The addition of spiritual counseling to standard medical management for patients with chronic heart failure patients appears to have a positive impact on QoL.     

Naming/Power: Linguistic Engineering and the Construction of Discourse in Early China

The interplay between language and politics has been the subject of increased academic interest in the last few decades. The idea that language can be used as a device not only for communication but also for control and manipulation, however, is by no means new. This article traces the emergence of one of the first fully formed Chinese theories of language, Xunzi’s ‘rectification of names’ doctrine, in order to reconstruct a social history of language in early China. In addition to situating Xunzi’s philosophical system in the intellectual and historical context of the late Warring States period, this article also draws on Michel Foucault’s theory of knowledge and power to argue that early Chinese thinkers were fully aware of language’s constitutive role in the restoration of sociopolitical stability and thus sought to portray linguistic engineering as an efficacious, noncoercive, tool of government as part of an overarching single ruler-based political system.     

The Living Fossil of Human Judgment

Although the biases and anomalies characterizing psychometric data should serve as conclusive evidence of systematic flaws in scientific methodology, these problems are usually ignored, which reduces empirical psychology to the closed system of its error theory. However, psychometric scores are ambiguous, and response-shifts and fluctuating validities point to fundamental differences in what the measuring-apparatus questionnaire records and how the measuring-apparatus person judges. Therefore, empirical methods fail when psychology requires evidence-based knowledge about cognitive processes and phenomena. Correcting these flaws requires a reassessment of basic scientific premises and careful consideration of Homo sapiens’ biosemiotic heuristics. Based on comprehensive biopsychosocial, data, the author reconstructs the evolutionary axioms of self-referenced cognitions and reveals what is usually obscured by the axioms of normal science. He substantiates the need for a paradigm shift toward basic bio–cultural principles and an evolutionary understanding of human thinking and behavior.     

MLK Day and Racial Attitudes: Liking the Group More but Its Members Less

Intuition suggests that the Martin Luther King holiday (MLK Day) should improve racial attitudes toward African Americans. However, its influence may depend on whether African Americans are evaluated as a group or individually. In two studies, we assessed racial attitudes either on MLK Day or on a control day. As might be expected, participants had more sympathetic attitudes towards African Americans as a group on MLK Day compared to control days; however, they evaluated individual African American exemplars more negatively on MLK Day compared to control days, who presumably seemed worse by comparison to the eminent political figure.     

Go with the flow: How the consideration of joy versus pride influences automaticity

Recently, we have shown that the consideration of joy, without the actual experience of the emotion, impaired performance on the antisaccade task (Katzir, Eyal, Meiran, & Kessler, 2010). We interpreted this finding as indicating inhibitory control failure. However, impaired antisaccade performance may result from either the weakening of inhibitory control, the potentiation of the competing automatic response, or both. In the current research we used a task switching paradigm, which allowed us to assess cognitive control more directly, using Backward Inhibition, Competitor Rule Suppression, and Competitor Rule Priming as cognitive-control indices as well as assessing the Task Rule Congruency Effect (TRCE) which, like the antisaccade, is influenced by both control and automaticity. We found that considering joy compared to pride did not influence any of the cognitive control indices but increased the TRCE. We interpret this finding as evidence that joy consideration leads to increased reliance on automatic tendencies, such as short-term desires.     

Spatial associations in number-related tasks: A comparison of manual and pedal responses

Bimanual parity judgments of numerically small (large) digits are faster with the left (right) hand (the SNARC effect; Dehaene, Bossini, & Giraux, 1993). According to one explanation, this effect is culturally derived and reflects ontogenetic influences such as the direction of written language; it might therefore be limited to, or at least be larger with, pairs of lateralized effectors which are instrumental to the production and comprehension of written language. We report two experiments which test for SNARC effects with pedal responses, and compare these effects to manual results. Pedal responses yielded highly systematic SNARC effects; furthermore, these effects did not differ from manual SNARC effects. These results argue against accounts in which the SNARC effect is specific for effectors that are habitually associated with the production or comprehension of written language.