Cultural Diversity and Patients with Reduced Capacity: The Use of Ethics Consultation to Advocate for Mentally Handicapped Persons in Living Organ Donation

Theoretical Medicine and Bioethics - Living organ donation will soon become the source of the majority of organs donations for transplant. Should mentally handicapped people be allowed to donate,...     

The sounds of dominance.

A study was conducted to determine the effects of vocal cues on judgements of dominance in an interpersonal influence context. Physical measures of human vocal cues and participant ratings of dominance were obtained from videotapes of actors delivering short influence messages. After controlling for linguistic and visual content of messages, results indicated that mean amplitude and amplitude standard deviation were positively associated with dominance judgments, whereas speech rate was negatively associated with dominance judgments. An unexpected interaction revealed that mean fundamental frequency (F₀) was positively associated with dominance judgments for male speakers but not significantly associated with dominance judgments for female speakers. F₀ standard deviation was not significantly associated with dominance judgments. Results support the conclusion that dominance judgments are inferred from multiple sources of information and that some vocal markers of dominance are more influential than others.     

Anesthesiological ethics: can informed consent be implied?

Surgical ethics is a well-recognized field in clinical ethics, distinct from medical ethics. It includes at least a dozen important issues common to surgery that do not exist in internal medicine simply because of the differences in their practices. But until now there has been a tendency to include ethical issues of anesthesiology as a part of surgical ethics. This may mask the importance of ethical issues in anesthesiology, and even help perpetuate an unfortunate view that surgeons are "captain of the ship" in the operating theater (leaving anesthesiologists in a subservient role). We will have a better ethical understanding if we see surgery and anesthesia as two equal partners, ethically as well as in terms of patient care. Informed consent is one such issue, but it is not limited to that. Even on the topic of what type of anesthesia to use, anesthesiologists have often felt subsumed to the surgeon's preferences. This commentary takes the case study and uses it as a exemplar for this very claim: it is time to give due recognition for a new field in clinical ethics, ethics in anesthesia.     

Preface

This article introduces the topic for this issue of the journal: “Social Justice and the Health Professions: Ethical and Experiential Issues.”     

Hypothalamo-Pituitary-Adrenocortical Regulation Following Lesions of the Central Nucleus of the Amygdala

Previous reports indicate that the central nucleus of the amygdala (CeA) stimulates adrenocorticotropin and corticosterone secretion, suggesting a role for this region in central hypothalamo-pituitary-adrenocortical (HPA) stress regulation. To evaluate this hypothesis, this study assessed the impact of CeA lesion on the response of hypophysiotrophic paraventricular nucleus (PVN) neurons to acute restraint and chronic unpredictable stress exposure. In contrast to previous reports, CeA lesions did not affect corticosterone or ACTH secretion induced by acute stress. Acute restraint increased PVN corticotropin releasing hormone (CRH) mRNA expression, increased the number of parvocellular PVN neurons expressing the co-secretagogue arginine vasopressin (AVP), and induced cFOS mRNA expression in the parvocellular PVN. However, there was no additional effect of CeA lesion on any measure of PVN activation. Chronic unpredictable stress exposure induced long-term activation of the HPA axis, noted by thymic involution, adrenal hypertrophy and increased PVN CRH mRNA expression. Stress-induced changes in thymus and adrenal weights were not affected by CeA lesion. Further, CeA lesion rats did not differ from controls in post-stress CRH mRNA expression. However, basal CRH mRNA expression was increased in the PVN of CeA rats, suggesting that the CeA plays a role in long-term inhibition of the PVN. The results of these studies are not consistent with the hypothesis that the CeA is necessary for stress-induced pituitary-adrenocortical activation. Rather, this region may play a stressor-specific modulatory role in regulation of HPA function.     

The need for teaching philosophy in medical education

The dearth of philosophical contributions to medicine has recently been discussed in a series of articles in this journal. The present article focuses on physicians' lack of training in philosophy as a part of the explanation of the scarcity of works in philosophy of medicine. In section I I outline two philosophy courses which would be reasonable additions to the medical school curriculum required of all medical students. In section II I suggest two other philosophy courses as electives in a medical education. All four courses are in the fields of epistemology and metaphysics, and so will help others see the relevance to medicine of philosophical fields other than ethics.     

Persuasion and the structure of affect.

Participants viewed eight PSAs, providing data on their cognitive and emotional responses to each, as well as judgments of the perceived effectiveness of the messages. They also responded to Carver and White's (1994) BIS/BAS scales designed to measure individual differences in the behavioral inhibition and behavioral activation systems. Consistent with dual‐systems theories of affect, the BIS scales predicted arousal of negative emotions, while BAS was associated with the elicitation of positive emotions. However, when predicting perceived message effectiveness, the positive affects showed variation in the sign and magnitude of the coefficients, as did the negative affects. This latter finding supports a discrete‐emotions perspective. Knowledge that the two affect structures are appropriate to different conceptual domains (i.e., elicitation vs. effect) should enable researchers to formulate more precise questions regarding the role of affect in persuasion.