Responding to Those Who Hope for a Miracle: Practices for Clinical Bioethicists

Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self. After the ethicist appreciates how these concepts influence the invocator's worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle.     

Supporting the spiritual needs of people with dementia in residential aged care

ABSTRACT

Objective: To describe how an Australian age care provider, BaptistCare NSW & ACT, has embraced the National Guidelines for Spiritual Care in Aged Care for people with dementia.

Method: A 12-month study was conducted in 19 Baptistcare residential homes, including 14 dementia units. Data were obtained from selected items of the Person-Centred Environment and Care Assessment Tool using interviews, observation, and document review.

Results: The person-centred approach was instituted in adhering to the Guidelines for people with dementia. Conclusion: The person-centred approach assists in actioning the Guidelines for people with dementia.     

Dissociation of reward and effort sensitivity in methcathinone‐induced Parkinsonism

Methcathinone‐induced Parkinsonism is a recently described extrapyramidal syndrome characterized by globus pallidus and substantia nigra lesions, which provides a unique model of basal ganglia dysfunction. We assessed motivated behaviour in this condition using a novel cost‐benefit decision‐making task, in which participants decided whether it was worth investing effort for reward. Patients showed a dissociation between reward and effort sensitivity, such that pallidonigral complex dysfunction caused them to become less sensitive to rewards, while normal sensitivity to effort costs was maintained.     

'Assaults upon the Self': Control and Surveillance in a Theological College

Training in a residential setting is a compulsory aspect of the professional preparation of those offering themselves for ordained ministry within the various denominations of Anglican Communion in the UK. This mode of preparation is seen as essential to an inculcation of the 'attitudes and habits' required of future occupational roles and status. The mode as well as the content of training can, therefore, be viewed as powerful facilitators of occupational socialisation and identity. The paper explores how residential training in one setting, through the timetable and 'gaze' of staff and other students, acts to regulate the body in preparation for the transition to an ordained status. The paper further outlines some of the means by which students conform to and contest this 'curriculum of the body'.     

Cholinergic modulation of visual attention and working memory: dissociable effects of basal forebrain 192-IgG-saporin lesions and intraprefrontal infusions of scopolamine

Two experiments examined the effects of reductions in cortical cholinergic function on performance of a novel task that allowed for the simultaneous assessment of attention to a visual stimulus and memory for that stimulus over a variable delay within the same test session. In the first experiment, infusions of the muscarinic receptor antagonist scopolamine into the medial prefrontal cortex (mPFC) produced many omissions but did not impair rats' ability to correctly detect a brief visual stimulus. However, these animals were highly impaired in remembering the location of that stimulus following a delay period, although in a delay-independent manner. In the second experiment, another group of animals with selective 192IgG-saporin lesions of the nucleus basalis magnocellularis (nBM) were not impaired under conditions of low-attentional demand. However, when the stimulus duration was reduced, a significant memory impairment was observed, but similar to the results of the first experiment, the nBM-lesioned animals were not impaired in attentional accuracy, although aspects of attention were compromised (e.g., omissions). These findings demonstrate that (1) cortical cholinergic depletion produces dissociable deficits in attention and memory, depending on the task demands, (2) delay-independent mnemonic deficits produced by scopolamine are probably due to impairments other than simple inattention, and (3) working memory deficits are not simply dependent on attentional difficulties per se. Together, these findings implicate the nBM cortical cholinergic system in both attentional and mnemonic processing.     

Conceptualizing Nonsuicidal Self‐Injury as a Process Addiction: Review of Research and Implications for Counselor Training and Practice

Nonsuicidal self‐injury (NSSI) may be characterized as a process addiction for some individuals who self‐injure. The authors review findings on the addictive features of NSSI, including compulsivity, loss of control, continued use despite negative consequences, and tolerance.     

Towards a neurobiology of creativity in nonhuman animals

We propose a cognitive and neurobiological framework for creativity in nonhuman animals based on the framework previously proposed by Kaufman and Kaufman (2004), with additional insight from recent animal behavior research, behavioral neuroscience, and creativity theories. The additional information has lead to three major changes in the 2004 model-the addition of novelty seeking as a subcategory of novelty recognition, the addition of specific neurological processing sites that correspond to each of the processes, and the transformation of the model into a spectrum in which all three levels represent different degrees of the creative process (emphasis on process) and the top level, dubbed innovation, is defined by the creative product. The framework remains a three-level model of creativity. The first level is composed of both the cognitive ability to recognize novelty, a process linked to hippocampal function, and the seeking out of novelty, which is linked to dopamine systems. The next level is observational learning, which can range in complexity from imitation to the cultural transmission of creative behavior. Observational learning may critically depend on the cerebellum, in addition to cortical regions. At the peak of the model is innovative behavior, which can include creating a tool or exhibiting a behavior with the specific understanding that it is new and different. Innovative behavior may be especially dependent upon the prefrontal cortex and/or the balance between left and right hemisphere functions.     

A funny thing happened on the way to articulation: N400 attenuation despite behavioral interference in picture naming

We measured Event-Related Potentials (ERPs) and naming times to picture targets preceded by masked words (stimulus onset asynchrony: 80 ms) that shared one of three different types of relationship with the names of the pictures: (1) Identity related, in which the prime was the name of the picture ("socks" - ), (2) Phonemic Onset related, in which the initial segment of the prime was the same as the name of the picture ("log" - ), and (3) Semantically related in which the prime was a co-category exemplar and associated with the name of the picture ("cake" - ). Each type of related picture target was contrasted with an Unrelated picture target, resulting in a 3×2 design that crossed Relationship Type between the word and the target picture (Identity, Phonemic Onset and Semantic) with Relatedness (Related and Unrelated). Modulation of the N400 component to related (versus unrelated) pictures was taken to reflect semantic processing at the interface between the picture's conceptual features and its lemma, while naming times reflected the end product of all stages of processing. Both attenuation of the N400 and shorter naming times were observed to pictures preceded by Identity related (versus Unrelated) words. No ERP effects within 600 ms, but shorter naming times, were observed to pictures preceded by Phonemic Onset related (versus Unrelated) words. An attenuated N400 (electrophysiological semantic priming) but longer naming times (behavioral semantic interference) were observed to pictures preceded by Semantically related (versus Unrelated) words. These dissociations between ERP modulation and naming times suggest that (a) phonemic onset priming occurred late, during encoding of the articulatory response, and (b) semantic behavioral interference was not driven by competition at the lemma level of representation, but rather occurred at a later stage of production.     

Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry

A key criticism of the main diagnostic tool in psychiatry, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV), is that it lacks a biological footing. In this article, we argue for a biological approach to psychiatry based on 'neurocognitive endophenotypes', whereby changes in behavioural or cognitive processes are associated with discrete deficits in defined neural systems. We focus on the constructs of impulsivity and compulsivity as key examples of the approach and discuss their possible cross-diagnostic significance, applying them to co-morbidities and commonalities across a range of disorders (attention-deficit/hyperactivity disorder, substance dependence, obsessive-compulsive disorder and eating disorders). We argue that this approach has important implications for the future classification of psychiatric disorders, genetics and therapeutics.