Physicians' Silent Decisions: Because Patient Autonomy Does Not Always Come First

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions—not all—are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time.     

Improving Health Education for Women Who Carry an <Emphasis Type="Italic">FMR1</Emphasis> Premutation

Women who carry an FMR1 (i.e., fragile X) premutation have specific health risks over their lifetime. However, little is known about their experience understanding these risks and navigating their health needs. The aim of this study was to use qualitative analysis to uncover both barriers and facilitators to personal healthcare using a framework of the Health Belief Model. Five focus groups were conducted with a total of 20 women who carry the FMR1 premutation using a semi-structured discussion guide. All sessions were transcribed verbatim and independently coded by two researchers. The coders used a deductive – inductive approach to determine the prominent themes related to the participants’ experiences seeking healthcare for premutation-related conditions. Salient barriers to personal healthcare included difficult clinical translation of research findings, lack of knowledge among healthcare providers and among the women themselves, different priorities, and shortage of premutation-specific support and targeted educational materials. Facilitators included family members, national and community support organizations, research studies, compassionate physicians, and other premutation carriers. Addressing barriers to personal healthcare through up-to-date educational materials can help diminish misperceptions regarding health risks. Targeted educational materials will aid in information sharing and awareness for women who carry the FMR1 premutation and their physicians.     

How does discourse among like-minded individuals affect their thinking about a complex issue?

Is there reason to be concerned about what has been seen as an increasing trend for discourse on complex issues to be confined to an “echo chamber” of like-minded individuals? To investigate how thinking regarding an issue changes in form following concentrated discourse with like-minded peers, we undertook a qualitative examination of changes in the reasoning that 34 older adults used to justify their positions prior to and following such discourse. They showed a divergence of patterns. A minority abandoned mention of previously expressed ideas at odds with their own positions or otherwise narrowed the reasoning used to justify their positions. Consistent with findings from previous studies, only a minority showed increased certainty and/or extremity (polarisation) on quantitative scales. Countering this minority were a larger proportion whose thinking appeared to benefit from such engagement in several respects that we describe. A follow-up study compares results for a sample of young adults.     

Transgressing the father figure: performing queer theology as an act of liberation

ABSTRACT

This chapter examines the intersection of power, ritual, and the sacred through the lens of performing drag as a tool to subvert dominant notions of theological discourse. Grounded in Cheng’s assertion that queer theology is transgressive (Radical Love) and Althaus-Reid’s Indecent Theology, the foundational text which introduces the concept of theology as destabilizing and grounded in subversion, particularly in the realm of sexuality, we critique the forces of power operating within Catholicism. We ask: Whose bodies are allowed to play a powerful role in Catholicism? How has ritual performance perpetuated the colonization of the mind/spirit and how can it be used to undo that same colonization? In discussing a public drag performance using George Michael’s “Father Figure,” we suggest the possibility of liberation that exists in bringing theology into queer spaces, extending theology beyond the realm of religious institutions or the academy.