In re Edna MF: Case Law Confusion in Surrogate Decision Making

I review the recent case of Edna Folz, a 73 year-old woman who was suffering through the end stages of very advanced Alzheimer's dementia when her case was adjudicated by the Wisconsin Supreme Court. I consider this case as an example of how courts are increasingly misinterpreting the ethical and legal decision-making standards known as substituted judgment and best interests and thereby threatening individuals' treatment decision-making rights as developed by other courts over the past two decades and creating serious roadblocks to health-care providers' ability to render appropriate patient care. The Wisconsin Supreme Court held that Edna's legal guardian could not authorize withdrawal of Edna's treatment, ruling that as a matter of law, if an incompetent person is not in a persistent vegetative state, it is not in his or her best interests for life-sustaining treatment to be withdrawn unless (s)he has executed an advance directive or other statement clearly indicating his or her desires.     

儿童自我控制学生自陈表的编制

本研究的目的是制定一套测量儿童自我控制能力的自陈式量表,在认知、行为、情绪、社会交往四个主要范畴内编定题目,经过项目分析、因素分析,认为测量儿童自我控制能力的量表包含学习行为、情绪、耐受性和独立性以及生活习惯四个方面的内容,还进一步分析了儿童自我控制的年级差异和性别差异,本量表的信度、效度都较好。     

Videoconferencing versus face-to-face psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance,empathy and treatment characteristics

Objective

Videoconferencing psychotherapy (VCT) is an effective treatment option. Yet, it is unclear whether a similar therapeutic alliance as in conventional face-to-face psychotherapy (F2F) can be achieved, since previous studies yielded mixed results. Furthermore, surveys about the attitudes towards VCT amongst patients have been missing until now. The current study gathered opinions from patients and psychotherapists about the perceived comparability of VCT and F2F regarding contextual factors and treatment characteristics, focusing on therapeutic alliance and empathy.

Method

An online survey amongst patients (N = 189) and practitioners (N = 57) taking part in cognitive behavioural therapy was conducted after the first lockdown in Germany due to the COVID-19 pandemic and a resulting transition from F2F to VCT for most participants.

Results

While patients experienced therapeutic alliance and empathy as comparable, psychotherapists indicated advantages of F2F. Both groups indicated advantages of F2F for the therapy contents and expressed advantages of VCT for flexibility regarding location and time. More than half of the participants expressed a preference for a combination of analogue and digital therapy.

Conclusion

The perceived disadvantages of VCT can be addressed, for example, with training programmes for psychotherapists targeting communication in VCT and adapting established psychotherapy methods to a digital format to further improve VCT.     

In Defense of the Jurisdiction Theory of Rights

This essay critically examines three theories of moral rights, theBenefit, the Interest, and the Choice theories. The Interest andChoice theories attempt to explain how rights can be more robustthan seems possible on the Benefit theory. In particular, moralrights are supposed to be resistant to trade-offs to supportprincipled anti-paternalism, to constitute a distinct dimensionof morality, and to provide right holders with a range ofdiscretionary choice. I argue that these and other featuresare better yet provided by a fourth theory of moral rights, theJurisdiction theory.     

Children learn words easier when they are interested in the category to which the word belongs

The overall pattern of vocabulary development is relatively similar across children learning different languages. However, there are considerable differences in the words known to individual children. Historically, this variability has been explained in terms of differences in the input. Here, we examine the alternate possibility that children's individual interest in specific natural categories shapes the words they are likely to learn – a child who is more interested in animals will learn a new animal name easier relative to a new vehicle name. Two‐year‐old German‐learning children (N = 39) were exposed to four novel word–object associations for objects from four different categories. Prior to the word learning task, we measured their interest in the categories that the objects belonged to. Our measure was pupillary change following exposure to familiar objects from these four categories, with increased pupillary change interpreted as increased interest in that category. Children showed more robust learning of word–object associations from categories they were more interested in relative to categories they were less interested in. We further found that interest in the novel objects themselves influenced learning, with distinct influences of both category interest and object interest on learning. These results suggest that children's interest in different natural categories shapes their word learning. This provides evidence for the strikingly intuitive possibility that a child who is more interested in animals will learn novel animal names easier than a child who is more interested in vehicles.     

Conflict of interest from a Romanian geneticist’s perspective

This paper examines Romanian bioethics regulations for biomedical sciences, looking in particular at the genetics area as a source for conflict of interest. The analysis is focused on the organizational level, national regulations, the sources for generating conflicts of interest, and management of conflicts. Modern biotechnology and gene technology are among the key technologies of the twenty-first century. The application of gene technology for medical and pharmaceutical purposes is widely accepted by society, but the same cannot be said of the development and application of gene technology in agriculture and food processing. Because the use of a technology in the production and processing of food is regarded more sceptically than in the production of biomedical products, there can be areas of conflict in many cases when communication is undertaken about gene technology in the agro-food sector. Ethical concerns play an important factor in this, but a society’s attitude to a developing technology is an amalgam of many effects which are beyond ethics as such. This paper contains a study carried out by the author for the Romanian Association for Consumer Protection about the attitudes of consumers towards genetically modified (GM) foods. This study revealed that in Romania more than 98% of consumers did not know anything about GM foods and frequently were confused about the definitions of these terms. In conclusion, it is necessary to say that there is a low level of knowledge regarding biotechnology in Romania and this is an important reason why there is neither public acceptance of gene technology products nor is there a rejection. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. Ioana Ispas, MD in Molecular Biology, is a scientific researcher and Member of the Romanian Association for Consumer Protection, NCP for FP5-Quality of life and management of living resources.     

Conflicts of interest in science and medicine: the physician's perspective

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest that can arise in the practice of medicine are outlined. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The World Medical Association (WMA) is a global federation of National Medical Associations representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavours to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.     

The assumed effects of positive feedback paired with success on motivation to do a task: The cases of characters with high and low initial levels of interest

This study investigated the effects of positive feedback paired with success on motivation to do a task, and examined whether this differed according to whether the person performing the task had a high or low initial level of interest in that task. Subjects (448 junior college students) were asked to rate (from 0–10) the level of motivation of characters in four different stories. Subjects believed that positive feedback would encourage the character to do a task regardless of initial level of interest. However, when positive feedback could not be expected, ratings for motivation fell. Ratings for motivation were further analyzed when no positive feedback could be expected, either after an earlier experience of positive feedback paired with success or after success only (no feedback). In the case of a low initial level of interest, it was assumed that motivation would be increased after positive feedback, but in the case of a high initial level of interest motivation was assumed to be decreased by an earlier experience of positive feedback paired with success. These results suggest that the effect of positive feedback paired with success will differ according to the level of a person's initial interest.     

医生与药业的关系：利益冲突重要根源

药业与医生的关系在最近40年日益受到医学界与社会的重视。药业以并不昂贵的馈赠及其他手段,资助学术交流、医学教育和医学研究,深刻地影响着临床医生的行为和诊治决策,从而危及医学的科学性和医学职业精神,加重了病人的负担,且祸及病人健康。药业与医生的这种关系,是道德与金钱关系的赤裸表现,是资本对医学的无情侵略。从道德、法律、行业管理等诸多方面正确规范行业与医生的相互关系,避免当前面临的种种弊端,维护医学的科学性,保护病人与社会公众的利益,刻不容缓。     

Are Newborns Morally Different from Older Children?

Policies and position statements regarding decision-making for extremely premature babies exist in many countries and are often directive, focusing on parental choice and expected outcomes. These recommendations often state survival and handicap as reasons for optional intervention. The fact that such outcome statistics would not justify such approaches in other populations suggests that some other powerful factors are at work. The value of neonatal intensive care has been scrutinized far more than intensive care for older patients and suggests that neonatal care is held to a higher standard of justification. The relative value placed on the life of newborns, in particular the preterm, is less than expected by any objective medical data or any prevailing moral frameworks about the value of individual lives. Why do we feel less obligated to treat the premature baby? Do we put newborns in a special and lesser moral category? We explore this question from a legal and ethical perspective and offer several hypotheses pertaining to personhood, reproductive choices, “precious children,” and probable evolutionary and anthropological factors.