Perception of genetic risk among genetic counselors

A mailed survey of female prenatal genetic counselors, obstetric nurses, and high school biology teachers was conducted to determine if these groups hold different attitudes toward genetic risk and to investigate the extent to which any differences result from the effect of different professional experiences. In this study, the participants were 166 genetic counselors, 116 obstetric nurses, and 78 biology teachers (n = 360). Survey participants completed a written questionnaire designed to assess their numeric estimate of the empiric risk for birth defects/genetic problems, their subjective perception of this risk, and their personal use of prenatal diagnosis. Genetic counselors were found to be less likely than the other groups to consider the frequency of birth defects/genetic problems as rare and were 10 times more likely than nurses and 8 times more likely than teachers to have had prenatal diagnosis. Furthermore, more than half of the prenatal diagnosis procedures had by genetic counselors were not medically indicated. These results suggest that genetic counselors have an increased perception of genetic risks relative to nurses or teachers. Possible explanations for this finding are discussed, and the potential role of discordant risk perception in creating biases in the genetic counseling process is explored.     

A case study of borderline anxiety andthe process of analytic transformation

Borderline patients present particular treatment problems and require close, devoted understanding of their often chaotic and shifting intrapsychic conflicts. Many of these patients act out, making it difficult to maintain an analytic process. In fact, many terminate early on. When they do stay for longer periods, they exhibit particular constellations of defense, anxiety, and conflict. One extensive case report is used to examine the overlapping cycles of treatment with this population. Frequently, self-destructive acting-out is present in the transference and extratransference. This acting-out is often followed by the self-destructive, antichange attitude of the death instinct. These ways of relating to the self and the object are mobilized within the vehicle of projective identification and are best understood as primitive defenses against core fantasies of loss and persecution. These issues of loss and fear are the final and vital phase of treatment with borderline patients, who are often able to make major fundamental changes in their internal sphere, but only if patient and analyst can tolerate and understand these three levels of intrapsychic experience.     

Heart Follows Head: Influencing Violence-related Attitudes in the Classroom

We examined whether an undergraduate course on violence would influence students’ violence-related attitudes and beliefs. Students (N=145) completed the Violence-Related Attitudes and Beliefs Scale (V-RABS) at the beginning (Time 1) and end (Time 2) of the semester-long course. As expected, support for the death penalty, punishment, and catharsis decreased significantly, as did belief in an association between mental illness and violence. Acceptance of environmental influences on violent behavior increased significantly, although belief in biological influences did not change. Support for violence prevention efforts was high at both Times 1 and 2, and did not change significantly. Consistent with previous research, the results of this study confirm that college curricula may influence students’ attitudes and beliefs in addition to imparting knowledge.     

论非正常死亡

“非正常死亡”概念带模糊性、悖论性、封闭性和诡辩性,并不科学。现实的死亡率千差万别。中国内地自杀死亡率16．78／10万,事故死亡率57．91／10万,他杀死亡率2．33／10万,自然死亡率535．9／10万,一切原因死亡率612／10万。一切原因死亡率较港澳高,自杀与事故死亡率较港澳低。澳门的一切原因死亡率特低(165．0／10万),自杀死亡率特高(40．9／10万)。     

The ‘redefinition of death’ debate: Western concepts and western bioethics

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. Ms. Jones is an intensive care clinical nursing specialist. Dr. Kessel is a public health physician and medical ethicist.     

Ronald Dworkin on Abortion and Assisted Suicide

In the first part of this article, I raisequestions about Dworkin's theory of theintrinsic value of life and about the adequacyof his proposal to understand abortion in termsof different ways of valuing life. In thesecond part of the article, I consider hisargument in ``The Philosophers' Brief on AssistedSuicide', which claims that the distinctionbetween killing and letting die is morallyirrelevant, the distinction between intendingand foreseeing death can be morally relevantbut is not always so. I argue that thekilling/letting die distinction can be relevantin the context of assisted suicide, but alsoshow when it is not. Then I consider why theintention/foresight distinction can be morallyirrelevant and conclude by presenting analternative argument for physician-assistedsuicide.     

A Social Version of Gerotranscendence: Case Study

This article reexamines the concept of gerotranscendence in the light of anthropological findings. Particular social patterns in a nursing home reveal a unique reality communal to its tenants. The author assumes that the tenants' spontaneous patterns of social gathering construct a collective death consciousness which is spiritual in its nature. Tornstam's term another paradigm seems suitable not only for a developmental shift in old age but also for the situational shift in the daily life of the subjects. Anthropological concepts, as well as contextual and inter-subjective parameters, join to indicate that some gerotranscendence dimensions are experienced in what the author terms as sitting and giving episodes.     

Research misconduct—Have we reached the turning point at last?

The laissez-faire attitude towards dishonesty in research has simply created an environment for widespread escalation of the problem. Can we now believe anything we read? Why should we have confidence in an author because of his eminence? Should we automatically accept that clinical trials are always conducted with total integrity? Why have we been afraid to tackle this crisis head-on?     

Surviving death: how to refute termination theses

When deciding how ‘death’ should be defined, it is helpful to consider cases in which vital functions are restored to an organism long after those vital functions have ceased. Here I consider whether such restoration cases can be used to refute termination theses. Focusing largely on the termination thesis applied to human animals (the view that when human animals die they cease to exist), I develop a line of argument from the possibility of human restoration to the conclusion that in many actual cases, human animals continue to exist after they die. The line of reasoning developed here can be extended to show that other organisms survive death in many actual cases. This line of reasoning improves on other arguments that have been offered against termination theses. And if my argument regarding human animals surviving death is successful, then assuming that human persons are animals, we can also conclude that human persons in many actual cases continue to exist after death.