Psychological wellbeing and quality of life in amyotrophic lateral sclerosis: A review

Amyotrophic lateral sclerosis is a fatal neurodegenerative disease with a progressive and rapid course that, so far, cannot be stopped or reversed. The psychological impact of the disease is huge, on both patients and caregivers. This review summarizes studies that have investigated quality of life, depression, anxiety, pain, spiritual and existential issues, hope, and hopelessness in the ALS field, with attention to both patients and their caregivers. Psychological support and the possible role of psychologists in the ALS field are also discussed.     

Cosmic Commons: Contact and Community

Abstract

As we Homo sapiens on planet Earth prepare for possible contact with extraterrestrial life (ET)—especially extraterrestrial intelligent (ETI) life—we need to consider ethics. What will be the ethical posture we adopt as Earth meets space? This article advocates an ethic of praxis based upon the concept of a Cosmic Commons. Intelligent extraterrestrial beings, from their experiences in biotic and abiotic environments, should share with us a universal regard for intelligence (intellilife), respect for biotic evolution, and a sense of responsibility for shared common space in our places in the universe. As we venture from Earth into space, what will be required? Not anxiety over human dis-placement to new worlds; nor should we invest our efforts in irresponsibly exploiting the natural goods of other planets. Rather, we need an ethical transformation of terrestrial human thought and conduct prior to, during, and as a consequence of extraterrestrial explorations and engagements. We need an anticipatory Cosmic Charter.     

Transhumanism and Roman Catholicism: Imagined and Real Tensions

Abstract

Transhumanists have asserted that religious people would both oppose life extension and allowing people with extended lives to die. In this paper, coming from a Roman Catholic perspective, I refute four myths associated with these claims: that the Church materially opposes life extension, that it conceptually opposes the very idea of life extension, that it opposes human genetic manipulation, and that it opposes letting people die in hospitals. I then propose that there are four real tensions that are much more significant: that material immortality is highly improbable, that injustice and inequality are major concerns, that transhuman omnipotence is impossible, and that utopianism is extremely dangerous.     

Book Review: Contemporary Perspectives on Psychotherapy and Homosexualities

Abstract

This paper is an attempt to illustrate some of the ethical and clinical difficulties which may arise when student counselling takes place under conditions which pay insufficient attention to the ground rules of therapy. It considers the importance of the frame in psychotherapy and the implications for this of working in an institutional setting. It also looks at the changes that may be made in the way the counsellor functions in the institution in order to secure the best conditions for effective counselling work with students, based on the author's personal experience.     

Monitoring the effects of adult psychotherapy in routine practice in Switzerland: A feasibility trial

Background: Several studies have been published on the effects of psychotherapy in routine practice. Complementing traditional views summarised as ‘dose‐effect models’, Stiles et al. put forward data consistent with the responsive regulation model underlining the importance of the client's active participant role in defining length of treatment. One may ask what level of change reached by a patient is considered to be the ‘good enough level’ (GEL) and if it is related to the duration of psychotherapy. Aims: The main objective of the present feasibility trial was to monitor the patient's session‐by‐session evolution using a self‐report questionnaire in order to define the GEL, i.e. the number of sessions necessary for the patient to reach significant change. Method: A total of N=13 patients undergoing psychotherapy in routine practice participated in the study, completing the Outcome Questionnaire – 45.2 (OQ‐45), which assesses the symptom level, interpersonal relationships and social role after every psychotherapy session. The data was analysed using multi‐level analyses (HLMs). Results: High feasibility of fine‐grained assessment of effects of psychotherapy in routine practice in Switzerland was shown; response rates being acceptable; however, detailed analysis of the GEL was not feasible within the short study time‐frame. Conclusions: Reflections on the political context of monitoring in the specific case of routine psychiatric practice in Switzerland are discussed.     

Churches as organisations: towards a virtue ecclesiology for today

This article is an attempt to offer insights from organisation studies to ecclesiology. To do so it draws particularly on the work of the moral philosopher Alasdair MacIntyre to offer a virtue ecclesiology for today. The application of MacIntyre's conceptual framework of practices, institutions, goods and virtues to all kinds of organisations, which already exists in the field of organisation studies, is extended to the church as an organisation. It suggests that the church may be re-described as an organisation in which the practices of faith are housed within the institution of the church. On this understanding, the gift of the church to the world is not simply the practices of faith but the manner in which they are institutionalised.     

Precarious life and the ethics of care: Subjectivity in an Indian religious phenomenon

This article relates certain figures of the subject in an emergent Indian pilgrimage. On the basis of ethnographic research and 15 in-depth interviews, I show that these religious subjectivities, phenomenologically immersed in highly precarious material conditions, are radically relational. Observations on the pilgrimage (en)counter the cognitivist assumptions of a body of scholarly opinion on contemporary religious practice. The analyst's attention to pilgrimage rituals and narratives traverses sociological, phenomenological, and psychoanalytic theories, and is, thereby, drawn to important questions of self, ethics, and time.     

Killing Me Softly

Abstract

“Forced termination” of psychoanalysis occurs when the analyst electively terminates the treatment for reasons of his own, independent of the clinical indications for termination. The author describes his own experience with the forced termination of his training analysis. The literature is reviewed, with an emphasis on the attitude of each author regarding the straggle around the decision. The author explores sources of general ethical knowledge, the ethical foundations of the analyst-analysand relation ship, and the application of these ideas to psychoanalysis. From these princi ples, the ethical problems of forced termination are derived and examined. The author proposes reforms to address these problems.     

Reasonable People,Double Jeopardy,and Justice

The equipoise requirement in clinical research demands that, if patients are to be randomly assigned to one of two interventions in a clinical trial, there must be genuine doubt about which is better. This reflects the traditional view that physicians must never knowingly compromise the care of their patients, even for the sake of future patients. Equipoise has proven to be deeply problematic, especially in the Third World. Some recent critics have argued against equipoise on the grounds that clinical research is fundamentally distinct from clinical care, and thus should be governed by different norms. I argue against this “difference position,” and instead take issue with the traditional, exclusively patient-centered account of physicians' obligations that equipoise presupposes. In place of this traditional view, I propose a Kantian test for the reasonable partiality that physicians should show their patients, focusing on its application in clinical research and medical education.