Resolving Ethical Dilemmas in a Tertiary Care Veterinary Specialty Hospital: Adaptation of the Human Clinical Consultation Committee Model

Technological advances in veterinary medicine have produced considerable progress in the diagnosis and treatment of numerous diseases in animals. At the same time, veterinarians, veterinary technicians, and owners of animals face increasingly complex situations that raise questions about goals of care and correct or reasonable courses of action. These dilemmas are frequently controversial and can generate conflicts between clients and health care providers. In many ways they resemble the ethical challenges confronted by human medicine and that spawned the creation of clinical ethics committees as a mechanism to analyze, discuss, and resolve disagreements. The staff of the North Carolina State University Veterinary Hospital, a specialty academic teaching institution, wanted to investigate whether similar success could be achieved in the tertiary care veterinary setting. We discuss the background and rationale for this method, as well as the approach that was taken to create a clinical ethics committee.     

Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review

Background: Testosterone therapy is the predominant treatment for voice masculinization in transgender patients. Although lowering of voice fundamental frequency (f₀) occurs with testosterone therapy, evidence suggests voice and gender identity may not fully align—i.e., voice-gender congruence may not be achieved—with its use.

Aim: This meta-analytic review evaluates the effectiveness of testosterone therapy to masculinize voice in transgender patients.

Methods: Multiple electronic databases were queried (inclusion dates: from database inception up to October 27, 2017) to identify original research on voice masculinization using testosterone therapy. Nineteen articles were included in this meta-analytic review, which followed PRISMA guidelines. In addition to qualitative analyses, random effects proportion meta-analyses were performed on data related to f₀, voice-gender congruence, voice problems, and satisfaction with voice.

Results: A meta-analysis on f₀ data showed after 1 year of testosterone therapy a combined estimate of 21% of participants (95% confidence interval [CI]: 5%–43%; I²: 59.9%) did not achieve cisgender male normative frequencies (f₀ ≤ 131 Hz). Meta-analyses on incomplete voice-gender congruence and voice problems indicated combined estimates of 21% (95% CI: 10%–34%; I²: 0.0%) and 46% (95% CI: 14%–79%; I²: 90.2%), respectively. Regarding incomplete satisfaction with voice, a meta-analysis showed a combined estimate of 16% (95% CI: 7%–28%; I²: 0.0%).

Discussion: We found that not all transgender patients using testosterone therapy to masculinize voice should expect f₀ lowering to cisgender male normative frequencies after 1 year. The vocal transition may involve voice problems for many patients, and some might not achieve voice-gender congruence without additional, voice-specific intervention. Given these findings, a voice evaluation should occur prior to initiating testosterone therapy and involve counseling on expectations for voice. Transgender patients who pursue voice masculinization may need management from laryngology and speech and language therapy to improve voice-gender congruence, mitigate voice problems, and increase satisfaction with voice.     

Bullies,blades, and barricades: Practical considerations for working with adolescents expressing concerns regarding gender and identity

ABSTRACT

Background: Adolescents, by their very nature and need for maturity, struggle with issues of the self and identity, while challenging the very systems that are there to support them. However, gender diverse adolescents may become detached and overwhelmed as a trans identity solidifies during this time. Bullies, blades and barricades describes the challenges, hardship and dispossession that some gender diverse adolescents face from interpersonal and intrapersonal conflicts, societal pressure and hostility.

Method: This paper utilizes the current research on safety and risks affecting trans youth, the authors clinical experience of trans and gender diverse adolescents, and recommendations in the literature for professional care and support of gender diverse adolescents to identify the various ways gender diverse adolescents are negatively affected by their experiences.

Results: Bullying is not limited to school or peer environments and may be present in adolescents' homes, in local communities, in professional services or from sources of information such as the media. The physical dangers gender diverse adolescents face may arise from victimization, violence or rejection, or self-harming behaviors due to negative beliefs, fear or frustration. Barriers preventing disclosure and expression of gender and/or identity may stem from negative experiences, rejection, pubertal changes, imposed limitations, dependence upon school, home or legal environments, or other spheres of influence.

Discussion: Affirmative approaches, individual focus, recognition of family dynamics, inclusion of significant others, advocacy in school and local community environments as well as professional training are the most commonly recommended interventions. This paper provides an inclusive review of the myriad of challenges confronting gender diverse adolescents including often unrecognized forms of pressure, oppression and restrictions. This paper aims to support clinicians by contextualizing the adversity that gender diverse adolescents face and offers strategies for engagement and intervention.     

Disrupting the trans-versus-Catholic dichotomy: An example from a Canadian elementary school policy

ABSTRACT

Background: Mainstream media is increasingly reporting on the relationships between Catholic and trans identities in parochial schools, particularly with regard to gendered washroom use. With greater numbers of trans youth coming out at younger ages, significant educational policy changes are being considered around how Catholic schools can or should include trans youth.

Method: This study applies trans and queer theologies to Critical Discourse Analysis (CDA) in investigating the Wilson case, which was the first known instance of a Catholic school including some affirming policy provisions for trans youth. The authors additionally collected and coded 12 news articles from a variety of platforms to discern and discuss the theological arguments in the public square against more fulsome trans student inclusion in Catholic schools.

Results: The authors found two related theological arguments against full inclusion, namely the notion that (1) Gender is God-given and therefore cannot be chosen or changed, and (2) That transgressive bodies are not sacred parts of the divine gender plan.

Conclusion: Trans theology allowed the authors to disrupt both of the theological claims advanced by the Catholic educators quoted in the Wilson case. This created rich, imaginative space in which to reconsider the relationships between Catholic and trans identities, namely by not arranging them in a binary. Significance for policy-making in parochial schools is discussed.     

Support for Leader's Decisions in Conflict and Negotiation: Women Do Not Benefit From Relevant Expertise While Men Do

In the present research, we examined the role of leaders' domain‐specific expertise and gender as affecting individuals' evaluation of proposals related to intergroup conflict. Across three studies, conducted in two different conflict‐related contexts (Israeli‐Palestinian conflict and the refugee crisis in Europe), we showed that men and women do not equally benefit from domain‐specific expertise. Having high (compared to low) domain‐specific expertise positively affected participants' attitudes towards the proposal when its author was a man but not when she was a woman. We further demonstrate that specific characteristics of the proposal (i.e., security relevance) and of the participants (i.e., level of sexism) affect reactions to different negotiation proposals. Our findings suggest that even when women acquire relevant knowledge and experience, they do not benefit from them as much as men. One implication of these findings is that training and enhancing women's expertise may not be enough to eliminate gender bias.     

Vocation and encounter: A Scandinavian theological reflection on everyday life as Christians

Martin Luther turned from understanding vocation as a Christian praxis of leaving the world to understanding it as a praxis within everyday life. In accordance with such an understanding, historically, vocation in the Scandinavian countries was central for organizing society as a whole. This article discusses a contemporary use of vocation where there is a tension between communal and individual aspects in a Scandinavian context characterized by democracy, gender equality, and migration. I then propose a focus on vocation and encounter.     

Gender role attitudes,relationship efficacy,and self-disclosure in intimate relationships

Drawing from the intimacy process model and data from 5,042 individuals who remained partnered across Waves 1 and 2 of the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam), this study examined the contributions of traditional gender role attitudes and relationship efficacy in predicting levels of self-disclosure within an intimate relationship. Independent samples t-tests demonstrated females scored higher than males on self-disclosure and relationship efficacy measures but lower on traditional gender role attitudes. An ordinary least squares regression analysis revealed relationship efficacy was a stronger predictor of self-disclosure compared to traditional gender role attitudes, which were not associated with self-disclosure. The findings suggest attitudes with an interpersonal motivational system may be especially important for setting the intimacy process into motion within an intimate union.     

Associative false consumer memory: effects of need for cognition and encoding task

Two experiments investigated the effects of product–attribute associations on false consumer memory. In both experiments, subjects were presented with sets of related product attributes under incidental encoding conditions. Later, recognition memory was tested with studied attributes, non-studied but associated attributes (critical lures) and non-studied unrelated attributes. In Experiment 1, the effect of Need for Cognition (NFC) was assessed. It was found that individuals high in NFC recognised more presented attributes and falsely recognised more associative critical lures. The increase in both true and associative false memory was accompanied by a greater number of responses that index the retrieval of detailed episodic-like information. Experiment 2, replicated the main findings through an experimental manipulation of the encoding task that required subjects to consider purchase likelihood. Explanations for these findings are considered from the perspective of activation processes and knowledge structures in the form of gist-based representations.     

Dietary planning,self-efficacy,and outcome expectancies play a role in an online intervention on fruit and vegetable consumption

Objective: An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more responsive to nutritional advice and benefit more from treatment.

Method: A two-arm digital intervention with 269 men and 395 women (M_age = 41.2, SD_age = 11.45; range: 19–66 years) was conducted in Italy, Spain and Greece, followed up at three and six months, comparing a static with a dynamic, feedback-intensive platform.

Results: Linear mixed models yielded an increase in FV consumption in both the dynamic and the static intervention arms. In men, outcome expectancies were positively related to follow-up FV intake. Dietary planning interacted with self-efficacy on behavioural outcomes.

Conclusion: FV intake increased overall, and being a woman and involvement in planning facilitated behaviour change. Women seemed to be more engaged in the dynamic platform resulting in a higher amount of planning. Initial motivation, as indicated by outcome expectancies, seemed to be beneficial for men. Self-efficacious individuals benefitted from their engagement in planning, but self-efficacy did not compensate for failing to plan.