`Watching' Medicine: Do Bioethicists Respect Patients' Privacy?

Agich has identified `watching' – the formal orinformal observation of the medical setting – as oneof the four main roles of the clinical bioethicist. By an analysis of a case study involving a bioethicsstudent who engaged in watching at an HIV/AIDS clinicas part of his training, I raise questions about theethical justification of watching. I argue that theinvasion of privacy that watching entails makes theactivity unacceptable unless the watcher has receivedprior consent from the patients who are beingobserved. I conclude that, even though it isimportant for bioethics students to understand thecomplexities of actual medical practice, watchingshould play a prominent role in bioethics educationonly if the privacy problems in it can be resolved.     

Medical Informatics and the Concept of Disease

This paper attempts to address the general questionwhether information technologies, as applied in thearea of medicine and health care, have or are likelyto change fundamental concepts regarding disease andhealth. After a short excursion into the domain ofmedical informatics I provide a brief overview of someof the current theories of what a disease is from amore philosophical perspective, i.e. the ``valuefree' and ``value laden' view of disease. Next, Iconsider at some length, whether health careinformatics is currently modifying fundamentalconcepts of disease. To this question I will answerlargely in the negative, and I will provide the sketchof some arguments from current research programs inmedical informatics why I think this is the case. Thisargumentation is supported by a detailed account ofhow the disease profile for beriberi heart disease,used in one of the major medical informaticsdiagnostic programs, QMR (and its ancestorINTERNIST-1), was developed, and why at least thisprogram essentially follows received views oftraditional medicine.The one main exception to theconformity of this program to ``received' views of adisease occurs when the program's designers need tofine-tune a disease definition. This fine-tuning is tocomport with the expert's perspective on the disease,including his or her epistemic values, as well as theprogram's other resources for diagnosing components ofa disease.     

Is analytical psychology a religion? Jung's search for a substitute for lost faith

Analytical psychology does not aim at curing neurotic symptoms, but at bringing about a change in the patient's attitude to him or her self, and therefore to life in general. This new attitude can be described as religious, but it has nothing to do with creeds or conventional forms of worship. Analytical psychology is not a religon, but can be described as a prolegomenon to religion or religion in statu nascendi.     

诱导细胞凋亡：一个有希望的治疗恶性肿瘤的新模式

长期以来,人们一直被肿瘤的无限增殖所困惑。传统的肿瘤治疗也主要围绕这一认识展开。本文辩证分析了细胞的增殖与凋亡这一对矛盾,认为：肿瘤的本质应该是增殖与凋亡的失衡,诱导细胞凋亡将会成为肿瘤治疗的新模式     

Daydreaming to navigate the social world: What we know,what we don't know,and why it matters

A substantial portion of daily life is spent daydreaming—that is, engaged in thought independent of, and unrelated to, goals in the external environment. We argue that this naturally occurring, unconstrained cognition is a vital, but currently underappreciated, form of social cognition that enables navigation of the social world. First, we present the results of a meta‐analysis of neuroimaging studies which illustrate the shared neural basis of daydreaming and social cognition (including regions of the anterior temporal lobes and the posterior cingulate cortex). Second, we review evidence regarding the frequency, correlates, and adaptive outcomes of social daydreaming, cumulative findings that point to the adaptive value of imaging others during this offline state. We end by encouraging cross‐fertilization between daydreaming research and domains of social psychology (goal pursuit, social interactions, and close relationships), which we hope will foster mutually beneficial directions for understanding the role that unconstrained thinking plays in social life.     

Trait lasting alteration of the brain default mode network in experienced meditators and the experiential selfhood

Based on the finding in novices that four months of meditation training significantly increases frontal default mode network (DMN) module/subnet synchrony while decreasing left and right posterior DMN modules synchrony, the current study tested the prediction whether experienced meditators (those who are practising meditation intensively for several years) had a change in the DMN “trinity” of modules as a baseline trait characteristic and whether this change is in a similar direction as in the novice trainees who practised meditation for only four months. Comparison of functional connectivity within DMN subnets (measured by electroencephalogram operational synchrony in the three separate DMN modules) between five experienced meditators and 10 naïve participants (who were about to start the meditation training) fully support the prediction. Interpretation that links such DMN subnets changes to the three-dimensional components of the experiential selfhood was proposed.     

L’évaluation de la perte de chance en responsabilité médicale,une mission à repréciser pour l’Expert

Loss of opportunity, which today is considered as a prejudice in its own right, both for the French Supreme Court and the Council of State, remains undeniably difficult to assess in practice. For many years, the issue of compensation for breach of duty of disclosure gave the various courts the ability to roadtest this concept. However, although the criteria defining this concept, of judicial origin, have been established, the modus operandi allowing the judge to quantify it does not exist. How can this portion of personal injury be determined in relation to the size of the opportunity lost? This is primarily a technical issue, similar to that of assessing a disability rate. However, this request does not feature in typical common law missions for judicial or administrative medical expertise. The judge alone is left to assess this probability, whereas the expert would be in a position, as far as possible, to provide scientific and statistical assistance enabling a better definition of loss of opportunity.     

Understanding time use,stress and recovery practices among early career physicians: an exploratory study

Early career physicians (ECPs) work an average of 80 h per week, and at times may approach 24 continuous hours working. These hours, combined with a stressful work environment, and an inability to physically and psychologically detach from work make ECPs likely to experience burnout and other negative health-related consequences. This study provides insight into the stress and recovery challenges faced by ECPs in a typical hospital environment. Rich qualitative and quantitative data were gathered from participants regarding daily time usage, and recovery practices and needs. ECPs report longer working hours, less leisure time and shorter amounts of sleep than average working adults. ECPs do not participate in many resource-replenishing activities while at work, and when out of work, they tend to participate in more passive than active forms of recovery. Resource-draining activities were identified as requiring much of ECP’s nonwork time, further limiting recovery. The prevention of burnout and other negative health consequences among ECPs requires the building of a workplace and educational culture that supports regular resource replenishment. This includes the need for a curriculum of medical education that teaches ECPs to identify the signs of stress and recovery needs, and how to effectively address these needs.     

‘What meaning does somebody's death have,what meaning does somebody's life have?’ Psychotherapists’ stories of their work with suicidal clients

Working with suicidal clients is perceived to be demanding and anxiety provoking for psychotherapists. This investigation explores what it is like for psychotherapists who work with suicidal clients, particularly as within the prevailing culture there is an increasing focus on strategies aimed at suicide prevention. Five themes were identified through narrative analysis, with support systems such as supervision and peer support being seen as vital in surviving working with suicidal clients. However, there is also ambivalence about involving other professionals, such as mental health services, as there is a sense that to do so may be anti-therapeutic and unhelpful to the client. Overall, what emerges from this study is that it is important to challenge the prevailing culture in which a medical discourse is dominant, in order to find a different way of talking about suicide and despair.