The Double Life of Double Effect

The U.S. Supreme Court's majorityopinion in Vacco v. Quill assumes thatthe principle of double effect explains thepermissibility of hastening death in thecontext of ordinary palliative care and inextraordinary cases in which painkilling drugshave failed to relieve especially intractablesuffering and terminal sedation has beenadopted as a last resort. The traditionaldoctrine of double effect, understood asproviding a prohibition on instrumental harmingas opposed to incidental harming or harming asa side effect, must be distinguished from otherways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care.     

Wisdom at the end of life: Hospice patients’ reflections on the meaning of life and death

The processes of aging and confronting mortality are often accompanied by unique psychological challenges. From the perspective of positive psychology, such challenges can yield opportunities for growth, including increased wisdom. This qualitative study explored 15 terminally ill hospice patients’ perspectives on wisdom, the dying process, and the meaning of life using consensual qualitative research methods. Most participants cited humility as a key component of wisdom, emphasizing that “Wisdom is when we realize ‘I don’t really know much’.” Other components of wisdom included self-knowledge, rationality, experiential learning, listening to and learning from others, and sharing knowledge with others. Participants also suggested that the process of facing illness and death presents opportunities for positive growth, including changing priorities and learning to appreciate life more fully in the present moment. In considering the sources of meaning in their lives, participants emphasized relational connections, personal growth, spirituality, vocational fulfilment, and living a full life. Participants also shared their reflections on important past experiences and regrets. Lastly, participants offered advice to others based on their experiences facing illness and mortality. Implications for psychological care of the dying and future research are discussed.     

A Review of “Trauma and Human Existence: Autobiographical,Psychoanalytic and Philosophical Reflections”

Abstract

The author sets out to locate Bion's model of the mind within the developmental history of psychoanalysis, from Freud to Klein to Bion, using biographical material and clinical case examples, to illustrate Bion's concepts of container/contained, his understanding and use of projective identification, his extension of the use of the countertransference, and his differentiation between the psychotic and non-psychotic aspects of the mind. Links, and attacks against linking are discussed, as well as Bion's thoughts about learning versus knowing, being versus becoming and his emphasis on the essential importance of the development of the capacity to think.     

红光照明条件下VDT不同显示色的视觉效果比较

本研究以VDT上持续进行的视觉作业速度和眼的调节辐合时间作为指标,对红光照明条件下VDT显示的红、黄、绿、蓝、白五种字符色的视觉效果进行了比较.实验中,VDT背景光的主波长为630nm.结果表明,五种字符色在两项指标上均表现出显著差异;绿色显示的视觉效果最好,红色显示的效果最差,黄、白、蓝三色处于中间.     

Why do residents accept a demanding rule?: Fairness and social benefit as determinants of approval of a recycling system1,2

Abstract: This study examined why people accepted a demanding rule in a recycling system that was newly introduced in Nagoya City. We focused on two social psychological topics: social dilemmas and fairness. While the new system succeeded in reducing waste, it imposed a burden on citizens without providing incentives and sanctions. In a research survey, 1442 responses from a sample of 3000 (48% response rate) were obtained using a stratified sampling method. The results showed that the new recycling system was approved despite the demands placed on citizens, with a preference for more strict rules such as penalties and surveillance for noncompliance. The main determinants of approval of the new recycling system were social benefit and procedural fairness, whereas the main determinant of preference for strict rules was outcome fairness. We argue that (a) social benefit should be emphasized to facilitate cooperative behavior in a social dilemma situation and (b) the government should ensure sufficient discussion with citizens and acknowledgment of their opinions.     

终末期癌症病人诊治中的心理特征与人文关怀

在诊治终末期癌症病人过程中不仅要关心他们的躯体方面,更要关心他们的心理方面,在诊治过程中要根据他们的独特的心理特征来进行人文心理关怀,维持生命质量和保证他们应有的人格尊严.     

老年糖代谢异常患者血浆NT—proBNP与血管内皮功能早期监测意义

通过检测老年糖代谢异常患者的血浆N末端血清脑钠肽前体（NT—proBNP）水平与肱动脉血管内皮依赖性舒张功能（FMD）,探讨其早期监测意义。共77例观察对象,其中12例血糖正常的健康老人为对照组,65例老年糖代谢异常组患者根据空腹血糖（FBG）和糖耐量2小时（0GTT2h）血糖水平分为空腹血糖受损组（IFG）14例、糖耐量受损组（IGT）23例和2型糖尿病组（DM）28例。各组均检测血浆NT—proBNP水平和无创超声监测FMD。随着血糖代谢异常程度加重,比较正常组,糖代谢异常组的血浆NT—proBNP水平升高（P〈0．01）,FMD调节下降（P〈0．01）;糖代谢异常发展过程中,IFG阶段FMD即出现舒张失调（P〈0．05）;IGT阶段血浆NT-proBNP水平升高有意义并达到无症状心衰诊断标准（P〈0．01）,且FMD出现舒张过度调节,提示收缩和舒张功能双向调节不良。空腹血糖升高增加血管内皮依赖性舒张功能损害,当FBG合并（或）餐后血糖升高,血浆NT—proBNP水平升高可以成为早期预测慢性无症状心功能不全的危险因素。因此,关注老年糖代谢异常早期阶段进程,并联合血浆NT—proBNP水平和血管内皮依赖性舒张功能监测,不仅对靶器官保护具有早期预警意义,而且是临床控制血糖管理的重要而简易的方法之一。     

Ego development in the face of death: How being HIV positive affects movement through Erikson's adult stages of development

Erikson's epigenetic model of psychosocial development posits that each of eight stages unfolds in a particular sequence, and each becomes the primary issue of concern at specified times in the life cycle. Erikson does not address, nor could any empirical studies be located, exploring how the emergence of these eight stages might be affected by a diagnosis of terminal illness. The purpose of this study was to understand how an HIV-positive diagnosis affected movement through Erikson's stages of development. In-depth interviews were conducted with a sample of 18 HIV-positive men and women under 45 years of age. Analysis of the qualitative data revealed three findings regarding Erikson's stages: (1) The fifth stage of idenitity versus role confusion was revisted and the sense of self is redefined; (2) the three adulthood stages of intimacy versus isolation, generativity versus stagnation, and ego integrity versus depair were dealt with simulataneously and, in most cases, resolved favorably; and (3) intimacy and generativity enabled and supported the resolution of the tasks of identity and ego integrity.     

The role of contingencies and "principles of behavioral variation" in pigeons' pecking

Staddon and Simmelhag's proposal that behavior is produced by “principles of behavioral variation” instead of contingencies of reinforcement was tested in two experiments. In the first experiment pigeons were exposed to either a fixed-interval schedule of response-contingent reinforcement, an autoshaping schedule of stimulus-contingent reinforcement, or a fixed-time schedule of noncontingent reinforcement. Pigeons exposed to contingent reinforcement came to peck more rapidly than those exposed to noncontingent reinforcement. Staddon and Simmelhag's “principles of behavioral variation” included the proposal that patterns (interim and terminal) were a function of momentary probability of reinforcement. In the second experiment pigeons were exposed to either a fixed-time or a random-time schedule of noncontingent reinforcement. Pecking showed a constant frequency of occurrence over postfood time on the random-time schedule. Most behavior showed patterns on the fixed-time schedule that differed in overall shape (i.e., interim versus terminal) from those shown on the random-time schedule. It was concluded that both the momentary probability of reinforcement and postfood time can affect patterning.     

Temporal context in concurrent chains: I. Terminal-link duration

Two experiments are reported in which the ratio of the average times spent in the terminal and initial links (Tt/Ti) in concurrent chains was varied. In Experiment 1, pigeons responded in a three-component procedure in which terminal-link variable-interval schedules were in constant ratio, but their average duration increased across components by a factor of two. The log initial-link response ratio was a negatively accelerated function of Tt/Ti. Overall, the data were well described by Grace's (1994) contextual choice model (CCM) with temporal context represented as (Tt/Ti)k or 2Tt/(Tt + Ti), and by Mazur's (2001) hyperbolic value-added model (HVA), with each model accounting for approximately 93% of the variance. In Experiment 2, fixed-parameter predictions for each model were generated, based on the data from Experiment 1, for conditions in which Tt/Ti was varied over a more extreme range. Data were consistent with the predictions of CCM with temporal context represented as 2Tt/(Tt + Ti) and to a lesser extent as (Tt/Ti)k, but not with HVA. Overall, these results suggest that preference increases as a hyperbolic function of Tt/Ti when terminal-link duration is increased relative to initial-link duration, with the terminal-link schedule ratio held constant.