Occupational therapy often uses craft activities as therapeutic tools, but their therapeutic effectiveness has not yet been adequately demonstrated. The aim of this study was to examine changes in frontal midline theta rhythm (Fmθ) and autonomic nervous responses during craft activities, and to explore the physiological mechanisms underlying the therapeutic effectiveness of occupational therapy. To achieve this, we employed a simple craft activity as a task to induce Fmθ and performed simultaneous EEG and ECG recordings. For participants in which Fmθ (...) activities were provoked, parasympathetic and sympathetic activities were evaluated during the appearance of Fmθ and rest periods using the Lorenz plot analysis. Both parasympathetic and sympathetic indices increased with the appearance of Fmθ compared to during resting periods. This suggests that a relaxed-concentration state is achieved by concentrating on craft activities. Furthermore, the appearance of Fmθ positively correlated with parasympathetic activity, and theta band activity in the frontal area were associated with sympathetic activity. This suggests that there is a close relationship between cardiac autonomic function and Fmθ activity. (shrink)

Heart rate variability (HRV), the change in the time intervals between adjacent heartbeats, is an emergent property of interdependent regulatory systems that operate on different time scales to adapt to challenges and achieve optimal performance. This article briefly reviews neural regulation of the heart, and its basic anatomy, the cardiac cycle, and the sinoatrial and atrioventricular pacemakers. The cardiovascular regulation center in the medulla integrates sensory information and input from higher brain centers, and afferent cardiovascular system inputs to adjust (...) heart rate and blood pressure via sympathetic and parasympathetic efferent pathways. This article reviews sympathetic and parasympathetic influences on the heart, and examines the interpretation of HRV and the association between reduced HRV, risk of disease and mortality, and the loss of regulatory capacity. This article also discusses the intrinsic cardiac nervous system and the heart-brain connection, through which afferent information can influence activity in the subcortical and frontocortical areas, and motor cortex. It also considers new perspectives on the putative underlying physiological mechanisms and properties of the ultra-low-frequency (ULF), very-low-frequency (VLF), low-frequency (LF), and high-frequency (HF) bands. Additionally, it reviews the most common time and frequency domain measurements as well as standardized data collection protocols. In its final section, this article integrates Porges' polyvagal theory, Thayer and colleagues' neurovisceral integration model, Lehrer et al.'s resonance frequency model, and the Institute of HeartMath's coherence model. The authors conclude that a coherent heart is not a metronome because its rhythms are characterized by both complexity and stability over longer time scales. Future research should expand understanding of how the heart and its intrinsic nervous system influence the brain. (shrink)

High blood pressure is an important component of pre-eclampsia. The underlying mechanism of development of hypertension in pre-eclampsia is complicated and still remains obscure. Several theories have been advanced including endothelial dysfunction, uteroplacental insufficiency leading to generalized vasoconstriction, increased cardiac output, and sympathetic hyperactivity. Increased blood flow and pressure are thought to lead to capillary dilatation, which damages end-organ sites, leading to hypertension, proteinuria and edema. Additional theories have been put forward based on epidemiological research, implicating immunological and (...) genetic factors. None of these theories have been substantiated. Based on a review of literature this paper postulates that the initiating event for the development of preeclampsia is intermittent hypoxia associated with irregular breathing during sleep, hypoapnea, apnea,inadequate respiratory excursions during the waking hours and inadequate cardiopulmonary synchronization (abnormal sympatho-vagal balance). (shrink)

The situation-dependent lateralization of sympathetic electrodermal arousal during real-life stress (Picard, Fedor, & Ayzenberg, 2016) may challenge a unitary notion of arousal, and call into question the practice of unilateral electrodermal recording, but there are broader implications. Here we consider a potential relationship between stress-induced lateralized shifts in electrodermal activity, and a theory concerning lateralized emotion-induced cardiac arrhythmia.

Previous studies suggest in line with dual process models that interoceptive skills affect controlled decisions via automatic or implicit processing. The “framing effect” is considered to capture implicit effects of task-irrelevant emotional stimuli on decision-making. We hypothesized that cardiac awareness, as a measure of interoceptive skills, is positively associated with susceptibility to the framing effect. Forty volunteers performed a risky-choice framing task in which the effect of loss versus gain frames on decisions based on identical information was assessed. The (...) results show a positive association between cardiac awareness and the framing effect, accounting for 24% of the variance in the framing effect. These findings demonstrate that good interoceptive skills are linked to poorer performance in risky choices based on ambivalent information when implicit bias is induced by task-irrelevant emotional information. These findings support a dual process perspective on decision-making and suggest that interoceptive skills mediate effects of implicit bias on decisions. (shrink)

ObjectiveTo assess the impact of the closure of group-based cardiac rehabilitation training during the first COVID-19 lockdown in spring 2020 on patients’ physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.DesignMixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.SettingOutpatient CR centre in Salzburg, Austria.ParticipantsTwenty-seven patients [six female, mean age 69 (...) years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.Outcome MeasureQuantitative: exercise capacity, cardiovascular risk. Qualitative: individual semi-structured interviews.ResultsExercise capacity had significantly reduced from pre- to post-lockdown: mean power in maximal ergometry 165 vs. 151, p < 0.001; submaximal ergometer training 99 vs. 97, p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 said they had been unable to maintain their exercise levels, and 15 felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.ConclusionThis study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward. (shrink)

Certain organoid subtypes are particularly sensitive. We explore whether moral intuitions about the heartbeat warrant unique moral consideration for newly advanced contracting cardiac organoids. Despite the heartbeat’s moral significance in organ procurement and abortion discussions, we argue that this significance should not translate into moral implications for cardiac organoids.

The ability to alter one’s emotional responses is central to overall well-being and to effectively meeting the demands of life. One of the chief symptoms of events such as trauma, that overwhelm our capacities to successfully handle and adapt to them, is a shift in our internal baseline reference such that there ensues a repetitive activation of the traumatic event. This can result in high vigilance and over-sensitivity to environmental signals which are reflected in inappropriate emotional responses and autonomic nervous (...) system dynamics. In this article we discuss the perspective that one’s ability to self-regulate the quality of feeling and emotion of one’s moment-to-moment experience is intimately tied to our physiology, and the reciprocal interactions among physiological, cognitive, and emotional systems. These interactions form the basis of information processing networks in which communication between systems occurs through the generation and transmission of rhythms and patterns of activity. Our discussion emphasizes the communication pathways between the heart and brain, as well as how these are related to cognitive and emotional function and self-regulatory capacity. We discuss the hypothesis that self-induced positive emotions increase the coherence in bodily processes, which is reflected in the pattern of the heart’s rhythm. This shift in the heart rhythm in turn plays an important role in facilitating higher cognitive functions, creating emotional stability and facilitating states of calm. Over time, this establishes a new inner-baseline reference, a type of implicit memory that organizes perception, feelings, and behavior. Without establishing a new baseline reference, people are at risk of getting “stuck” in familiar, yet unhealthy emotional and behavioral patterns and living their lives through the automatic filters of past familiar or traumatic experience. (shrink)

Cardiac disease is the leading cause of death worldwide. Cardiovascular diseases can be prevented if an effective diagnostic is made at the initial stages. The ECG test is referred to as the diagnostic assistant tool for screening of cardiac disorder. The research purposes of a cardiac disorder detection system from 12-lead-based ECG Images. The healthcare institutes used various ECG equipment that present results in nonuniform formats of ECG images. The research study proposes a generalized methodology to process (...) all formats of ECG. Single Shoot Detection MobileNet v2-based Deep Neural Network architecture was used to detect cardiovascular disease detection. The study focused on detecting the four major cardiac abnormalities with 98% accuracy results were calculated. The work is relatively rare based on their dataset; a collection of 11,148 standard 12-lead-based ECG images used in this study were manually collected from health care institutes and annotated by the domain experts. The study achieved high accuracy results to differentiate and detect four major cardiac abnormalities. Several cardiologists manually verified the proposed system’s accuracy result and recommended that the proposed system can be used to screen for a cardiac disorder. (shrink)

"Sympathetic Sentiments develops an innovative interdisciplinary framework to explore the implications of living in a 'culture of feeling' that seems ill at ease with itself, one in which 'sentiments' are frequently denounced for being 'sentimental' and self-indulgent. This is traced back to the inheritance of the eighteenth century, enabling us to identify a distinctive 'spectacle of sympathy' in which sympathy seems inherently to entail public forms of expression whereby being 'on show' is both a condition of the authenticity of (...) such affects and of their capacity to be masked and simulated -- hence stimulating controversy, but also the exploration of the vicarious dimensions of modern experience so central to modern literature, art and culture. The implications of all this are further explored in the context of current debates over the display of trauma as the language of sympathetic engagement, and the alleged prevalence of 'compassion fatigue' in the era of media sensationalism. Overall, the book uncovers the patterns that both reproduce our capacity for 'sympathetic sentiments' while revealing the inherent underlying tensions."--. (shrink)

Background: The majority (70%) of cardiac arrests in Sweden are experienced in the patient’s home. In these situations, the ambulance nurses may encounter several ethical dilemmas. Aim: The aim was to investigate Swedish specialist ambulance nurses’ experiences of ethical dilemmas associated with cardiac arrest situations in adult patients’ homes. Methods: Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. Ethical considerations: Ethical principles (...) mandated by the Swedish Research Council were carefully followed during the whole process. Findings: Two main themes with six sub-themes were identified: The scene – creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients’ integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being’s dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. Conclusion: The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient’s dignity and to serve life and health. (shrink)

Unlike Yiddish (_fargin_) and Sanskrit (_muditā_), English has no single word to describe the practice of sharing someone else’s joy at their success. Sympathetic joy has also escaped attention in philosophy. We are familiar with schadenfreude, begrudging, envy, jealousy, and other terms describing either (a) pleasure at someone else’s misfortune or (b) displeasure at someone else’s good fortune. But what, exactly, is sympathetic joy? I argue that it is a short-term or long-term feeling of great delight at another’s (...) good fortune, requiring no more than minimal understanding of the relevant person and event. It is intensified relative to understanding, sharing, and positive disposal. It is importantly different from empathetic emotions and also from vicarious pride. It may be group-directed. Empirical research suggests it occurs fairly often, activates the brain in the same way as does sympathetic sadness, and may increase our well-being. It is primarily not a reactive attitude (an emotional reaction to good or bad will), but, rather, a sign of good will toward another. (shrink)

The category of sympathy marks a number of basic divisions in early modern approaches to action explanations, whether for human agency or for change in the wider natural world. Some authors were critical of using sympathy to explain change. They call such principles “unintelligible” or assume they involve “mysterious” action at a distance. Others, including Margaret Cavendish, Anne Conway, and Gottfried Wilhelm Leibniz, appeal to sympathy to capture natural phenomena, or to supply a backbone to their metaphysics. Here I discuss (...) how concerns about sympathetic actions form at least a partial background for differing seventeenth-century conceptions of what it is to explain action. I argue that critics of sympathy generally insist on an “atomistic” approach to action explanation, which makes primitively relational phenomena come out as problematic. Proponents of sympathy, by contrast, allow for a more holistic approach to action explanation, which allows for such basic connections. Hence, divergent attitudes toward sympathetic action in part explain differences in approaches to explanation. I conclude by showing how some of these core concerns fade into the background when in the eighteenth-century sympathy gets psychologised and individualised. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:American Journal of Philology 123.1 (2002) 61-87 [Access article in PDF] (Un)Sympathetic Magic: A Study of Heroides 13 Laurel Fulkerson In the Ovidian Corpus, reading and writing are dangerous if not done with great care. Ovid's Laodamia, both hypersensitive and unlucky, is no exception: she shows herself to be an uncritical reader who misconstrues language in a fatal way. She is also a writer, and her carmen (Her. (...) 13) is the "wrong" kind of carmen. The letter that she writes to her husband, Protesilaus, is intended to encourage him to return from the Trojan War, but (along with some of her other behaviors) it precipitates a chain of events that is fraught with supernatural, perhaps even deadly, coincidences. Laodamia's suspicious nature leads her to create by her very words the situation she most fears. She is, ironically, a superstitious woman in a story full of events that serve only to increase her superstition. 1 Yet she herself contributes to these circumstances, most notably by creating a statue of her still-living husband and worshiping it. Because she loses control over her text, the multiple representations that Laodamia creates prove catastrophic for both Protesilaus and herself.This essay explores the literary use of erotic magic imagery in Ovid's Heroides 13 and suggests that the ambiguity of the word carmen ("poem, magic spell") seduces its protagonist into unwittingly replicating (and perhaps even causing) the death of her husband. The key to unlocking the magical referents of the poem lies in the wax imago 2 of Protesilaus and in Laodamia's account of her behavior during his absence. Commentators and critics have often marked her actions as peculiar, but few offer convincing interpretations, and the imago has received infrequent treatment. Most discussions of the poem to date treat isolated actions of Laodamia and therefore fail to make sense of the poem as a whole. [End Page 61] Sources and Background In Heroides 13, the newly wed Laodamia is writing to her husband Protesilaus, commander of the Thessalian ships sent to Troy. 3 Laodamia thinks that the ships are still at Aulis, awaiting a favorable wind, and Ovid offers no reason to doubt this, despite the fact that his heroines are often "incorrect" about specific details of their stories. 4 Laodamia worries about her husband's safety at war, repeatedly urging him to take care of himself and reminding him that her life depends on his. Readers with mythological and etymological knowledge know that she worries with good reason, because, as Laodamia herself notes, an oracle had stated that the first Greek to set foot on Trojan soil would die first (93-94). As a result none of the Greeks was willing to disembark once the ships arrived. 5 Protesilaus scoffed at the oracle and leapt from his boat; he was accordingly the first to die, and a hero cult was established for him in the Chersonesus, near his tomb.In their versions of the story, Eustathius and Hyginus concur with these elements of the tale but disagree on Laodamia's subsequent fate. According to Eustathius, the deceased Protesilaus (at either his request or Laodamia's) 6 is granted permission by Hades to appear to his wife and tell her of his fate. 7 When she hears the news, she kills herself. Eustathius says that she runs a sword through herself; other sources give different accounts of the means she chose, ranging from the sword and [End Page 62] hanging to immolation. 8 Hyginus tells the story twice: first, a brief mention of Laodamia's death, and then a more detailed version (secs. 103-4). The elaborated version serves our analysis better. In it, Laodamia creates a statue of him to fondle after she hears of Protesilaus' death. 9 A servant sees her "Protesilai simulacrum tenentem atque osculantem" ("holding and kissing the image of Protesilaus"), assumes she is committing adultery, and summons her father, who discovers the truth. He orders the statue to be burnt and Laodamia, "dolorem non sustinens" ("not able to bear the pain"), throws herself onto the pyre and... (shrink)

McGovern, Kevin After a brief account of the process, this article considers three significant ethical issues about Donation after Cardiac Death.

This commentary on blumberg et al. addresses complications associated with diagnostic testing for sympathetic dependence of pain that can lead to inappropriate positive and negative conclusions. In addition, it is suggested that their test be conceived as a test of the effect of local vascular pressure and that the two types of sensory disorders presented may differ primarily in the degree of sensitization of central pain pathways. Detailed reports with functionally-oriented testing like that done by BLUMBERG are essential for (...) an understanding the pathophysiological mechanisms. (shrink)

Sympathy is a powerful principle in human nature, which can change our passions, sentiments and ways of thinking. For the 18th century Scottish philosopher David Hume, sympathy is a working mechanism accountable for a wide range of communication: the ways of interacting with the others’ affections, emotions, sentiments, inclinations, ways of thinking and even opinions. The present paper intends to find a systematic reading of Hume’s Treatise of Human Nature from the point of view of what the mechanism of (...) class='Hi'>sympathetic communication implies in terms of strengthening our action of understanding, of being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of others. Hume’s description of the sympathetic mechanism appears to suggest that sympathetic passions come upon us purely by natural means in a passive manner, without the active use of any of our faculties. Consequently, scholarly attention is drawn to the mechanistic character of the sympathetic process; its automatic nature is emphasized to such an extent that some experts even find it to be completely void of any reflective process. The current study investigates to what extent the sympathetic process can actively be modified and in what manner sympathetic feelings can be generated as described in Hume’s system of emotions. The paper identifies at which points the otherwise mechanically and passively operating process of sympathetic feelings is open to be modified by actively altering or strengthening certain skeletal points of the mechanism. I argue that the alterations can be initiated by the person who receives the sympathetic feelings and also by the person whose passions are transmitted, moreover even by a third party. In a seemingly mechanic model, there is room for altering or at least amplifying one’s sympathetic feelings. (shrink)

Sympathetic magic features strongly in virtually all religious traditions and in folk customs generally. Scholars agree that It is based on the association of ideas perceived as external, mind-independent causal realities, as connections mediating causal influence. Moreover, religious folk believe that this mediation involves forms of supernatural agency. From a psychological perspective, the key question revolves around the principles by which the cognitive system deems some of its content to reference the external world and other content to constitute internal (...) mental forms of activity like thoughts, feelings and attitudes. The paper proposes that the critical factor has to do with the balance between two distinctly different kinds of cognitive content: representations of things (mentation arising in the form of something other than itself), as distinct from registrations referencing the intrinsic phenomenal properties of the mental state itself. The balance between these two determines whether content is perceived as external worldly event or a form of internal mental content. (shrink)

The sympathetic plot—featuring a goal-directed protagonist who confronts obstacles, overcomes them, and wins rewards—is ubiquitous. Here, I propose that it recurs because it entertains, engaging two sets of psychological mechanisms. First, it triggers mechanisms for learning about obstacles and how to overcome them. It builds interest by confronting a protagonist with a problem and induces satisfaction when the problem is solved. Second, it evokes sympathetic joy. It establishes the protagonist as an ideal cooperative partner pursuing a goal, appealing (...) to mechanisms for helping. When the protagonist succeeds, they receive rewards, and audiences feel sympathetic joy, an emotion normally triggered when beneficiaries triumph. The capacities underlying the sympathetic plot evolved for learning and cooperation before being co-opted for entertainment. (shrink)

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The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component, and is suppressed by the ischemia test. Under those circumstances, the pain is likely (...) to respond to sympatholytic interventions. In a second group, called (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic–sensory coupling may also vary between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied. (shrink)

Interoception in the broader sense refers to the perception of internal states, including the perception of the actual state of the internal organs and the motor system. Dimensions of interoception include interoceptive accuracy, i.e., the ability to sense internal changes assessed with behavioral tests, confidence rating with respect to perceived performance in an actual behavioral test, and interoceptive sensibility, i.e., the self-reported generalized ability to perceive body changes. The relationship between dimension of cardioceptive and proprioceptive modalities and their association with (...) affect are scarcely studied. In the present study, undergraduate students filled out questionnaires assessing positive and negative affect, interoceptive sensibility, and body competence. Following this, they completed a behavioral task assessing cardioceptive accuracy and two tasks assessing proprioceptive accuracy with respect to the tension of arm flexor muscles and the angular position of the elbow joint. Confidence ratings were measured with visual analog scales after the tasks. With the exception of a weak association between cardioceptive accuracy and the respective confidence rating, no associations between and within modalities were found with respect to various dimensions of interoception. Further, the interoceptive dimensions were not associated with state and trait positive and negative affect and perceived body competence. In summary, interoceptive accuracy scores do not substantially contribute to conscious representations of cardioceptive and proprioceptive ability. Within our data, non-pathological affective states are not associated with the major dimensions of interoception for the cardiac and proprioceptive modalities. (shrink)

Comatose survivors of cardiac arrest may die following withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis. Family members, acting as surrogate decision makers, are frequently asked to decide whether the patient should continue to receive ongoing life-sustaining therapy such as mechanical ventilation in this context of risk of death following removal. Sometimes, physicians and family members disagree about what is in the patient's best interest, and this conflict causes distress for both families and medical personnel. This article (...) examines themes recorded in the medical records of 24 cardiac arrest patients at Columbia University Medical Center (CUMC) whose families chose to pursue continued life support despite physician recommendations for withdrawal. In documented conversations between patients' families and their providers, the most prominent themes included faith in miracles, the inappropriateness of "playing God," the value of more time with the patient, and differences in how providers and family members perceived the patient's status. (shrink)

Donation after cardiac death (CDC) is an important issue in the spiritual care and hospital chaplaincy ministry to patients, staff, and families in the Pittsburgh Mercy Health System. Key members of the interdisciplinary care teams must be well informed about the facts of this controversial issue. Ethical decisions made in particular cases contribute to the development of hospital policies and the establishment of “best practices” in large Catholic health care systems throughout the United States, and must be made with (...) the utmost care. This article provides a brief history and overview of donation after cardiac death and discusses the major ethical issues that were addressed during CDC policy development for the Pittsburgh Mercy Health System. The issues center on questions of whether donors are really dead. Specific issues include death criteria, including the time of pronouncement of death; conflicts of interest; treatment of patients and their loved ones; and organ preservation techniques. National Catholic Bioethics Quarterly 7.3 (Autumn 2007): 527–543. (shrink)

In the work of Charles H. Cooley, sympathy is a central subject matter of sociology and social psychology, a descriptive and explanatory method similar to “interpretive understanding,” and an evaluative method used for social critique and arguments for social reforms. The latter feature of the value-orienting qualitative method of sympathetic introspection is pertinent in light of discussions regarding the development of a critical qualitative methodology. The uniqueness of Cooley's method, when compared to value-neutral approaches in the interpretive tradition, is (...) its theoretically- and methodologically-grounded license for social scientific thinking to cultivate concern for the people it studies, with the following practical implication: arguments for social reforms rooted in a form of knowledge that embeds individuals in the social whole. Further, Cooley's notion of sympathy contributes to the theory of mind debate by theorizing both a philosophical-anthropological and sociological foundation for attributing mental states to others in order to participate in social action. (shrink)

Recent studies indicate a role of the sympathetic nervous system in acute and chronic pain. However, the terminology of the clinical sympathetically maintained pain (SMP) syndromes continues to be confusing and the criteria for diagnosis of SMP are being refined. (blumberg et al.) Despite significant progress in recent years, the mechanisms of the interaction between the sympathetic and sensory systems in SMP remain puzzling.

A 68-year-old patient who suffered from gastric cancer diagnosed 8 months earlier presented with multiple peritoneal and hepatic metastasis, despite several rounds of chemo- and radiotherapy. After admission to hospital, his general condition quickly became severely compromised. He was nearly emaciated, despite being on partial parenteral feeding. Four years earlier, due to a cardiac arrhythmia that was refractory to medication, the patient had a cardiac pacemaker implanted, regulated to go off at frequencies of below 70 beats per minute. (...) Given the patient's terminal situation, the team started developing some doubts about the pacemaker's effects during his dying process. The patient had mentioned his intention to donate his pacemaker after his death, but had not asked for its deactivation. The specialists were not sure about the effect of the pacemaker in unnecessarily prolonging the patient's final hour. Nevertheless, they opposed deactivation, which they considered ethically uncertain. The family, who had been initially for the deactivation, decided against it. The patient's condition was progressively deteriorating, as he was falling into a state of sopor and, later, into a coma. (shrink)

The gambler's fallacy and hot hand were studied in predictions about outcomes of coin tosses. A critical trial occurred when participants made predictions after a “run” of four heads or tails. Participants' attention was manipulated to focus on the person flipping the coin, the coin, or neither (control group) as a possible cause of the run. We also manipulated whether or not there was a change in who tossed the coin. In the control condition the standard reversal was observed (gambler's (...) fallacy); however, when participants focused on the person, and it was that same person who conducted the run and critical coin toss, more people chose in the direction of continuation (hot hand). Directing attention to the person tossing the run seemed to prompt participants to behave as if that individual was “hot” in terms of getting a specific outcome (e.g., heads), as if by sympathetic magic, thus eliminating the gambler's fallacy. (shrink)

Managing cardiac illness is not easy because it dramatically disrupts people’s daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic (...) coping plays in moderating the link between patient and partner cardiac illness-related distress and partner support. The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple’s cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support. With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping. (shrink)

Pain perception is influenced by several factors, and among them, affect, sex, and perception of bodily signals are assumed to play a prominent role. The aim of the present study is to explore how sex, cardiac interoceptive accuracy, and the interaction of the latter two influence the perception of experimentally induced pain. We investigated a large sample of young adults (n= 159, 50.9% female, age: 23.45, SD = 3.767), assessing current positive and negative affective state with the Positive and (...) Negative Affect Schedule (both involved as control variables), cardiac interoceptive accuracy with the mental heartbeat tracking task, and pain sensitivity with electrical stimulation on the back of the dominant hand, applying a repeated-measures staircase protocol. Males showed a significantly higher pain threshold and tolerance level than females, whereas cardiac interoceptive accuracy was not associated with pain sensitivity. The impact of sex × cardiac interoceptive accuracy interaction was significant for pain threshold only, while pain tolerance was predicted only by sex. According to these findings, the associations between pain sensitivity, cardiac IAc, and sex might be more complicated than it was supposed in previous studies. Interactions between factors impacting pain perception appear worthy of further investigation. (shrink)

This article applies a theoretical framework developed by the late American sociologist Anselm Strauss to the discovery of a new resuscitation technique, closed-chest cardiac massage. The discovery, which took place in the laboratories of Johns Hopkins University between 1956 and 1960, is analyzed as the collective management of a trajectory over time. The article follows the discovery trajectory from its origins in defibrillator research to the establishment of closed-chest cardiac massage and cardiopulmonary resuscitation as a universal life-saving method. (...) The analytical focus on the experimental, clinical, and promotional activities performed by the different actors interacting with the emerging technology allows one to critically question the value of concepts such as closure, stabilization, and black boxing in sociology of science and technology. Instead of prematurely freezing the analysis of technoscience, a trajectory conceptual framework emphasizes the ongoing dynamic between actors and medical technology to define the scope, effectiveness, and multiple interpretations of the technology-actor interaction. (shrink)

This paper examines the ethical aspects of organ transplant surgery in which a donor heart is transplanted from a first recipient, following determination of death by neurologic criteria, to a second recipient. Retransplantation in this sense differs from that in which one recipient undergoes repeat heart transplantation of a newly donated organ, and is thus referred to here as “reuse cardiac organ transplantation.” Medical, legal, and ethical analysis, with a main focus on ethical analysis. From the medical perspective, it (...) is critical to ensure the quality and safety of reused organs, but we lack sufficient empirical data pertaining to medical risk. From the legal perspective, a comparative examination of laws in the United States and Japan affirms no illegality, but legal scholars disagree on the appropriate analysis of the issues, including whether or not property rights apply to transplanted organs. Ethical arguments supporting the reuse of organs include the analogous nature of donation to gifts, the value of donations as inheritance property, and the public property theory as it pertains to organs. Meanwhile, ethical arguments such as those that address organ recycling and identity issues challenge organ reuse. We conclude that organ reuse is not only ethically permissible, but even ethically desirable. Furthermore, we suggest changes to be implemented in the informed consent process prior to organ transplantation. The organ transplant community worldwide should engage in wider and deeper discussions, in hopes that such efforts will lead to the timely preparation of guidelines to implement reuse cardiac organ transplantation as well as reuse transplantation of other organs such as kidney and liver. (shrink)

Organ transplantation offers many people who suffer from organ failure a chance to live longer. The Catholic Church, which has endorsed organ donation if it is practiced in an ethically acceptable manner, requires that unpaired vital organs be donated only after the donor is certainly dead. In an effort to increase the number of viable organs, a procedure called donation after cardiac death was introduced in the 1990s. This procedure violates the Roman Catholic moral teaching on the dignity of (...) human life because it violates the dead donor rule and undermines the dignity of the dying person. National Catholic Bioethics Quarterly 12.1 (Spring 2012): 55–65. (shrink)

To be more than a meta-ethical stance, moral phenomenology must provide an account of moral norms. This paper unites two sorts of phenomenological considerations. The first considers the teleological character of intentional experiences as ordered toward "truthfulness" in all the spheres of reason and toward a notion of self-responsibility for our beliefs, attitudes, and actions as the flourishing of rational agents. The second considers the phenomenological tradition's identification of empathy as the experience in which we encounter others as conscious agents (...) like me but irreducibly different from me and that grounds the emotions of respect and sympathy. Respect grasps the other conscious agent as an irreducibly different cognizing, rational, reflection-capable being, as making articulated judgments of value, and as making articulated choices about what activities conduce to what ends. Respect for others cannot be separated from a sympathetic care for others, a sympathy that inclines one toward caring for and aiding the other person in developing her own rational capacities. Sympathy, in brief, complements respect. At the same time, respect complements sympathy insofar as sympathy runs the risk of transmuting into paternalism. This is why, just as we need sympathy in relation to respect, we need respect in relation to sympathy. The paper introduces a distinction between first-order goods for an agent and the second-order goods associated with truthfulness. The second-order goods, the paper argues, necessarily override first-order goods when they prevent the attainment of the second-order goods for anyone. (shrink)

In the Doctrine of Virtue Kant divides duties of love into three categories: beneficent activity , gratitude and Teilnehmung – commonly referred to as the duty of sympathy . In this paper I will argue that the content and scope of the third duty of love has been underestimated by both critics and defenders of Kant's ethical theory. The account which pervades the secondary literature maintains that the third duty of love includes only two components: an obligation to make use (...) of our natural receptivity to sympathetic feelings as a means to fulfilling other duties of love, and an indirect duty to cultivate these feelings. As a result, Kant's duty of sympathy has been widely regarded as a duty whose value is derived from the way in which it serves other duties, in particular, the duty of beneficent activity, which obliges agents ‘to promote according to one's means the happiness of others in need’ . Teilnehmung has thus assumed something of a second-class status among the duties to others. My aim in this paper is to demonstrate that the prevailing account of Kant's third duty of love is incomplete. (shrink)

Certain patients with a possible contribution of the sympathetic system to pain may not fit the definition of complex regional pain syndromes (CRPS), which raises the question of terminology for those patients. To further clarify the relationship between the sympathetic system and pain, apart from the need for placebo studies, there remains an urgent need for a satisfactory definition of the criteria for a complete sympathetic block. It also remains uncertain whether a change in the discharge pattern (...) of sympathetic fibres underlies the changes in sympathetic organ function, often found in patients with CRPS. (shrink)