BackgroundSevere brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope.MethodsTo examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who were (...) enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study.ResultsTwelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results.ConclusionThis study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. (shrink)

We examine the interface of entrepreneurship and society by considering a novel source of gender bias (public opinion) and a novel expression of it (affective evaluations). We posit that women-led teams displaying success will trigger a “penalty for success” bias, and this will be inhibited if the team receives a “stamp of approval” from a gender congruent individual (i.e., an investor who is a man). Analysis from our first study, based on archival data, indicated that other mechanisms might be at (...) play that we could not tease apart in our archival data, so we conducted a follow-up experimental study to further examine our initial findings. Results jointly indicate that women are viewed unfavorably unless either (a) they are validated by success or endorsement from a man, or (b) they fail but are “warm and accommodating” about it. We also find that while men benefit from being validated by success or endorsement of an opposite-gender investor, they do not face a similarly steep penalty absent that validation. (shrink)

Views of the self may be plotted on a set of coordinates. On the axis that runs from fragmentation to unity, Rorty and Rorty's Freud champion the decentered self while Wallwork, Taylor, and Ricoeur argue for a sovereign, unified self. On the other axis, which runs from the disengaged, inward-turning self to the engaged and "sedimented" self, Wallwork, would be positioned near Rorty, defending self-creation against the narrative identity affirmed by Taylor and Ricoeur. Despite his skepticism concerning the communitarian agenda (...) of the narrativists, Flanagan grants that the self is social and relational--a position further explored by Oliver, Stendahl, Deutsch, and Mack in "Selves, People, and Persons". (shrink)

This article considers the various emergence of an explicitly recognized right to life in papal teaching and the canon law of the last century and a quarter. The Church's opposition to abortion is deeply embedded within the tradition and law of the Church. It was, however, only in recent times, since the middle twentieth century, really, that the Church began to speak explicitly of a right to life. This paper explores the consequences for papal thought of this explicit recognition of (...) rights. By speaking of a right to life, the Church has moved beyond the abortion debate to embrace a variety of other concerns. This is not to say that abortion does not remain important. Direct participation in abortion is a crime at canon law that results in automatic excommunication. But the language of rights has allowed the Church to address such matters as the protection of refugees; the moral requirement of adequate health care; the odious use of child-soldiers; and the use of economic embargoes that have the effect of destroying the civilian infrastructure (and public health systems) of entire societies. (shrink)

Copyright © 2015 by the Society of Criti. Objective: Global lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver is inversely associated with lung stress and mortality in acute respiratory distress syndrome. Design: Substudy of an acute respiratory distress (...) syndrome clinical trial on esophageal pressure-guided positive end-expiratory pressure titration. Setting: U.S. academic medical center. Patients: Forty-two patients with acute respiratory distress syndrome in whom airflow, airway pressure, and esophageal pressure were recorded during the recruitment maneuver. Interventions: A single recruitment maneuver was performed before initiating protocol-directed ventilator management. Recruitment maneuvers consisted of a 30-second breath hold at 40 cm H2O airway pressure under heavy sedation or paralysis. VRM was calculated by integrating the flow-time waveform during the maneuver. End-inspiratory stress was defined as the transpulmonary pressure during end-inspiratory pause of a tidal breath and tidal stress as the transpulmonary pressure difference between end-inspiratory and end-expiratory pauses. Measurements and Main Results: VRM ranged between 7.4 and 34.7 mL/kg predicted body weight. Lower VRM predicted high end-inspiratory and tidal lung stress. After adjusting for Pao2/Fio2 and either driving pressure, tidal volume, or plateau pressure and positive end-expiratory pressure, VRM remained independently associated with both end-inspiratory and tidal stress. In unadjusted analysis, low VRM predicted increased risk of death. VRM remained significantly associated with mortality after adjusting for study arm. Conclusions: Low VRM independently predicts high lung stress and may predict risk of death in patients with acute respiratory distress syndrome. (shrink)

Patient outcome after serious brain injury is highly variable. Following a period of coma, some patients recover while others progress into a vegetative state (unresponsive wakefulness syndrome) or minimally conscious state. In both cases, assessment is difficult and misdiagnosis may be as high as 43%. Recent advances in neuroimaging suggest a solution. Both functional magnetic resonance imaging and electroencephalography have been used to detect residual cognitive function in vegetative and minimally conscious patients. Neuroimaging may improve diagnosis and prognostication. These techniques (...) are beginning to be applied to comatose patients soon after injury. Evidence of preserved cognitive function may predict recovery, and this information would help families and health providers. Complex ethical issues arise due to the vulnerability of patients and families, difficulties interpreting negative results, restriction of communication to “yes” or “no” answers, and cost. We seek to investigate ethical issues in the use of neuroimaging in behaviorally nonresponsive patients who have suffered serious brain injury. The objectives of this research are to: (1) create an approach to capacity assessment using neuroimaging; (2) develop an ethics of welfare framework to guide considerations of quality of life; (3) explore the impact of neuroimaging on families; and, (4) analyze the ethics of the use of neuroimaging in comatose patients. (shrink)