BackgroundPeople with upper extremity amputations report receiving insufficient information about treatment options. Furthermore, patients commonly report not knowing what questions to ask providers. A question prompt sheet, or list of questions, can support patient-centered care by empowering patients to ask questions important to them, promoting patient-provider communication, and increasing patient knowledge. This study assessed information needs among people with UE amputations about UE vascularized composite allotransplantation and developed a UE VCA-QPS.MethodsThis multi-site, cross-sectional, mixed-methods study involved in-depth and semi-structured interviews with (...) people with UE amputations to assess information needs and develop a UE VCA-QPS. Qualitative data were analyzed by thematic analysis; quantitative data were analyzed by descriptive statistics. The initial UE VCA-QPS included 130 items across 18 topics.ResultsEighty-nine people with UE amputations participated. Most were male, had a mean age of 46 years, and had a unilateral and below-elbow amputation. Participants desired information about UE VCA eligibility, evaluation process, surgery, risks, rehabilitation, and functional outcomes. After refinement, the final UE VCA-QPS included 35 items, across 9 topics. All items were written at a ≤ 6th grade reading level. Most semi-structured interview participants reported being ‘completely’ or ‘very’ likely to use a UE VCA-QPS.ConclusionPeople with UE amputations have extensive information needs about UE VCA. The UE VCA-QPS aims to address patients’ information needs and foster patient-centered care. Future research should assess whether the UE VCA-QPS facilitates patient-provider discussion and informed decision-making for UE VCA. (shrink)

In his article, “The Unified Brain-Based Determination of Death Conceptually Justifies Death Determination in DCDD and NRP Protocols,” James Bernat argues that Thoracoabdominal Normothermic Regiona...

Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and (...) in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after transplant, (...) Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)

Abstract:This symposium includes thirteen personal narratives from people who have received at least one organ transplant from a living or deceased donor. These narratives foster better understanding of the experiences of life-saving organ recipients and their families, including post-transplant difficulties experienced—sometimes requiring multiple transplants. This issue also includes three commentaries by Macey L. Levan, Heather Lannon, and Vidya Fleetwood, Roslyn B. Mannon & Krista L. Lentine. Dr. Levan is a living kidney donor and associate professor of surgery (...) and population health. She writes and teaches on organ transplant and has expertise and experience in governance at the federal level as a member of the board of directors for the U.S. Organ Procurement and Transplantation Network. Dr. Lannon is a social worker and transplant advocate. Her work and interest in the topic were inspired by her husband who needed a heart transplant. Dr. Fleetwood is a surgeon specializing in liver transplantation, pancreas transplantation, kidney transplantation, as well as living donor nephrectomy. Dr. Mannon is a nephrologist and professor of medicine, pathology and microbiology. Her work focuses on understanding and improving long-term kidney transplant outcomes for patients, donors, and caregivers. Dr. Lentine is a nephrologist specializing in treatment of adult patients with kidney disease. She is a researcher and co-chaired the international work group that developed guidelines for living donor kidney transplantation. (shrink)

Hennepin County is the largest metropolitan area in Minnesota and includes the city of Minneapolis and surrounding suburbs. On Tuesday, March 24, 2020, the weekly local shelter count identified 1,494 individuals accessing homeless shelters within Minneapolis—205 children with adults, 112 adults with children, 56 youth without an adult, 971 individual adults, and 115 adults accessing emergency hotel placement in response to COVID-19 pandemic. Beyond the shelter system, a recent local point-in-time count logged 732 individuals sleeping on transit, in encampments, in (...) abandoned buildings, or otherwise outdoors. This total of 2,226 Hennepin County residents identified who lacked residence in the late winter of 2020 is... (shrink)

In this letter to the editor, the author responds to articles by G. Testa and colleagues, "Living Donation and Cosmetic Surgery: A Double Standard in Medical Ethics?" and by L. Friedman Ross and colleagues, "Different Standards Are Not Double Standards: All Elective Surgery Patients Are Not Alike," which were published in the Summer 2012 issue of The Journal of Clinical Ethics.

The one -- The first limit and the first infinity -- The henads -- Intellect -- Soul -- Time and eternity.

About 6,000 individuals participate in the U.S. transplant system as a living organ donor each year. Organ donation by living individuals is a unique procedure, where healthy patients undergo a major surgical operation without any direct functional benefit to themselves. In this article, the authors explore how the ideal of informed consent guides education and evaluation for living organ donation. The authors posit that informed consent for living organ donation is a process. Though the steps in this process are partially (...) standardized through national health policy, they can be improved through institutional structures at the local, transplant center-level. Effective structures and practices aimed at supporting and promoting comprehensive informed consent provide more opportunities for candidates to ask questions about the risks and benefits of living donation and to opt out voluntarily Additionally, these practices could enable new ways of measuring knowledge and improving the consent process. (shrink)

Volume 19, Issue 11, November 2019, Page 42-44.

The training relationship between sport psychology professionals (SPPs) and their students is a critical aspect of graduate training. Maintaining ethical, appropriate boundaries within training relationships is imperative, as boundary crossings can have deleterious effects on students. SPPs (N = 152) and Sport Psychology graduate students (N = 165) completed The Survey of Applied Sport Psychologists to explore their experiences and perceptions of sexual attractions and boundary crossings within training relationships. Nearly 30% of SPPs acknowledged sexual attractions toward their students, yet (...) few students (8.5%) perceived such attractions. Compared to the SPPs, the students reported higher levels of anxiety regarding the SPP’s attraction toward them; both groups reported infrequent use of supervision for this attraction. Nine students and 13 SPPs reported engaging in sexual behaviors (e.g., kissing, dating, intercourse) with the other. Within the larger sample, the three most common nonsexual boundary crossings were becoming social friends, attending social gatherings, and the SPP initiating nonsexual touching. Both groups are advised to engage in ongoing monitor their behaviors, receive training specific to ethics within training relationships, and seek consultation/supervision to ensure appropriate boundaries remain intact. (shrink)

The Industrial Revolution caused an expansion of our ideas of property to include other forms of wealth, such as innovations and productive techniques. And the modern age has caused a further expansion of our ideas of property to include inchoate items, particularly information. The Framers of the U.S. Constitution presumed that government not only took an expansive view of the nature of property rights, they also believed that such rights should be protected. To James Madison and the other Framers, property (...) was a “broad and majestic term” that “embraces everything which may have a value to which man may attach a right.”. (shrink)

The most comprehensive study of the controversial French thinker--and of his place in the history of philosophy. As public as Foucault was in his militant campaigns on behalf of prisoners, dissidents, and homosexuals, his private life was mysterious: he tried to destroy all documents that might offer clues to his personality.

The existence of a meaningful distinction between economic rights and “other rights” has been a cornerstone of constitutional law for the past sixty years. During this period, the federal courts consistently have taken the position that Congress is free to abuse citizens’ economic liberties, but is not permitted to interfere with such other, noneconomic “rights” as freedom of expression, freedom of assembly, and freedom of religion.

In this essay, I identify the reasons that libertarian principles have failed to capture the popular imagination as an acceptable form of civil society. By the term “libertarian” I mean a belief in and commitment to a set of methods and policies that have as their common aim greater freedom under law for individuals. The term “freedom” in this context means not only a commitment to civil liberties, such as freedom of expression, but also to economic liberties, including a commitment (...) to a laissez-faire policy of free enterprise and free trade between countries. Libertarians, therefore, are committed to the absolute minimum state intervention in the economy as well as in people's private lives. In a world constrained by these libertarian principles, people should be permitted to do as they please, constrained only by rules that prevent them from encroaching on the liberty of others. (shrink)

This article examines the ambivalences in Foucault’s elaboration of the concept of biopower and biopolitics. From the beginning, he relates the idea of a power over life to struggle and war, and so to race. In the period of the formation of the nation-state, threats to the unity and strength of the population were thought to come from a contagion by an alien element. In this context, tropes of race became aligned with the ‘sciences and technologies of the social’ that (...) were emerging as part of biopolitics. They became part of the new rationality of the state, finding expression in projects such as public hygiene and eugenics, and, at the extreme, in Nazism. (shrink)

With_ Michel Foucault_, Reaktion Books introduces an exciting new series that brings the work of major intellectual figures to general readers, illuminating their groundbreaking ideas through concise biographies and cogent readings. There is no better thinker than Foucault with which to begin the "Critical Lives" series. Though reticent about his personal life for most of his career, Foucault, in the last years of his life, changed his stance on the relationship between the personal and the intellectual and began to speak (...) of an "aesthetics of existence" in which "the life" and "the work" become one. David Macey, a renowned expert on Foucault, demonstrates that these contradictions make it possible to relate Foucault's work to his life in an original and exciting way. Exploring the complex intellectual and political world in which Foucault lived and worked, and how that world is reflected in his seminal works, Macey paints a portrait of Foucault in which the thinker emerges as a brilliant strategist, one who-while fiercely promoting himself as a maverick-aligned himself with particular intellectual camps at precisely the right moments. _Michel Foucault_ traces the philosopher's career from his comfortable provincial background to the pinnacle of the French academic system, paying careful attention to the networks of friendships and the relations of power that sustained Foucault's prominence in the academy. In an interview in 1966, Foucault said, "One ought to read everything, study everything. In other words, one must have at one's disposal the general archive of a period at a given moment." It is precisely this archive that Macey restores here, accessibly relating Foucault's works to the particular context in which they were given form. (shrink)

The paper provides a preliminary study of algebraic semantics for modal and superintuitionistic non-monotonic logics. The main question answered is: how can non-monotonic inference be understood algebraically?

It has become almost conventional to describe the early work of Frantz Fanon as an expression of individual political revolt, and his later work as testimony to his commitment to a collective (national) revolution. This article contends that the early work (and especially Peau noire, masques blancs), while individualistic, is a continued source of political embarrassment in that it is unclassifiable and raises difficult issues about the construction of race and racism, as well as challenging conventional views of Fanon as (...) ‘revolutionary’ psychiatrist. Fanon’s representation of his native Martinique, which he effectively disowned, is negative, but proves to be of surprising contemporary relevance, while his analysis of the mechanisms of racism is still pertinent: the situation in which racist stereotypes are invoked may have changed, but the stereotypical structures they employ remain remarkably constant, as do their profoundly dehumanizing effects. Fanon raises embarrassing questions for a French Republic that claims to be universal, demonstrating that its universal values are undermined by those it claims as its subjects. (shrink)