Poems and Commentaries by Amit Majmudar, Kelly Sievers, Bonnie Salomon, David Watts, Paul Boor, and Beth Lown.Jack Coulehan, Editor.

In his story entitled "Toenails," the surgeon Richard Selzer (1982) warns readers that total immersion in medicine is wrongheaded. Rather, to ensure their own health, doctors should discover other passions that permit them periodically to disconnect from medical practice. Selzer's surgeon character devotes his Wednesday afternoons to the public library, where he joins "a subculture of elderly men and women who gather … to read or sleep beneath the world's newspapers" (p. 69). Among these often eccentric personages is Neckerchief, an (...) arthritic man in his 80s who suffers from severe foot pain. His toenails, never trimmed because of his inability to reach them, have grown so long that they curve beneath his toes and .. (shrink)

Ten years ago there was little talk about adding “professionalism” to the medical curriculum. Educators seemed to believe that professionalism was like the studs of a building—the occupants assume them to be present, supporting and defining the space in which they live or work, but no one talks much about them. Similarly, educators assumed that professional values would just “happen,” as trainees spent years working with mentors and role models, as had presumably been the case in the past. To continue (...) the metaphor, when educators did discuss ethics and values, they tended to focus more on external building codes than on the nature of construction materials. Building codes are designed to ensure the public's safety by establishing procedures and standards. Likewise, the “new” bioethics of autonomy and informed consent that entered the medical curriculum in the 1970s and 1980s was oriented primarily toward protecting human rights by codification. In fact, educators explicitly warned students against acting on their personal or professional values in a misguided way—that is, in the absence of adequate ethical constraints, a type of behavior that came to be labeled, pejoratively, as paternalism. (shrink)

Hope helps alleviate suffering. In the case of terminal illness, recent experience in palliative medicine has taught physicians that hope is durable and often thrives even in the face of imminent death. In this article, I examine the perspectives of philosophers, theologians, psychologists, clinicians, neuroscientists, and poets, and provide a series of observations, connections, and gestures about hope, particularly about what I call “deep hope.” I end with some proposals about how such hope can be sustained and enhanced at the (...) end of life. Studies of terminally ill patients have revealed clusters of personal and situational factors associated with enhancement or suppression of hope at the end of life. Interpersonal connectedness, attainable goals, spiritual beliefs and practices, personal attributes of determination, courage, and serenity, lightheartedness, uplifting memories, and affirmation of personal worth enhance hope, while uncontrollable pain and discomfort, abandonment and isolation, and devaluation of personhood suppress hope. I suggest that most of these factors can be modulated by good medical care, utilizing basic interpersonal techniques that demonstrate kindness, humanity, and respect. (shrink)

Robert Coles' sentiment characterizes well the moral tenor of medical education today. Indeed, medical educators are frequently “seized by spasms of genuine moral awareness,” as they try to cope with the massive social and economic problems that face medical schools and teaching hospitals. The perception among educators that we currently fail to adequately teach several core aspects of doctoring, including professional values and behavior, constitutes one such spasm. In this case, the proposed remedy has generated considerable enthusiasm, but whether the (...) “core competencies” curriculum will make a difference, or simply “accommodate to the prevailing rhythms of the world we inhabit,” remains to be seen. (shrink)

Jack Henry Abbott, In the Belly of the Beast: Letters from Prison, New York: Random House, 1981, xvi + 166 pp. John Monahan, The Clinical Prediction of Violent Behavior Rockville, Md.: National Institute of Mental Health, 1981, xi + 134 pp.

This article examined the effect of culture and religiosity on perceptions of business ethics among students in a tertiary institution in Malaysia. A structured questionnaire was developed with scenarios on various aspects of business ethics, and self-administered to the students in the business studies program. The results from 767 respondents showed that there were significant differences among the Malays, Chinese, and Indian students on seven scenarios namely selling hazardous products, misleading instructions, selling defective products, padding expense account, taking sick to (...) take a day off, keeping quiet on defective products, and respond to supplier's take good care of clients attitude. There was also an association between culture and religiosity. The MANOVA results also showed that culture and religiosity have an effect on perceptions of business ethics. (shrink)

There is a photo of George W. Bush circulating..

The process of dehumanization, or thinking of others as less than human, is a phenomenon with significant societal implications. According to Haslam's model, two concepts of humanness derive from comparing humans with either animals or machines: individuals may be dehumanized by likening them to either animals or machines, or humanized by emphasizing differences from animals or machines. Recent work in cognitive neuroscience emphasizes understanding cognitive processes in terms of interactions between distributed cortical networks. It has been found that reasoning about (...) internal mental states is associated with activation of the default mode network and deactivation of the task positive network ; whereas reasoning about mechanical processes produces the opposite pattern. We conducted two neuroimaging studies. The first examined the neural bases of dehumanization and its relation to these two brain networks, using images and voice-over social narratives which either implicitly contrasted or implicitly likened humans to either animals or machines. The second study addressed a discrepancy between findings from the first study and prior work on the neural correlates of dehumanization: using a design similar to prior work we examined neural responses to pictures of humans, animals and machines, presented without any social context. In both studies, human and humanizing conditions were associated with relatively high activity in the DMN and relatively low activity in the TPN. However, the non-human and dehumanizing conditions deviated in different ways: they demonstrated more marked changes either in the DMN or in the TPN. Notably, differences between the animal dehumanizing and humanizing conditions were most evident in regions associated with mechanistic reasoning, not in the mentalizing network. Conjunction analysis of contrasts from both paradigms revealed that only one region was consistently more active when participants saw human, a medial parietal region regarded as the central hub of the DMN. These findings provide a neural basis for Haslam's distinction between two types of dehumanization, and suggest that the DMN and TPN play opposing roles in creating a sense of moral concern. (shrink)

The history of the Frankfurt School cannot be fully told without examining the relationships of Critical Theorists to their Jewish family backgrounds. Jewish matters had significant effects on key figures in the Frankfurt School, including Max Horkheimer, Theodor W. Adorno, Erich Fromm, Leo Lowenthal and Herbert Marcuse. At some points, their Jewish family backgrounds clarify their life paths; at others, these backgrounds help to explain why the leaders of the School stressed the significance of antisemitism. In the post-Second World War (...) era, the differing relationships of Critical Theorists to their Jewish origins illuminate their distinctive stances toward Israel. This book investigates how the Jewish backgrounds of major Critical Theorists, and the ways in which they related to their origins, impacted upon their work, the history of the Frankfurt School, and differences that emerged among them over time. (shrink)

Karl Popper and Friedrich von Hayek became close friends soon after they first met in the early 1930s. Ever since, they discussed their ideas intensively on many occasions. But even though an analysis of the origins and contents of their ideas and correspondence reveals a number of important and fundamental differences, they rarely criticize each other in their published work. The article analyzes in particular the different ideas they have on the role of reason in society and on rationalism and (...) the roots of these differences. Popper’s “Towards a Rational Theory of Tradition” of 1948 contains a criticism of Hayek’s idea—published, for instance, in “Individualism: True and False” of 1945—that we must accept tradition without trying to change it. An analysis of the differences between the two authors touches on topics such as the possibility of public intervention in society, the role of social science in this, the methodology of social science, and the differences between liberalism and social democracy. The article concludes with some possible explanations for Popper and Hayek downplaying their differences in public. The fact remains that they never resolved the tension between Popper’s critical rationalism and Hayek’s conservative rationalism. (shrink)

The potential for the occurrence of multiple-role relationships is increased when professors also consult with athletic teams on their campuses. Such multiple-role relationships have potential ethical implications that are unclear and largely unexplored, and consultants may find multiple-role relationships both difficult to deal with and unavoidable. Therefore, the purpose of this study was to explore the nature of teacher–practitioner multiple-role relationships. Participants (N = 35) were recruited from Association for the Advancement of Applied Sport Psychology (AAASP) certified consultants (CCs) who (...) were also affiliated with a university (N = 68). All participants completed a 28-item survey exploring the incidence and relevant issues pertaining to multiple-role relationships. Chi-square analyses revealed that licensed mental health practitioners (i.e., psychologists and counselors) were more likely than nonlicensed AAASP CCs to believe that multiple-role relationships were never appropriate in sport psychology, χ2(1, N = 30) = 12.80, p <.001, and to have never taken part in a multiple-role relationship, χ2(1, N = 33) = 12.44, p <.001. Independent samples t tests revealed that mental health practitioners also reported that they would have higher levels of concern for both the practitioner, t(30) = –2.77, p =.009, and the client, t(30) = –2.50, p =.018, in such a relationship. (shrink)

Two widespread assumptions concerning networks, including guanxi networks, are that they function in terms of trust relations and that their structure is dyadic. This article subjects both assumptions to critical assessment and proposes alternative formulations. When the distinctions between trust and trustworthiness and between trust and assurance are made, then broader understandings of guanxi relationships emerge. The article shows that the assurance mechanism of guanxi is public exposure of transgressions against network norms, leading to the transgressor’s loss of face (mianzi). (...) The necessity of third-party intervention of this type, typically but not exclusively through gossip, indicates the triadic rather than dyadic structure of guanxi relationships when sanction of reputation is included in the conceptualization of guanxi. Changes in guanxi during economic transition in China, from strong-to weaker-tie associations, require careful consideration of the changing nature of the mechanisms of face-loss. (shrink)

While self-interest is depreciated in Confucian ethics the processes of family relations in traditional China are animated by the self-interested actions of family members. The paper outlines the Confucian ideology of filial piety which is commensurate with the governance of family life organized hierarchically and through the senior male's management of the joint-family's collective property. The structure, operations and principles of membership in traditional Chinese families are indicated, highlighting the tensions within them between consanguinity and conjugality and their material bases. (...) The differential operation of self-interested actions by husbands and wives is also presented. A non-Confucian model of the relational-self is outlined in which both the collective context of Chinese families and the self-interested actions of individual family members within them is explicated. (shrink)