ObjectiveFatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological factors, including burn severity, pain, and acute PTSD symptoms, to the course and persistence of fatigue was studied in a multifactorial model.MethodsParticipants were 247 adult burn survivors. Fatigue symptoms were assessed with the Multidimensional Fatigue (...) Inventory during the acute phase and subsequently at 3, 6, 12, and 18 months postburn, and were compared to population norms. Age, gender, burn severity, acute PTSD symptoms and pain were assessed as potential predictors of fatigue over time in a latent growth model.ResultsAt 18 months postburn, 46% of the burn survivors reported fatigue, including 18% with severe fatigue. In the acute phase, higher levels of fatigue were related to multiple surgeries, presence of pain, and higher levels of acute PTSD symptoms. Fatigue gradually decreased over time with minor individual differences in rate of decrease. At 18 months, pain and acute PTSD symptoms remained significant predictors of fatigue levels.ConclusionsProtracted fatigue after burns was found in almost one out of five burn survivors and was associated with both pain and acute PTSD symptoms. Early detection of PTSD symptoms and early psychological interventions aimed at reducing PTSD symptoms and pain may be warranted to reduce later fatigue symptoms. (shrink)

Bioethics needs an expanded moral vision. It is now time for bioethics to take full account of the problems of health disparities and structural injustice that are made newly urgent by the COVID-19 pandemic and the effects of climate change. Nancy M. P. King, Gail E. Henderson, and Larry R. Churchill make the case for a more social understanding and application of justice, a deeper humility in assessing expertise in bioethics consulting, a broader and more relevant research agenda, and (...) greater appreciation of the profound health implications of global warming. (shrink)

Informed consent in clinical research is widely regarded as broken, but essential nonetheless. The most recent attempt to reform it comes as part of the first revisions to the Common Rule since it became truly “common” in 1991. This change, the addition of a “key information” requirement for most consent forms, is intended to support and promote a reasoned decision-making process by potential subjects. The key information requirement is both promising and problematic. It is promising because it encourages clarity and (...) honesty about research participation, creativity in information disclosure, and mutual learning through the investigator-subject relationship. It is problematic because those goals — which have remained aspirational since the beginning — may be difficult to achieve in what has become an excessively compliance-oriented regulatory regime. (shrink)

Hastings Center Report, Volume 52, Issue 3, Page 3-3, May–June 2022.

This book investigates consciousness as an emergent state arising from the global functioning of the brain and the body. In this research Krieger applies these concepts to analytical psychology, particularly to the constellation of the complex and of the archetype. Global brain functioning is considered as a complex system whose macroscopic, emergent patterns such as thoughts and behaviours are determined by physical parameters including emotion, memory, and perception. The concept of the feeling-toned complex was among the first of the theories (...) to be developed by Jung, and the theories of complexity and dynamical systems which subsequently developed in the physical sciences did not exist at the time. This book takes a new look at the feeling-toned complex as a basin of attraction which competes for consciousness against other complexes to determine behaviour. By drawing parallels between current ideas in neuroscience and Jung's more traditional theories, Krieger discusses the relevance for both psychotherapy and everyday life. Bridges to Consciousness considers the importance of the link between emotion and the complex in both the establishment of consciousness and the determination of self-esteem, making the work relevant to therapists and analysts. This book will also awaken interest in complexes in both the Jungian and wider neuroscientific research communities and will therefore interest researchers and academics in the field of psychology who want an insight into how the ideas of Jung can be applied beyond the traditional analytic field. (shrink)

This paper contributes to our understanding of participation in the Eucharist by examining the swallow. The paper begins with a thick description of the swallow as act, as phenomenon, and as symbol. This description reveals the swallow’s interstitial nature, which is then examined for its implications on the meaning of participation in the sacrament. The paper then recommends approaches to the Eucharist for Catholics for whom swallowing is difficult or impossible. The paper finally incorporates these findings with the ex opere (...) operato doctrine, demonstrating participation as efficacious interaction. National Catholic Bioethics Quarterly 13.2 (Summer 2013): 253–262. (shrink)

One of my favorite bioethics quotes is nearing 50 years old:Let us not forget that progress is an optional goal, not an unconditional commitment, and that its tempo in particular, compulsive as it may become, has nothing sacred about it. Let us also remember that a slower progress in the conquest of disease would not threaten society, grievous as it is to those who have to deplore that their particular disease be not yet conquered, but that society would indeed be (...) threatened by the erosion of those moral values whose loss, possibly caused by too ruthless a pursuit of scientific progress, would make its most dazzling triumphs not worth having.Despite its age, this invocation seems to me increasingly relevant as time... (shrink)

Institutional review boards and investigators are used to talking about risks of harm. Both low risks of great harm and high risks of small harm must be disclosed to prospective subjects and should be explained and categorized in ways that help potential subjects to understand and weigh them appropriately. Everyone on an IRB has probably spent time at meetings arguing over whether a three-page bulleted list of risk description is helpful or overkill for prospective subjects. Yet only a small fraction (...) of all the time and attention lavished on risk disclosure has been devoted to discussing whether and when potential benefit to subjects can reasonably be claimed and, if so, how it should be described in the consent form and process.Traditionally, IRBs and regulators have worked to ensure that clear lines can be drawn between research that, by definition, carries no potential for direct benefit — because it uses healthy volunteers or because it is not foreseeably focused on the development of treatments — and research that does have the development of effective treatments as its goal. (shrink)

In this paper I attempt to show that the doctrine of informed consent, as practiced in the relationships between physicians and patients, often does not fulfill its main purpose, i.e., it does not safeguard the interests, rights, and dignity of patients. This happens because of clinicians' skepticism about the existence of the right to informed consent, patients' disinclination to make decisions, the current nature of health care, and the absence of clear guidelines about implementing informed consent. In the context of (...) this paper informed consent refers to the principle of respect for autonomy. (shrink)

_Bioethics, Public Moral Argument, and Social Responsibility_ explores the role of democratically oriented argument in promoting public understanding and discussion of the benefits and burdens of biotechnological progress. The contributors examine moral and policy controversies surrounding biomedical technologies and their place in American society, beginning with an examination of discourse and moral authority in democracy, and addressing a set of issues that include: dignity in health care; the social responsibilities of scientists, journalists, and scholars; and the language of genetics and (...) moral responsibility. (shrink)

A Catholic environmental virtue ethic must include an understanding of prudence that incorporates attunement significantly. Catholic theologians are reluctant to revise notions of prudence, but there are traditions in theology that support such an approach. Catholic virtue ethical traditions point to this necessity, and, in addition, philosophical environmental virtue ethics (which are much more fully developed) simply insist on it. The comparison of a moral character (as it is understood in virtue ethics) with a bioregion’s ecosystem helps support this argument.

Clinical gene transfer research has both a unique history and a complex and layered system of research oversight, featuring a unique review body, the Recombinant DNA Advisory Committee. This paper briefly describes the process of decision-making about clinical GTR, considers whether the questions, problems, and issues raised in clinical GTR are unique, and concludes by examining whether the RAC's oversight is a useful model that should be reproduced for other similar areas of clinical research.Clinical GTR is governed by the same (...) oversight system as most clinical trials, with a significant addition: the RAC. Like other research with human subjects, GTR, if it is affiliated with a federally funded institution, must be approved by an institutional review board whose activities are governed by the common rule, that is, the federal regulations for protection of human subjects in research. Like other research intended to produce a drug, device, or biologic to be marketed in the United States, GTR is also overseen by the Food and Drug Administration. (shrink)

An introduction to informal logic, critical thinking and rhetoric utilizing actual public discourse .

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It is time (...) to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

Giving up the increasingly troubled distinction between “experiment” and “treatment” would make it easier to focus on informed consent and harder to beg questions about uncertainty and shared decisionmaking in medicine.

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...

Our paper examines what is required to protect and promote effective public discussion and policy development in the current climate of divisive disagreement about many public policy questions. We use abortion as a case example precisely because it is morally fraught. We first consider the changes made by Dobbs, as well as those which led up to the Dobbs decision, accompany it, and follow from it.

First-in-human research has several characteristics that require special attention with respect to ethics and human subjects protections. At least some nanomedical technologies may also have characteristics that merit special attention in clinical research, as other papers in this symposium show. This paper considers how to address these characteristics in the consent form and process for FIH nanomedicine research, focusing principally on experimental nanotherapeutic interventions but also considering nanodiagnostic interventions.It is essential, as a starting point, to recognize that the consent form (...) and process are by no means the primary protectors of human subjects. Instead, consideration of the form and content of informed consent becomes relevant only after a clinical trial has been reviewed and deemed scientifically and ethically acceptable.Two convergent types of challenges to informed consent are posed by nanomedicine FIH research. First, some issues appear generally applicable to FIH research, but have specific nanomedicine implications. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Scandal of White Complicity in US Hyper-Incarceration: A Nonviolent Spirituality of White Resistance by Alex Mikulich, Laurie Cassidy, and Margaret PfeilNancy M. RourkeThe Scandal of White Complicity in US Hyper-Incarceration: A Nonviolent Spirituality of White Resistance Alex Mikulich, Laurie Cassidy, and Margaret Pfeil new york: palgrave macmillan, 2013. 203 pp. $90.00As a white American Catholic ethicist, I often envy my Protestant counterparts’ legacy of acknowledging and fighting (...) racism. Catholic moral theology lacks Protestantism’s bodies of literature, activism, and bold ecclesial statements addressing racism in the United States. (For more on this, see Bryan Massingale’s Racial Justice and the Catholic Church.) The Scandal of White Complicity in US Hyper-Incarceration demonstrates how Catholicism might approach American racism using several elements of Catholic theology.The book opens with series editor Mary Jo Iozzo’s introduction to the Content and Context in Theological Ethics series, of which this is the fifth book. A personal and reflective foreword by Sr. Helen Prejean follows. Then the book’s argument begins with a description of the United States’ practice of mass incarceration and brief discussions of what is meant by “whiteness” and “complicity.” This book employs a phenomenological understanding of race and of whiteness, taking whiteness as habitus. The literature about this approach to race and to identity is enormous, but familiarity with that literature is not necessary to follow this book’s presentation, argument, or use of the idea.Each of the book’s three authors has written a two-chapter section. Alex Mikulich’s explanation of white habitus speaks on levels of social thought and of the individual’s experience. Laurie Cassidy’s section looks at the culture of hyperincarceration and the development of the “dangerous black man” myth, and Margaret Pfeil’s section on spirituality works from the beatitudes, John of the Cross, and a wide array of other sources to describe a political spirituality of resistance for white Christians.This book would be most useful to masters-level graduate students in theological ethics or anyone preparing to begin teaching in areas of ethics related to racism or criminal justice (particularly in Catholic institutional settings). Rather than drawing exclusively on Catholic social teaching to talk about white participation in racism, these authors more satisfyingly put many Catholic traditions into action. For example, the book demonstrates careful use of the concepts of complicity, responsibility, participation, and intention; it considers specific [End Page 195] actions while maintaining focus on systems’ structures; and it uses a wide range of Catholic thinkers, including Metz, Copeland, Soelle, Gutiérrez, Carmelite Sr. Constance FitzGerald, Lonergan, Day, and John of the Cross.This book assumes and asserts that racism still exists, that whiteness exists and aims to make itself invisible, and that racism is kept alive through social structures that flow from white habitus. However, the book does not assume the reader’s agreement with any of these. Instead, the book first makes the case that these things are true and then takes next steps toward responsive practices of resistance. Rhetorically tinged homiletic shortcuts are not used to bolster this argument. For example, in similar works, the question of moral culpability for racist social structures is sometimes managed only with a discussion of how such structures distribute benefits and harms unequally. In this book, that argument is not used alone but in tandem with a careful look at the intention of one’s participation in such structures.Minor problems exist. The book would have benefited from one more round of editing to eliminate minor punctuation and writing problems, and the Catholic moral concept of “scandal” receives little systematic attention despite its presence in the title. Otherwise, the book demonstrates well what Catholic moral theology could do if applied to American white racism. Here’s hoping that this is just the beginning of more such scholarship.Nancy M. RourkeCanisius CollegeCopyright © 2015 Society of Christian Ethics... (shrink)