What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

Conscientious objection among physicians is a perennial hot topic on both sides of the Atlantic. Sven Nordstrand's survey of Norwegian medical students adds fresh data to this ongoing debate.1Their starting point, whether doctors should be allowed to refuse any procedure to which they object on cultural, moral or religious grounds, is truly at the heart of the debate. Their finding that only 20.8% of students endorse this position is striking as it is less than half the number reported by Sophie (...) Strickland in her survey of medical students in the UK.2 It also suggests much less support for conscientious objection than was found among USA primary care physicians, where 78% agreed that “A physician should never do what he or she believes is morally wrong, no matter what experts say.”3These data invite speculation about why there is such dramatic variation between countries. Much can be made of Nordstrand's comments that in Norway “each citizen is assigned a particular general practitioner” and “In the Norwegian healthcare system the general practitioner has a crucial role as …. (shrink)

Background: Genetic tests for schizophrenia may introduce risks and benefits. Among young adults at clinical high risk for psychosis, little is known about their concerns and how they assess potential risks. Methods: We conducted semistructured interviews with 15 young adults at clinical high risk for psychosis to ask about their concerns. Results: Participants expressed concerns about test reliability, data interpretation, stigma, psychological harm, family planning, and privacy. Participants’ responses showed some departure from the ethics literature insofar as participants were primarily (...) interested in reporting their results to people to whom they felt emotionally close, and expressed little consideration of biological closeness. Additionally, if tests showed an increased genetic risk for schizophrenia, four clinical high-risk persons felt obligated to tell an employer and another three would “maybe” tell an employer, even in the absence of clinical symptoms. Conclusions: These findings suggest opportunities for clinicians and genetic counselors to intervene with education and support. (shrink)

Deep brain stimulation is an experimental procedure for treatment-resistant depression. Some results show promise, but blinded trials had limited success. Ethical questions center on vulnerability: especially on whether depressed patients can weigh the risks and benefits effectively, whether depression causes “desperation,” and whether media portrayals create unrealistic hopes. We interviewed 24 psychiatric inpatients with treatment-resistant depression, qualitatively analyzing their comments. Most had minimal interest in deep brain stimulators. Some might consider them if their depression worsened, if alternatives were exhausted, or (...) if the evidence were stronger. Fears focused on the surgery, adverse effects, and the novelty of the device. Patients felt the depression interfered with their ability to weigh the risks and benefits. Patients seemed highly attuned to the risks, and were skeptical that the treatment would be effective. We conclude that ethical concerns about vulnerability remain, yet patients with treatment-resistant depression were thoughtful and cautious about trying a novel therapy. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

The gap between the decision to engage in physical activity and subsequent behavioral enactment is considerable for many. Action control theories focus on this discordance in an attempt to improve the translation of intention into behavior. The purpose of this mini-review was to overview one of these approaches, the multi-process action control framework, which has evolved from a collection of previous works. The main concepts and operational structure of M-PAC was overviewed followed by applications of the framework in physical activity, (...) and concluded with unanswered questions, limitations, and possibilities for future research. In M-PAC, it is suggested that three layered processes build upon each other from the formation of an intention to a sustained profile of physical activity action control. Intention-behavior discordance is because of strategic challenges in goal pursuit and automatic tendencies. Regulatory processes are employed to hold the relationship between reflective processes and behavior concordant by countering these strategic challenges and automatic tendencies until the development of reflexive processes begin to co-determine action control. Results from 29 observational and preliminary experimental studies generally support the proposed M-PAC framework. Future research is needed to explore the temporal dynamic between reflexive and regulatory constructs, and implement M-PAC interventions in different forms, and at different levels of scale. (shrink)

Perceived size is a function of viewing distance, retinal images size, and various contextual cues such as linear perspective and the size and location of neighboring objects. Recently, we demonstrated that illusion magnitudes of classic visual size illusions may be greatly enhanced or reduced by adding dynamic elements. Specifically, a dynamic version of the Ebbinghaus illusion (classically considered a “size contrast” illusion) led to a greatly enhanced illusory effect, whereas a dynamic version of the Corridor illusion (a “size constancy” illusion) (...) led to a greatly diminished illusory effect. Although these differences may arise from the different processes underlying these illusions (size contrast vs. size constancy), the dynamic variants we tested in our previous work also differed in the nature of the dynamic elements; specifically, whereas the Dynamic Ebbinghaus included a moving target and inducers that changed size and position, the Dynamic Corridor only included a moving target on a static background. Here, we explore further dynamic versions of the Ebbinghaus illusion and the Corridor and Ponzo illusions by separately manipulating three types of dynamic elements: target motion, context translation, and dynamic changes in context. Across five experiments examining 21 dynamic illusory configurations, adding target motion or a dynamically changing context separately resulted in little-to-no illusory effect. In contrast, the combination of target motion and a dynamically changing context led to a robust size illusion, consistent with an interactive effect. However, illusory effects that exceeded the matched classic, static illusory configuration were only observed for the dynamic versions of the Ebbinghaus illusion and the Revealed Ponzo illusions, in which the contextual elements changed size. We conclude that the combination of target motion and a dynamically changing context are necessary to produce dynamic size illusions, but that enhancement above and beyond static illusions may be largely specific to size contrast effects. Our results have important implications for the integration of motion signals, a ubiquitous environmental stimulus, in the perception of object size. (shrink)

This study examined the approaches used by two preservice elementary school teachers as they designed and taught antiracist social studies lessons about civil rights history during a community-based field experience. Using a theoretical framework of racial pedagogical content knowledge (RPCK), we identified three domains of RPCK needed to enact antiracist elementary social studies teaching and analyzed how these domains surfaced during lessons and interviews. Our cross-case analysis revealed that both preservice teachers struggled to balance presenting civil rights events as historically (...) significant while also calling their legacy into question. However, the preservice teacher who fostered dialogic and student-centered discussions was ultimately more successful with antiracist teaching. We provide implications for supporting elementary school teachers in developing social studies lessons that embody antiracism and teach the long civil rights movement. (shrink)

In this paper we use a critically reflective research approach to analyze our efforts at transformative learning in food systems education in a land grant university. As a team of learners across the educational hierarchy, we apply scholarly tools to the teaching process and learning outcomes of student-centered inquiries in a food systems course. The course, an interdisciplinary, lower division undergraduate course at the University of California, Davis is part of a new undergraduate major in Sustainable Agriculture and Food Systems. (...) We provide an overview of the course’s core elements—labs, exams, assignments, and lectures—as they relate to social constructivist learning theory and student-centered inquiries. Then, through qualitative analysis of students’ reflective essays about their learning experiences in the course, we demonstrate important transformative outcomes of student-centered inquiries: (1) most students confronted the commodity fetish and tried to reconcile tensions between what the food system is and ought to be, and (2) students repositioned themselves, their thinking, and social deliberation in relation to the food system. Students’ reflections point to the power of learning that emerges through their inquiry process, including in the field, and from critical self-reflection. We also highlight the importance of reflective essays in both reinforcing experiential learning and in helping instructors to better understand students’ learning vis-à-vis our teaching. (shrink)

Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. Objective To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Methods Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, (...) and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Results Data were collected from 8308 of 11 620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small. (shrink)

The literature on affective determinants of physical activity is growing rapidly. The present paper aims to provide greater clarity regarding the definition and distinctions among the various affect-related constructs that have been examined in relation to PA. Affective constructs are organized according to the Affect and Health Behavior Framework, including: affective response to PA; incidental affect; affect processing; and affectively charged motivational states. After defining each category of affective construct, we provide examples of relevant research showing how each construct may (...) relate to PA behavior. We conclude each section with a discussion of future directions for research. (shrink)

Images portraying exercise are commonly used to promote exercise behavior and to measure automatic associations of exercise (e.g., via implicit association tests). The effectiveness of these promotion efforts and the validity of measurement techniques partially rely on the untested assumption that the images being used are perceived by the general public as portrayals of exercise that is pleasant and motivating. The aim of this study was to investigate how content of images impacted people's automatic and reflective evaluations of exercise images. (...) Participants ( N = 90) completed a response time categorization task (similar to the implicit association test) to capture how automatically people perceived each image as relevant to Exercise or Not exercise. Participants also self-reported their evaluations of the images using visual analog scales with the anchors: Exercise / Not exercise, Does not motivate me to exercise / Motivates me to exercise, Pleasant / Unpleasant, and Energizing/Deactivating. People tended to more strongly automatically associate images with exercise if the images were of an outdoor setting, presented sport (as opposed to active labor or gym-based) activities, and included young (as opposed to middle-aged) adults. People tended to reflectively find images of young adults more motivating and relevant to exercise than images of older adults. The content of exercise images is an often overlooked source of systematic variability that may impact measurement validity and intervention effectiveness. (shrink)

The negative emotions generated following stressful life events can increase one’s risk of depressive symptoms and promote higher levels of perceived stress. The process model of emotion regulation can help distinguish between adaptive and maladaptive emotion regulation strategies to determine who may be at the greatest risk of worse psychological health across the lifespan. Heart rate variability may affect these relationships as it indexes aspects of self-regulation, including emotion and behavioral regulation, that enable an individual to dynamically adapt to the (...) changing demands of both internal and external environments. In this study, we expected individual differences in resting vagally mediated HRV to moderate the influence of emotion regulatory strategies among our sample of 267 adults. We found support for the hypothesis that higher vagally mediated HRV buffers against the typical adverse effects of expressive suppression when evaluating depressive symptoms and found weak support when considering perceived stress. There was no evidence for an interaction between cognitive reappraisal and vagally mediated HRV but there was a significant, negative association between cognitive reappraisal and depressive symptoms and perceived stress. Future work may determine if intervening on either emotion regulation strategies or HRV may change these within-persons over time. (shrink)

Recent advances in the cognitive psychology of inference have been of great interest to philosophers of science. The present paper reviews one such area, namely studies based upon Wason's 4-card selection task. It is argued that interpretation of the results of the experiments is complex, because a variety of inference strategies may be used by subjects to select evidence needed to confirm or disconfirm a hypothesis. Empirical evidence suggests that which strategy is used depends in part on the semantic, syntactic, (...) and pragmatic context of the inference problem at hand. Since the factors of importance are also present in real-world science, and similarly complicate its interpretation, the selection task, though it does not present a quick fix, represents a kind of microcosm of great utility for the understanding of science. Several studies which have examined selection strategies in more complex problem-solving environments are also reviewed, in an attempt to determine the limits of generalizability of the simpler selection tasks. Certain interpretational misuses of laboratory research are described, and a claim made that the issue of whether or not scientists are rational should be approached by philosophers and psychologists with appropriate respect for the complexities of the issue. (shrink)

Clinical mental health researchers may understandably struggle with how to incorporate biological assessments in clinical research. The options are numerous and are described in a vast and complex body of literature. Here we provide guidelines to assist mental health researchers seeking to include biological measures in their studies. Apart from a focus on behavioral outcomes as measured via interviews or questionnaires, we advocate for a focus on biological pathways in clinical trials and epidemiological studies that may help clarify pathophysiology and (...) mechanisms of action, delineate biological subgroups of participants, mediate treatment effects, and inform personalized treatment strategies. With this paper we aim to bridge the gap between clinical and biological mental health research by (1) discussing the clinical relevance, measurement reliability, and feasibility of relevant peripheral biomarkers; (2) addressing five types of biological tissues, namely blood, saliva, urine, stool and hair; and (3) providing information on how to control sources of measurement variability. (shrink)

Der Philosoph Frane Petrić , widmet einen bedeutenden Teil seiner Studien über Ontologie und Kosmologie, insbesondere in seinen Hauptwerken Discussiones peripateticae und Nova de universis philosophia, einer höchst originellen Untersuchung des Lichtes und der Zeit, zwei Konzepten, die auch in Einsteins „Zur Elektrodynamik bewegter Körper“ eine wichtige Rolle spielen. Bei der Gegenüberstellung der Konzepte dieser zwei Philosophen kommt ihre Verwandtschaft in jedem der erwähnten Systeme zum Ausdruck. Sowohl für Patricius, als auch für Einstein besitzt das Licht eine einmalige, unveränderliche Funktion (...) im Universum. In seiner Analyse der Zeit und mit ihr verwandter Konzepte, beispielsweise der Dauer, entwickelte Patricius eine konzeptuelle Struktur, dynamisch genug, um ihre Konsistenz mit Einsteins Analyse von Zeit und Simultaneität erkennbar zu machen. (shrink)

Carl Jung's work played an important role in shaping modern psychology. Through a thorough exploration of Jung's psychological ideas and the ancient beliefs of shamanistic cultures, this unique investigation unveils startling parallels between the two. As different as they may seem at first glance, these two branches of human paradigm and belief have amazing similarities in structure and function. Interspersed with the writings of Jung, this fascinating account traces the forces and patterns of symbolism common to shamanism and depth psychology. (...) By studying these parallels, it is possible to get a glimpse into major aspects of the human psyche and understand the universality of psychic events in time and space. (shrink)