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PubMedDate not supplied

Oedipal grief.

This paper concerns a common clinical picture, one that is seen particularly clearly in young men. It is a picture which, within a traditional psychoanalytic framework, has much to do with that set of mental structures referred to as the superego and with the patterns which follow from the oedipal period of development. Using two case examples, this paper suggests the outlines of a treatment strategy and looks at some of the theoretical issues involved (in particular, the contribution of an object relations emphasis to classical theory). It argues for the importance of grief in the oedipal dilemma and suggests that the role of grief in the formation and maintenance of morbid conscience can overshadow that more familiar explanation, the struggle with one's own forbidden wishes.

Competitive Behavior↗
PubMed2000

Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder.

BACKGROUND: Major damage to gray and white matter in the prefrontal cortex and autonomic deficits have been found to result in pseudopsychopathic personality in patients with neurological disorders, but it is not known whether people with antisocial personality disorder (APD) in the community who do not have discernable brain trauma also have subtle prefrontal deficits. METHODS: Prefrontal gray and white matter volumes were assessed using structural magnetic resonance imaging in 21 community volunteers with APD (APD group) and in 2 control groups, comprising 34 healthy subjects (control group), 26 subjects with substance dependence (substance-dependent group), and 21 psychiatric controls. Autonomic activity (skin conductance and heart rate) was also assessed during a social stressor in which participants gave a videotaped speech on their faults. RESULTS: The APD group showed an 11.0% reduction in prefrontal gray matter volume in the absence of ostensible brain lesions and reduced autonomic activity during the stressor. These deficits predicted group membership independent of psychosocial risk factors. CONCLUSIONS: To our knowledge, these findings provide the first evidence for a structural brain deficit in APD. This prefrontal structural deficit may underlie the low arousal, poor fear conditioning, lack of conscience, and decision-making deficits that have been found to characterize antisocial, psychopathic behavior.

Adult↗
PubMed2004

The structure of obsessionality among young adults.

Although the phenomenology of obsessive-compulsive disorder (OCD) is well understood, less is known about the structure of obsessive symptoms in non-clinical populations. The present study examines the factorial structure of the Leyton Obsessional Inventory short form (LOI-SF) in a sample of 1,015 undergraduate college students. Four factors were extracted describing concerns about contamination (labeled the Contamination factor); repeating behaviors or uncomfortable thoughts or doubts (labeled the Doubts/Repeating factor); checking behaviors, too much attention to detail, honesty concerns, strict conscience and strict routine (labeled the Checking/Detail factor); and taking a long time to dress and to hang up and put away clothing, as well as belief in extremely unlucky numbers (labeled Worries/Just Right factor). Self-report measures of anxiety and ADHD symptoms were correlated positively with these factors, particularly with the checking/detail factor. The prevalence, symptom structure, and patterns of comorbidity seen in this sample of unselected college students are similar to the patterns seen in adolescents with OCD, suggesting that obsessional symptoms and OCD may exist along a continuum.

Adolescent↗
PubMed2006

De novo methylation, long-term promoter silencing, methylation patterns in the human genome, and consequences of foreign DNA insertion.

This chapter presents a personal account of the work on DNA methylation in viral and mammalian systems performed in the author's laboratory in the course of the past 30 years. The text does not attempt to give a complete and meticulous account of the work accomplished in many other laboratories; in that sense it is not a review of the field in a conventional sense. Since the author is also one of the editors of this series of Current Topics in Immunology and Microbiology on DNA methylation, to which contributions by many of our colleagues in this field have been invited, the author's conscience is alleviated that he has not cited many of the relevant and excellent reports by others. The choice of viral model systems in molecular biology is well founded. Over many decades, viruses have proved their invaluable and pioneering role as tools in molecular genetics. When our interest turned to the demonstration of genome-wide patterns of DNA methylation, we focused mainly on the human genome. The following topics in DNA methylation will be treated in detail: (1) The de novo methylation of integrated foreign genomes; (2) the long-term gene silencing effect of sequence-specific promoter methylation and its reversal; (3) the properties and specificity of patterns of DNA methylation in the human genome and their possible relations to pathogenesis; (4) the long-range global effects on cellular DNA methylation and transcriptional profiles as a consequence of foreign DNA insertion into an established genome; (5) the patterns of DNA methylation can be considered part of a cellular defense mechanism against foreign or repetitive DNA; which role has food-ingested DNA played in the elaboration of this mechanism? The interest in problems related to DNA methylation has spread-like the mechanism itself-into many neighboring fields. The nature of the transcriptional programs orchestrating embryonal and fetal development, chromatin structure, genetic imprinting, genetic disease, X chromosome inactivation, and tumor biology are but a few of the areas of research that have incorporated studies on the importance of the hitherto somewhat neglected fifth nucleotide in many genomes. Even the fly researchers now have to cope with the presence of this nucleotide, in however small quantities it exists in the genome of their model organism, at least during embryonal development. The bulk of the experimental work accomplished in the author's laboratory has been shouldered by many very motivated undergraduate and graduate students and by a number of talented postdoctoral researchers. Their contributions are reflected in the list of references in this chapter. We have also had the good luck to receive funding through a number or organizations as acknowledged.

Adenoviridae↗
PubMed2002

Ethics in publication.

In this review, various facets of scientific communication are explored from the ethics point of view and specific questions related to the relevant steps of producing a scientific publication are addressed. Firstly, a brief overview of the ethics concept is presented with its association to other moral directives such as traditions, law and conscience, while the intersections of logic and faith with the hypothetic boundary of ethics, are analyzed by using a Venn diagram. Secondly, the everchanging concept of scientific (co)authorship is evaluated according to the degree of intellectual contribution to the final outcome and a brief emphasis is placed on the importance of an urgent need for rapidly developing the ethical rules for electronic publication in cyberspace. And lastly, the characteristics of different forms of scientific misconduct are summarized.

Authorship↗
PubMed1995

Three ethically justified indications for selective termination in multifetal pregnancy: a practical and comprehensive management strategy.

The authors provide an ethical justification for three indications for performing selective termination of multi-fetal pregnancies. These indications are (1) achieving a pregnancy that results in a live birth or one or more infants with minimal neonatal morbidity and mortality, (2) achieving a pregnancy that results in a live birth of one or more infants without antenatally detected anomalies, and (3) achieving a pregnancy that results in a singleton live birth. This ethical justification is based on two basic approaches to obstetric ethics that emphasize that these indications must be established on the basis of informed consent. The authors underscore the importance of matters of private conscience and demonstrate the consistency of ethical justification with existing public policy in the United States.

Beneficence↗
PubMedDate not supplied

Consciousness and the brain.

Following the advice of I.P. Pavlov to the effect that "it is important to understand psychologically before translating a phenomenon into physiological language", the author defines more precisely the content and origin of consciousness as a phenomenon of human higher nervous activity. The necessity of distinguishing two fundamentally different phenomena in the sphere of unconscious mental activity, defined as subconsciousness and superconsciousness, is substantiated. The emotional languages of superconsciousness are described, namely, the senses of beauty, humor, and conscience. The contradictory nature of objectively determined behavior along with subjectively experienced freedom of choice are regarded from the points of view of their initial supplementarity. It is asserted that the activity of superconsciousness, recombining previously accumulated experience, underlies the so-called self-determination of behavior, as a result of which decision options may arise that have never been encountered previously. In other words: the freedom that is maximally available to man is manifested in his creative activity.

Animals↗
PubMed2004

Developing and teaching the virtue-ethics foundations of healthcare whistle blowing.

Healthcare whistle blowing, despite the benefits it has brought to healthcare systems in many developed countries, remains generally regarded as a pariah activity by many of the most influential healthcare professionals and regulatory institutions. Few if any medical schools or law department health law and bioethics classes, teach whistle blowing in a formal sense. Yet without exception, public inquiries initiated by healthcare whistle blowers have validated their central allegations and demonstrated that the whistle blowers themselves were sincere in their desire to implement the fundamental virtues and principles of medical ethics, bioethics and public health law. In many jurisdictions, the law, this time remarkably in advance of professional opinion, has offered legislative protection for reasonable allegations of whistleblowers made in good faith and in the public interest concerning a substantial and imminent threat to public safety. One reason for this paradoxical position, explored here, is that healthcare whistle blowing lacks a firm virtue-based theoretical bioethical and jurisprudential foundation. The hypothesis discussed is that the lack of this bioethical and jurisprudential substrate has contributed to a situation where healthcare whistle blowing suffers in terms of institutional support due to its lack of academic legitimacy. This article commences the process of redressing this imbalance by attempting to lay the theoretical foundations for healthcare whistle blowing. As a case study, this article concludes by discussing the Personal and Professional Development course at the ANU Medical School where healthcare whistle blowing is a formal part of a virtue-based curriculum that emphasises the foundational importance of conscience. Illustrative elements of that program are discussed.

Australia↗
PubMed2004

[Fifty years of nutrition counseling. Remarks and perspectives].

Fifty years of nutrition information and education did not reach their goals. Nutrition-dependent diseases, obesity, and misinformation are still increasing. Cognitive information about nutrition does not induce changes in primary emotion-controlled eating habits. Better knowledge of nutrition on the part of consumers mainly activates their bad conscience when they rate their own eating habits. Future prevention campaigns, which clearly address consumer needs using social marketing principles, will be better able to change eating behavior.

Feeding Behavior↗
PubMed2005

Cerebral scedosporiosis: an emerging fungal infection in severe neutropenic patients: CT features and CT pathologic correlation.

Scedosporium prolificans is an emerging opportunistic fungal agent encountered in severely neutropenic patients. The purpose of this paper is to describe the main cranial CT findings from a retrospective review of six patients (four men and two women, 18-66 years old) afflicted with disseminated infection by S. prolificans with neurological symptoms. They were severely neutropenic and presented with severe respiratory failure and conscience deterioration, with a subsequent 100% mortality. The final diagnosis was established by autopsy (performed in five patients) and blood culture findings. Cranial CT showed multiple low-density lesions in four patients without contrast enhancement located in the basal ganglia and corticomedullary junction. Autopsy findings of these lesions demonstrated necrosis and hyphae proliferation inside brain infarcts. Also, two of the patients had a subarachnoid hemorrhage, but angiography could not be performed. CT and autopsy findings were fairly similar to those encountered in cerebral aspergillosis; however, possibly because of its rapid and fatal evolution, no edema or ring enhancing lesions were encountered. Thus, Scedosporium can be included as a rare but possible cause of invasive fungal disseminated central nervous system infections in severely neutropenic patients.

Adolescent↗
PubMed2003

[From alms to entitlements. A historical approach on private and public attitudes towards long life expectancies].

At all times in history, there have been people reaching a high age. However, long life expectancies as a--relatively seen--socially non-stratified phenomenon are of a very recent date. This essay identifies three different currents which have shaped the related massive development of population. First, there was what could be called the "democratization of long life expectancies", rooted in the steadily growing access to the fruits of medical and technical progress during the past centuries. Second, the state constantly took over from the private sector responsibilities to provide services for old people. Third and simultaneously, a commonly shared idea of entitlement to a period of retirement after the working career gained acceptance. These three currents are summarized in the essay under the heading of the development of "social rights". Until the end of the 19th century those rights were totally neglected. It was only under the impression of industrialization, the appearance of a strong labor movement, world economic crisis and the catastrophe of two world wars that a conscience for the social dimension of citizenship developed. The history of German social policies from Bismarck to the present day serves as a measurement for these developments towards social rights. In this respect, particular attention is paid to the "Grosse Rentenreform" of 1957, the breakthrough of the modern German welfare state.

Aged↗
PubMed2000

[Legal aspects: nonbinding recommendations or jurisdiction upon medicine?].

The freedom of therapy granted to doctors through the ages by the jurisdiction does not imply a preferred position of the doctor but lies in the interest of the patient: the doctor after thorough examination should carry out self-responsibly the therapy that is in the best interest of the patient if and as far as the patient agrees. Unfortunately, today the freedom of medical treatment is thoroughly and from multiple sides endangered. Danger derives on the one hand from the increasing influence of jurisdiction on medicine, and on the other hand, from the increasing specialization and the segregation of fields of expertise resulting therefore. Most dangerous is the multiple and subtle regulation on free medical practice of the profession by reforming the mandatory health insurance with quotas, positive lists (allowed prescriptions), fixed budgets, etc. That the doctors have substantially contribute to the erosion of freedom of therapy which also increases the risk of criminal and civil liability of the doctor by excessive support of the creation of guidelines in the recent past, is not generally acknowledged. The following should cast a little light on the missing conscience.

Budgets↗
PubMed2006

Myron Wegman: early days, lasting influence.

Dr. Myron Wegman's long life (1908-2004) and career connected him with the most important and formative period of child health in American history. His work paralleled momentous changes in federal child health policy and in the fields of pediatrics and public health. He began professional life at a moment that gave him entrée into the forefront of that history, and he was part of it at every level, from the most rural local settings to the international stage. Despite his high profile, little has been written about his early career in Maryland or how that period shaped him as a leader in maternal and child health (MCH). This article describes Wegman's work in rural Maryland and his initiation into academic public health at Johns Hopkins University. We suggest that Wegman's time in Maryland was formative, both for himself and for the MCH field. His work during this time influenced his own thinking and subsequent work in MCH education, his understanding of the healthy development of children, and his emergence as a social conscience for the field. This apparently modest start to his career gains import because his achievements rose above the individual level: his life and his ideals became part of our current approach to maternal and child health science and social philosophy. This article is based on life history interviews and less formal discussions conducted with Wegman by the authors, his own colloquia and lectures on child health history presented at Johns Hopkins from 1991 through 1998, his manuscripts, and the written and oral accounts of his contemporaries.

Child↗
PubMed2004

A Baldrige Process for ethics?

In this paper we describe and explore a management tool called the Caux Round Table Self-Assessment and Improvement Process (SAIP). Based upon the Caux Round Table Principles for Business--a stakeholder-based, transcultural statement of business values--the SAIP assists executives with the task of shaping their firm's conscience through an organizational self-appraisal process. This process is modeled after the self-assessment methodology pioneered by the Malcolm Baldrige National Quality Award Program. After briefly describing the SAIP, we address three topics. First, we examine similarities and differences between the Baldrige approach to corporate self-assessment and the self-assessment process utilized within the SAIP. Second, we report initial findings from two beta tests of the tool. These illustrate both the SAIP's ability to help organizations strengthen their commitment to ethically responsible conduct, and some of the tool's limitations. Third, we briefly analyze various dimensions of the business scandals of 2001-2002 (Enron, WorldCom, Tyco, etc.) in light of the ethical requirements articulated with the SAIP. This analysis suggests that the SAIP can help link the current concerns of stakeholders--for example, investors and the general public--to organizational practice, by providing companies with a practical way to incorporate critical lessons from these unfortunate events.

Benchmarking↗
PubMed1990

Does obstetric ethics have any role in the obstetrician's response to the abortion controversy?

We defend the view that the obstetrician's response to the abortion controversy cannot be based on accounts of the independent moral status of the fetus, because all such accounts are irresolvably disputable. That response, however, can be based on an account of the dependent moral status of the fetus. For such an account the central question is, "When is the fetus a patient?" Viable fetuses are patients. Nonviable third-trimester fetuses are not patients. Previable fetuses are patients solely as a function of the woman's autonomous decision to confer such status. The abortion of a viable fetus is, with few exceptions, never ethically justified, because it is a patient. The abortion of nonviable third-trimester fetuses (i.e., premature termination of pregnancy) is justified when the pregnant women consents to it. Abortion of the previable fetus is justifiable when the pregnant women consents to it. We distinguish between professional and private conscience. We identify the limits of the former and the legitimate role of the latter, especially in the area of religious beliefs. Finally, we address the implications of our view for residency training programs. The most important of these implications is that requiring all residents to perform abortions is ethically unjustifiable.

Abortion, Induced↗
PubMed1992

Spinning the wheels: a CAPS survey of ethical issues in pediatric surgery.

To evaluate decision-making factors of pediatric surgeons when faced with ethical dilemmas in a clinical setting, questionnaires were mailed to members of the Canadian Association of Paediatric Surgeons. The surgeons were asked to respond to scenarios regarding ethical dilemmas in the treatment of children. Fifty-one responses (57%) were computer analyzed based on chosen responses to the clinical dilemma and demographic factors such as age, sex, marital status, country of citizenship, religion, and "religiousness," a determination of religious conviction as viewed by the respondent. In addition, ethical convictions were sought regarding abortion, fetal research, AIDS, HIV testing, denial of medical care due to religious beliefs (Jehovah's Witness), and limitations in health care access for indigents. In general, respondents found it difficult to separate ethical guidelines for determining aggressive treatment--absolute value of life; best interests of the child; parental authority; and ability of the child to engage in social, intellectual, or emotional attachments (quality of life)--in the face of actual patient care issues. In fact, results of this survey indicate that the operating surgeon applies his/her medical knowledge and surgical "experience" to each individual case, incorporating his or her own ethical beliefs (in a respondent's words: "In the operating room, the surgeon must satisfy his own conscience in making decisions") while cognizant of legal guidelines for "standard care" ("Decisions would be based on personal experience, and what the local society believes to be right").(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMedDate not supplied

Intentional and unintentional abuse of infants and children.

Intentional abuse of an infant is usually apparent. External injuries such as burns, bites, and bruises, as well as the skeletal changes of fractures, frequently multiple and in various stages of healing, are obviously intentionally inflicted, and are impossible accidental injuries for the nonambulatory young infant. Similar injuries in young children may be more difficult to evaluate because of their fear of and intimidation by the person who inflicted the injury. Fortunately, the high degree of suspicion regarding the nature of the injury permits the physician to make his accusations with legal protection in our judicial system. Every radiologist should be concerned with the responsibility of reporting to the referring physician the possibility of intentional trauma to infants and children. In Harris County, where Houston is located, there are 1,500 reports per month of child abuse; in other words, this approximates 18,000 cases a year in our community, and the radiologist is frequently the first physician to see evidence of the abused child. Not only is it a moral responsibility for the radiologist to report his suspicions, but in the state of Texas, as in other states, "any person having cause to believe that a child's physical and mental health, or welfare has been or may be adversely affected by abuse or neglect shall report" to the appropriate agency. A more recent amendment to this law is a penalty for failure to report. A person commits an offense if the person has cause to believe that a child's physical and mental health or welfare has been or may be adversely affected further by abuse or neglect and knowingly fails to report it. It is hoped that any radiologist recognizing either pathognomonic or suspicious signs of child abuse will have the conscience and courage to take a strong stand for the protection of the abused infant or child. Accidental injuries in older children may offer problems in diagnosis if there is no history available or if there is a denial of an injury. Some of these injuries may produce radiographic findings suggesting some form of metaphyseal or diaphyseal dysplasia. Iatrogenic injuries are frequently the result of physiologic or anatomical response to proper and lifesaving treatment. The most serious of these are found in the premature infant, who may suffer chronic lung disease or, more seriously, brain damage.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Diseases, Developmental↗