Chapter 1: The Pronatalist Imperative: Medicine, Money, and Markets

The first chapter of Anne Donchin's Procreation, Power, and Personal Autonomy: Feminist Reflections

Depression, Volition, and Death: The Effect of Depressive Disorders on the Autonomous Choice to Forgo Medical Treatment

Many contemporary models of medical ethics champion patient autonomy to counterbalance historically paternalistic decision-making processes. These models tend to suggest an autonomous agent free from cognitive bias and systematic distortion (e.g., Kantian or Cartesian rational agents). Evidence is emerging from the fields of cognitive psychology, cognitive science, and neuroscience that fundamentally challenge this cognitive model, demonstrating the dependence of cognition on deeper, avolitional structures (e.g., backstage cognition, cognitive heuristics and biases, automaticity, emotionally-valenced memory, etc.), and hence, shifting the cognitive model towards reductionistic and deterministic philosophies and psychologies. Medical ethics models must adapt their sense of autonomy in light of these findings if the term is to have any meaning - absent this necessary adaptation, medical ethics centers around a cognitive agent that does not actually exist. In contrast to the homuncular models championed (i.e., overly rationalistic and lacking an account of empirically-validated cognitive phenomena), a cognitive model of autonomy is proposed, along with useful psychometrics and a case metric to assist clinicians in assessing the possibility of compromised autonomy in patients electing to forgo medical treatment

Evaluation of driving ability of the disabled persons in the context of the psychological activity theory

In the future the number of the disabled drivers requiring a special evaluation of their driving ability will increase due to the ageing population, as well as the progress of adaptive technology. This places pressure on the development of the driving evaluation system. Despite quite intensive research there is still no consensus concerning what is the factual situation in a driver evaluation (methodology), which measures should be included in an evaluation (methods), and how an evaluation has to be carried out (practise). In order to find answers to these questions we carried out empirical studies, and simultaneously elaborated upon a conceptual model for driving and a driving evaluation. The findings of empirical studies can be condensed into the following points: 1) A driving ability defined by the on-road driving test is associated with different laboratory measures depending on the study groups. Faults in the laboratory tests predicted faults in the on-road driving test in the novice group, whereas slowness in the laboratory predicted driving faults in the experienced drivers group. 2) The Parkinson study clearly showed that even an experienced clinician cannot reliably accomplish an evaluation of a disabled person’s driving ability without collaboration with other specialists. 3) The main finding of the stroke study was that the use of a multidisciplinary team as a source of information harmonises the specialists’ evaluations. 4) The patient studies demonstrated that the disabled persons themselves, as well as their spouses, are as a rule not reliable evaluators. 5) From the safety point of view, perceptible operations with the control devices are not crucial, but correct mental actions which the driver carries out with the help of the control devices are of greatest importance. 6) Personality factors including higher-order needs and motives, attitudes and a degree of self-awareness, particularly a sense of illness, are decisive when evaluating a disabled person’s driving ability. Personality is also the main source of resources concerning compensations for lower-order physical deficiencies and restrictions. From work with the conceptual model we drew the following methodological conclusions: First, the driver has to be considered as a holistic subject of the activity, as a multilevel hierarchically organised system of an organism, a temperament, an individuality, and a personality where the personality is the leading subsystem from the standpoint of safety. Second, driving as a human form of a sociopractical activity, is also a hierarchically organised dynamic system. Third, in an evaluation of driving ability it is a question of matching these two hierarchically organised structures: a subject of an activity and a proper activity. Fourth, an evaluation has to be person centred but not disease-, function- or method centred. On the basis of our study a multidisciplinary team (practitioner, driving school teacher, psychologist, occupational therapist) is recommended for use in demanding driver evaluations. Primary in a driver’s evaluations is a coherent conceptual model while concrete methods of evaluations may vary. However, the on-road test must always be performed if possible.Tulevaisuudessa ajokyvyn erityistutkimusta vaativien toimintarajoitteisten henkilöiden määrä tulee kasvaamaan väestön vanhenemisen ja apuvälineteknologian kehittymisen myötä. Huolimatta varsin intensiivisestä tutkimuksesta edelleenkään ei ole olemassa yhteistä näkemystä siitä, mistä ajokykyarvioinneissa on kysymys (metodologia), mitä menetelmiä ja mittoja arvioinneissa tulisi käyttää (metodit) ja miten arviointi tulisi suorittaa (käytäntö). Empiiriset tutkimukset osoittivat, että kokemattomilla virheet laboratoriossa ennustivat virheitä ajokokeessa kun kokeneilla hitaus laboratoriossa ennusti virheitä ajokokeessa. Parkinson-tutkimuksen keskeinen löydös oli, että kokenutkaan kliinikko ei kykene ajokykyä luotettavasti arvioimaan tekemättä yhteistyötä muiden asiantuntijoiden kanssa. Potilastutkimuksemme osoittivat myös selkeästi, etteivät potilaat itse eivätkä heidän puolisonsa kykene ajokykyä luotettavasti arvioimaan. Turvallisuuden kannalta hallintalaitteilla suoritetut operaatiot eivät ole ratkaisevia, vaan keskeisessä asemassa ovat henkiset toiminnot, jotka kuljettaja toteuttaa hallintalaitteiden avulla. Arviointityön on oltava persoonalähtöistä eikä sairaus-, funktio- tai menetelmälähtöistä. Persoonallisuustekijät mukaan lukien tarpeet, motiivit, asenteet ja itsetiedostuksen aste, etenkin sairauden tunne, ovat keskeisiä arvioitaessa toimintarajoitteisten henkilöiden ajokykyä. Persoonallisuus on myöskin tärkein kompensaatiolähde fyysisille ja kognitiivisille rajoitteille. Väitöstyössä kehitettiin empiirisen tutkimuksen ja psykologisen toiminnan teorian pohjalta ajotoiminnan ja ajokyvyn arvioinnin käsitteellinen malli. Luotu malli korostaa sekä toiminnan subjektin, kuljettajan, että itse toiminnan, autolla-ajamisen, hierarkista ja kompleksista luonnetta. Ajokyvyn arvioinnissa on kysymys näiden kahden dynaamisen systeemin vertailusta. Tutkimustemme perusteella suosittelemme moniammatillisen tiimin (lääkäri, liikenneopettaja, psykologi, toimintaterapeutti,) käyttöä vaativissa ajokyvyn arvioinneissa. Ajokyvyn arvioinnissa ensisijaista on johdonmukainan ja perusteltu käsitteellinen malli konkreettisten arviointimene-telmien voidessa vaihdella. Tien päällä suoritettu liikenneopettajan valvoma ajokoe on kuitenkin aitona toiminnallisena testinä ehdottomasti sisällyttyvä ajokyvyn arviointiin aina kun se turvallisuussyistä on mahdollista

Re-thinking the distinction between therapy and enhancement: a study in empirical ethics

My aim in this thesis is twofold: to advance philosophical understanding of the contested therapy / enhancement distinction and its ethical implications; and to achieve this via the integration of empirical data into the philosophical and ethical debate. Despite its implications for justice in healthcare, and despite the abundance of theoretical literature, little is known about how human enhancement is understood within its own context. The division between therapy and enhancement is nominally defined by whatever is identified as ‘normal’ health. This seems unproblematic, however it is extremely difficult to offer a clear, non-relative account of normality that is not beset by logical and semantic difficulties, or modified by historical, socio-cultural, technological, economic, and geographical contingencies. This raises a challenge: if what is ‘normal’ cannot be clearly identified, how can we clearly identify the difference between therapy and enhancement? If we cannot clearly identify the difference between therapy and enhancement, how can we ensure that our medical policies are ethically appropriate in distinguishing between who may and may not receive assistance? The empirical data communicate relevant views held by medical professionals whose work involves a prominent ‘enhancement’ drug, recombinant human erythropoietin (EPO). I use the insights gained from analysing theory and data to develop a refined account of the therapy / enhancement distinction which integrates the two. I use this as the basis for developing normative conclusions and policy recommendations in response to the ethical challenges posed by any future proliferation of enhancement technologies. I use the philosophical approach of Critical Realism for integrating the theory and data and constructing the normative conclusions developed. This is the first time critical realism has been used in empirical bioethics, and this thesis therefore also makes an original methodological contribution to the field

The ethics in genetics - The legitimacy and application of stem cell research

This dissertation provides an in-depth analysis of the practical application and judicial framework pertaining to stem cell research in South Africa. In the realisation of the above-mentioned analysis, and ultimate critique on the current and proposed legal position, focus is placed on aspects of Medical Law, Legal Philosophy and Human Rights. These include concerns on the procurement of informed consent from stem cell donors, ethical and religious influences on the regulation of biomedicine in general as well as the impact of socio-economic indicators in the realisation of the effective implementation of stem cell research. Focus is firstly placed on the medical aspects surrounding the research, whereafter an examination of the current legal position and its practical application is made. Following the discussion of the current legal position, with reference to the array of influences and concerns pertaining thereto, the newly proposed regulative measures are examined within the current international framework. These regulative measures are placed within context of the private and public sector with their different benefits and disadvantages. In a further discussion of the realisation of the private sector’s interests, focus is placed on the role that Intellectual Property Rights play in the protection of monetary incentives to conduct stem cell research. All of the above ultimately leads the author to provide an informed set of recommendations in which the proposed regulative measures can be adapted to ensure the legitimate and practically sound implementation of stem cell research in South Africa.Dissertation (Magister Legum (Public Law))--University of Pretoria, 2007.Public Lawunrestricte

Handbook of Well-Being

It is a pleasure to bring to you the eHandbook of Subjective Well-Being, the science of when and why people experience and evaluate their lives in positive ways, including aspects such as positive feelings, life satisfaction, and optimism. There are chapters in this eHandbook on the philosophy and history of well-being, as well as reviews of empirical research on the ways to assess well-being, the circumstances that predict it, the outcomes that it produces, the societal policies that enhance it, and many other social, biological, and cultural processes that help us understand why some people are happy and satisfied with their lives, while others are not. There are also chapters on theories of well-being, such as the baseline or set-point models. We believe that Open publication is the wave of the future (Jhangiani & Biswas-Diener, 2017). Therefore, we are presenting the handbook in an electronic format so that it is widely available to everyone around the world. The handbook is entirely open and free – anyone can read and use it without cost. This is important to us as we desire to lower knowledge barriers for individuals and communities, especially because it provides access to students, educators, and scholars who do not have substantial financial resources. We are not certain if this is the first free and open handbook in the behavioral sciences, but hopefully it will not be the last. In the past the prohibitive price of many handbooks have made them available only to scholars or institutions in wealthy nations, and this is unfortunate. We believe scientific scholarship should be available to all. The field of subjective well-being has grown at rapid pace over the last several decades, and many discoveries have been made. When Ed Diener began his research within the field in 1981 there were about 130 studies published that year on the topic, as shown using a Google Scholar search on “subjective well-being.” Eighteen years later when Shigehiro Oishi earned his Ph.D. in 2000 there were 1,640 publications that year on the topic, and when Louis Tay was awarded a Ph.D. in 2011 there were 10,400 publications about subjective well-being. Finally, in 2016 there were 18,300 publications – in that single year alone! In other words, during the time that Diener has been studying the topic, scholarship on subjective well-being has grown over 100-fold! It is not merely the number of published studies that has grown, but there have been enormous leaps forward in our understanding. In the 1980s, there were questions about the reliability and validity of subjective well-being assessments, and the components that underlie it. One notable advance is our understanding and measurement of well-being. We now know a great deal about the validity of self-report measures, as well as the core evaluative and affective components that make up subjective well-being. Further, scholars have a much greater understanding of the processes by which people report their subjective well-being, and various biases or artifacts that may influence these reports. In 1982 many studies were focused on demographic factors such as income, sex, and age that were correlated with subjective well-being. By 2016 we understood much more about temperament and other internal factors that influence happiness, as well as some of the outcomes in behavior that subjective well-being helps produce (e.g., income, performance, physical health, longevity). In the 1980s, researchers assumed that people adapt to almost any life event, and that different life events only have a short-term effect on subjective well-being. A number of large-scale longitudinal studies later showed that that is not the case. By now we know what kinds of life events affect our subjective well-being, how much, and for roughly how long. In the 1980s researchers believed that economic growth would not increase the happiness of a given nation. Now we know when economic growth tends to increase the happiness of a given nation. Additionally, we know much more about the biology of subjective well-being, and an enormous amount more about culture and well-being, a field that was almost nonexistent in 1982. With the advent of positive psychology, we are also beginning to examine practices and interventions that can raise subjective well-being. Given the broad interest in subjective well-being in multiple fields like psychology, economics, political science, and sociology, there have been important developments made toward understanding how societies differ in well-being. This understanding led to the development of national accounts of well-being – societies using well-being measures to help inform policy deliberations. This advance changes the focus of governments away from a narrow emphasis on economic development to a broader view which sees government policies as designed to raise human well-being. We were fortunate to have so many leading scholars of subjective well-being and related topics contribute to this volume. We might be slightly biased but most of the chapters in this eHandbook are truly superb. Not only do they provide a broad coverage of a large number of areas, but many of the chapters present new ways of thinking about these areas. Below is a brief overview of each of the sections in this volume: In Section 1 we begin the volume with chapters on philosophical, historical, and religious thinking on well-being through the ages. Next, we cover the methods and measures used in the scientific study of well-being. Section 2 is devoted to theories of well-being such as the top-down theory, activity theory, goal theory, self-determination theory, and evolutionary theory. Section 3 covers the personality, genetics, hormones, and neuroscience of well-being. Then, demographic factors such as age, gender, race, religion, and marital status are discussed. Section 4 is devoted to how domains of life – such as work, finance, close relationships, and leisure – are related to overall subjective well-being. Section 5 covers the various outcomes of subjective well-being, ranging from work outcomes, to cognitive outcomes, to health, and finally relationship outcomes. Section 6 covers interventions to increase subjective well-being. Finally, Section 7 is devoted to cultural, geographical, and historical variations in subjective well-being. This eHandbook presents the most up-to-date and comprehensive understanding of subjective well-being – and it is freely available to all! The editors would like to extend their thanks to several individuals who have been critical to the success of the handbook. First, our gratitude is immense toward Chris Wiese, Keya Biswas-Diener, and Danielle Geerling, who organized and kept the entire venture on track. Their hard work and organizational skills were wonderful, and the book would not have been possible without them. Second, we extend our thanks to the Diener Education Fund, a charitable organization devoted to education that in part made this project possible. In particular we express deep gratitude to Mary Alice and Frank Diener. Not only did their help make this eHandbook possible, but their lives stood as shining examples of the way to pursue well-being!https://digitalcommons.unomaha.edu/psychfacbooks/1008/thumbnail.jp

2015 Oklahoma Research Day Full Program

This document contains all abstracts from the 2015 Oklahoma Research Day held at Northeastern State University