Medical Ethics

Supportive Palliative Care and Hospice professionals frequently attend to Minimally Conscious State (MCS) patients near the end of life and in so doing, face decisions over maintenance or withdrawal of artificial nutrition and hydration. Although both withholding and withdrawal of artificial nutrition and hydration (ANH) in such circumstances are considered by experts in ethics and law to be acceptable, not all families nor health care professionals agree. This paper will explore basic aspects of serious brain injuries, especially MCS, the psychological role of food in interpersonal relationships, and lessons from clinical ethics that can help in goals of care discussions about withdrawal of ANH...

People with Alzheimer's dementia experience significant neuropsychological decline, and this seems to threaten their sense of self. Yet they continue to have regard for their moral standing, especially from the feedback they receive from others in relation to such things as pride in their work, retaining a valued role, or acting out of a sense of purpose. This continuing self-regard is based on a self-image which often persists through memory loss. I will argue that in care settings the self-image ought to be assumed to remain intact...

At the end of World War II anti-Semitism was pervasive in the United States. Quotas to limit the number of Jewish students were put in place at most U.S. medical schools in the 1920s and were well-entrenched by 1945. By 1970 the quota was gone. Why? Multiple factors contributed to the end of the quota. First, attitudes toward Jews shifted as Americans recoiled from the horrors of the Holocaust and over half a million Jewish GIs returned home from World War II. Many entered the higher education system. Second, governmental and private investigations in New York City, New York State and Philadelphia exposed the quota...

Recovery is a commonly used concept in both professional and everyday contexts. Yet despite its extensive use, it has not drawn much philosophical attention. In this paper, I question the common understanding of recovery, show how the concept is inadequate, and introduce new and much needed terminology. I argue that recovery glosses over important distinctions and even misrepresents the process of moving away from malady as "going back" to a former state of health. It does not invite important nuances needed to distinguish between biomedical, phenomenological, and social perspectives...

No abstract text is available yet for this article.

Although past research has shown that social comparisons made through social media contribute to negative outcomes, little is known about the nature of these comparisons (domains, direction, and extremity), variables that determine comparison outcomes (post valence, perceiver's self-esteem), and how these comparisons differ from those made in other contexts (e.g., text messages, face-to-face interactions). In 4 studies (N = 798), we provide the first comprehensive analysis of how individuals make and respond to social comparisons on social media, using comparisons made in real-time while browsing news feeds (Study 1), experimenter-generated comparisons (Study 2), and comparisons made on social media versus in other contexts (Studies 3 and 4)...

How does organized cognition arise from distributed brain activity? Recent analyses of fluid intelligence suggest a core process of cognitive focus and integration, organizing the components of a cognitive operation into the required computational structure. A cortical 'multiple-demand' (MD) system is closely linked to fluid intelligence, and recent imaging data define nine specific MD patches distributed across frontal, parietal, and occipitotemporal cortex. Wide cortical distribution, relative functional specialization, and strong connectivity suggest a basis for cognitive integration, matching electrophysiological evidence for binding of cognitive operations to their contents...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability...

BACKGROUND: Predicting neurological outcome in comatose survivors of cardiac arrest relies on clinical findings, radiological and neurophysiological test results. To evaluate the predictive accuracy of brain computed tomography (CT) and magnetic resonance imaging (MRI) for prognostication of neurological outcomes after cardiac arrest. METHODS: We searched MEDLINE (database inception to August 2018) and included all observational cohort studies or randomized controlled trials including adult (16 years or older) survivors of cardiac arrest which evaluated the diagnostic accuracy of CT or MRI for predicting neurologic outcome or mortality...

OBJECTIVES: To characterize approaches to neurologic outcome prediction by practitioners who assess prognosis in unconscious cardiac arrest individuals, and assess compliance to available guidelines. DESIGN: International cross-sectional study. SETTING: We administered a web-based survey to members of Neurocritical Care Society, Society of Critical Care Medicine, and American Academy of Neurology who manage unconscious cardiac arrest patients to characterize practitioner demographics and current neuroprognostic practice patterns...

A crossbow is a bow that shoots an arrow when a gun-like trigger is pulled. Deaths caused by accidental crossbow shootings are extremely rare. Here we describe an autopsy case of a penetrating wound to the left cerebral hemisphere caused by an accidental shooting with a crossbow. A man in his early 60s who lived with his wife and had used crossbows for 20 years as his hobby was found one early morning in the shed of his house, collapsed and bleeding from the head and neck. He was taken to a hospital and died after approximately 3 days of conservative treatment...

Stroke is the second highest cause of death globally and a leading cause of disability, with an increasing incidence in developing countries. Ischaemic stroke caused by arterial occlusion is responsible for the majority of strokes. Management focuses on rapid reperfusion with intravenous thrombolysis and endovascular thrombectomy, which both reduce disability but are time-critical. Accordingly, improving the system of care to reduce treatment delays is key to maximizing the benefits of reperfusion therapies...

BACKGROUND: Although delirium is typically an acute reversible cognitive impairment, its presence is associated with devastating impact on both short-term and long-term outcomes for critically ill patients. Advances in our understanding of the negative impact of delirium on patient outcomes have prompted trials evaluating multiple pharmacological interventions. However, considerable uncertainty surrounds the relative benefits and safety of available pharmacological interventions for this population...

The extent of behavioral recovery that occurs in patients with traumatic disorders of consciousness (DoC) following discharge from the acute care setting has been under-studied and increases the risk of overly pessimistic outcome prediction. The aim of this observational cohort study was to systematically track behavioral and functional recovery in patients with prolonged traumatic DoC following discharge from the acute care setting. Standardized behavioral data were acquired from 95 patients in a minimally conscious (MCS) or vegetative state (VS) recruited from 11 clinic sites and randomly assigned to the placebo arm of a previously completed prospective clinical trial...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Type "rogue scientist" into Google, and the first page of results contains nothing but articles about He Jiankui, the Chinese scientist who stunned the world in November 2018 by announcing the birth of twin girls whose genomes were edited during in vitro fertilization (IVF). Along with the..

OBJECTIVE: To test the hypothesis that brain pathology is associated with total daily physical activity proximate to death in older adults. METHODS: We studied brain autopsies from 428 decedents of the Rush Memory and Aging Project. The quantity of all physical activity was measured continuously for up to 10 days with actigraphy (Actical; Philips Healthcare, Bend, OR). Multiple regression analyses controlling for age and sex were used to examine the relation of brain indexes to total daily physical activity and other clinical covariates proximate to death...