Professional directives are unwavering: educational intimate exams should only ever occur with patients’ explicit consent. This article describes the current clinical, educational, and ethical landscape of educational pelvic examinations under anesthesia, underscores the imperative that these exams only ever occur with patients’ explicit consent, and offers accessible modifications to students’ involvement in these exams.

Recent media articles have stirred controversy over anecdotal reports of medical students practising educational pelvic examinations on women under anaesthesia without explicit consent. The understandable public outrage that followed merits a substantive response from the medical community. As medical students, we offer a unique perspective on consent for trainee involvement informed by the transitional stage we occupy between patient and physician. We start by contextualising the role of educational pelvic examinations under anaesthesia (EUAs) within general clinical (...) skill development in medical education. Then we analyse two main barriers to achieving explicit consent for educational pelvic EUAs: ambiguity within professional guidelines on how to operationalize ‘explicit consent’ and divergent patient and physician perspectives on harm which prevent physicians from understanding what a reasonable patient would want to know before a procedure. To overcome these barriers, we advocate for more research on patient perspectives to empower the reasonable patient standard. Next, we call for minimum disclosure standards informed by this research and created in conjunction with students, physicians and patients to improve the informed consent process and relieve medical student moral injury caused by performing ‘unconsented’ educational pelvic exams. (shrink)

Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. (...) This paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients’ autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations. (shrink)

It is argued here that the practice of medical students performing pelvic exams on women who are under anesthetic and have not consented is immoral and indefensible. This argument begins by laying out the ethical justification for the practice of informed consent, which can be found in autonomy and basic rights. Foregoing the process of consent within medicine can result in violations of both autonomy and basic rights, as well as trust, forming the basis of the wrong of unauthorized (...) pelvic examinations. Several objections to this argument are considered, all of which stem from the idea that this practice constitutes an exception to the general requirement of informed consent. These objections suggest that nonconsensual pelvic examinations on women under anesthetic are ethically acceptable on utilitarian grounds, in that they offer benefits either to the patient or to society, or on the grounds of triviality, in that consent is already presumed, or the practice is insignificant. Each of these objections is rejected and the practice is deemed indefensible. (shrink)

There have been many reports of medical students performing pelvic exams on anaesthetised patients without the necessary consent being provided or even sought. These cases have led to an ongoing discussion regarding the need to ensure informed consent has been secured and furthermore, how it might be best obtained. We consider the importance of informed consent, the potential harm to both the patient and medical student risked by the suboptimal consent process, as well as alternatives to teaching pelvic (...) examinations within medical school. The subsequent discussion focuses on whether medical students should perform pelvic examinations on anaesthetised patients without personally ensuring that they have given their explicit consent. Whilst we question the need to conduct pelvic examinations on anaesthetised patients in any circumstance, we argue that medical students should not perform such exams without personally securing the patients informed consent. (shrink)

Unconsented pelvic exams under anesthesia are assaults cloaked in defense of healthcare education. Preemptive linguistic qualifiers “presumed” or “implied” attempt to justify such violations with flippancy toward their oxymoronic implications: to suggest a priori that consent can be assumed undermines its otherwise standalone social, ethical, and medico-legal reverence. In this paper I conceptualize “medical sexual assault” and argue that presumed consent for intimate exams exemplifies its definition. By bluntly describing pelvic exams as “penetration,” this work aims to reify (...) the intimate reality of the clinical label “pelvic exam” and to call attention to cisheteronormative and androcentric assumptions involved in its practice. Additionally, this scholarship seeks to create a foundation toward broader work in conceptualizing clinical rape culture. Given recent national survey data indicating a surprising frequency of unconsented intimate exams, detailed language as to their problematics is necessary for ongoing legal and ethical efforts. Explicit consent for intimate exams must be the standard of care for conscious and unconscious patients. (shrink)

IntroductionThe pelvic floor muscles are active during motor tasks that increase intra-abdominal pressure, but little is known about how the PFM respond to dynamic activities, such as gait. The purpose of this study was to characterize and compare PFM activity during walking and jogging in continent adults across the entire gait cycle.Methods17 able-bodied individuals with no history of incontinence participated in this study. We recorded electromyography from the abdominal muscles, gluteus maximus, and PFM while participants performed attempted maximum voluntary (...) contractions of all muscles and completed 60–70 strides in four gait conditions: slow walk ; regular walk ; transition walk ; jog. We quantified activity throughout the whole gait cycle and during periods of bursting for each participant, and analyzed the timing of PFM bursting periods to explore when the PFM were most active in the gait cycle. We also conducted a phase metric analysis on the PFM and GM burst timings. We performed a Spearman's rank-order correlation to examine the effect of speed on %aMVCGC, %aMVCBR, and phase metric score, and used the Wilcoxon Signed-Rank test to evaluate the effect of gait modality, matched for speed, on these variables.ResultsThe PFM were active throughout the gait cycle, with bursts typically occurring during single-leg support. The PFM and GM were in phase for 44–69% of the gait cycle, depending on condition. There was a positive correlation between gait speed and both %aMVCGC and %aMVCBR. Phase metric scores were significantly higher during jogging than transition walking, but there was no difference between gait modality on %aMVCGC or %aMVCBR. Where possible we disaggregated data by sex, although were unable to make statistical comparisons due to low sample sizes.ConclusionThe PFM are active during walking and jogging, with greater activity at faster speeds and with bursts in activity around single-leg support. The PFM and GM co-activate during gait, but are not completely in phase with each other. (shrink)

This chapter examines the human enteric nervous system to discern some of the physiological effects of sexism, sexual abuse, and male privilege. It argues that to understand the gut, we must appreciate the affective relationship of the entire digestive tract with both itself and the pelvic floor. Examining the body’s digestive tube from the throat to the cloaca—the phylogenetic common origin of the pelvic floor’s separate urinary, genital, and anal tracts—Chapter 2 develops cloacal thinking, which treats the gut (...) and pelvic floor as psychosomatically integrated. Cloacal thinking blurs without erasing boundaries between the function and substance of the digestive tract’s “parts,” refusing to consider them as isolated from either each other or from the “outside” world. It also can help us appreciate gut functioning as transgenerational. The gut’s particular relationship with the world can result in a person’s physiologically passing the harmful effects of sexism and sexual abuse to her offspring. (shrink)

Many bioethicists accept the Consciousness Condition (CC): roughly, that a person can be wronged only if she can be benefited or harmed, which is possible only if she retains the capacity for consciousness. We argue that CC is false. People can be wronged even if they permanently lack consciousness and thus have no ability to experience benefit or harm. In support of this claim, we introduce a clinical case in which a profoundly vegetative patient is routinely subjected to unauthorized (...) class='Hi'>pelvic examinations for the benefit of medical trainees, then show that the truth of CC falsely implies the patient is not thereby wronged. We also offer a different explanation of the wrong done to patients by such behavior: they have been treated as objects—specifically, as tools for the purposes of others. We argue that our view—the instrumentalization account—not only yields the correct verdict on that case but that it enjoys advantages not shared by bare appeals to respect for autonomy or human dignity. (shrink)

Studies have recently begun to attend to the ways paid labor is embodied. However, the literature on embodied labor has not adequately addressed occupations for which the site of labor is the worker’s own body. One such occupation is that of gynecological educators—female-bodied instructors who teach breast and pelvic examinations to medical students using their own bodies as models. Drawing on interviews with current and former gynecological educators and professional directors, I ask how workers use their bodies to (...) produce legitimated forms of knowledge and how workers navigate gendered meanings attached to bodies. Gynecological educators use a distancing technique I call strategic dualism, which draws on using constructions of the body as an object while simultaneously relying on subjective experiences. This technique allows them to maintain their knowledge and authority, and suggests that workers are able to selectively draw on gendered meanings about the female body to pursue their goals. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 7-9, March‐April 2022.

Hastings Center Report, Volume 52, Issue 1, Page 28-31, January/February 2022.

Introducción: La ablación o mutilación genital femenina incluye una amplia variedad de prácticas que suponen la extirpación total o parcial de los genitales externos o su alteración por razones que no son de índole médica. Causa daños irreversibles y pone en peligro la salud, e incluso la vida de la mujer o niña afectada. Objetivo: Caracterizar la mutilación genital femenina y sus complicaciones a largo plazo en la comunidad de Fajikunda, Gambia, entre marzo y septiembre de 2012. Método: Se realizó (...) un estudio descriptivo prospectivo a 117 mujeres que asistieron al centro de salud por cualquier motivo que requiriera examen ginecológico y se estudiaron las variables grupo de edades, tipo de mutilación, grupo étnico y complicaciones. Resultados: Del total, 98 mujeres eran de 45 años de edad o menos; la clitoridectomía fue la práctica más frecuente; la inflamación pélvica crónica y el dolor en los genitales fueron las complicaciones a largo plazo que mayor asociación estadística demostraron con relación a la mutilación. La anorgasmia presentó una alta incidencia en la población estudiada. Conclusiones: La prevalencia de la mutilación genital femenina en Fajikunda es aproximadamente la misma que en Gambia, la tipo I es la más practicada y generalmente en jóvenes de la etnia Mandinga. Introduction: The ablation or female genital mutilation includes a wide variety of practices dealing with total or partial extirpation of the external genitalia or its alterations for reasons other than of medical nature. It causes irreversible damages and puts in danger the health or even the life of the woman or child involved. Objective: The aim of the present study is to characterize female genital mutilation and its long-term complications in Fajikunda community, Gambia, between March and September 2012. Method: A descriptive prospective study was performed to 117 women that attended the health unit for reasons requiring gynecological examination and the variables age group, mutilation type, ethnic group and complications were studied. Results: Of the total, 98 women were 45 years old or less; the clitoridectomy was the most frequent practice; cronical pelvic and genital pains were the long-term complications that showed a major statistical association with relation to mutilation. Conclusions: The prevalence of female genital mutilation in Fajikunda is approximately the same as in Gambia, the type I is the most performed and generally within young women belonging to Mandinga ethnic group. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Removing the Mask: Hopeless Isolation to Intersex AdvocacyAlexandra von KlanStrangers undoubtedly perceive me as female, but I identify as an intersex woman. My karyotype is 46,XY, a typically defined marker of male biological sex, and I was born with undeveloped, non–functioning gonads. As an intersex person, I know firsthand the negative consequences of pathologizing intersex people’s lived experience by categorizing otherwise healthy, functioning organs and bodies as abnormal. The (...) following narrative recounts conversations and interactions with medical providers during my diagnosis and subsequent treatment of pure XY gonadal dys-genesis, sometimes referred to as Swyer Syndrome. I hope to elaborate upon emotionally significant actions and inactions of medical care providers to expose consequential effects on my emotional processing, physical health, and self–actualization.In December 1988, I was born with “typical” female genitalia. No one knew I was an intersex woman with 46,XY karyotype. Thus, there was no hesitation in the announcement of the birth of a girl in the delivery room or later, on my birth certificate. My parents raised me as a girl and dressed their firstborn in culturally normative feminine garments and accessories: lace frilly frocks, oversized bows, white stockings, and black patent leather Mary Jane’s. I embraced femininity and expressed this gender identity throughout my childhood and adolescence. I’m the eldest of six children split between two households.In January 2005, a month after my sixteenth birthday, delayed puberty and absent menstruation prompted an appointment to a local women’s health center. Nurses collected blood samples and administered an MRI scan on my pelvic region. A week later, my father received a perplexing phone call. An inexperienced doctor told him “there must be something wrong” with me, because lab results revealed I was “chromosomally male.” My father recalls the information presented like, based on the evidence, “your daughter may not be completely female,” and that is that. His impression was that she knew little about the subject and was a bit clueless. She did not mention Swyer Syndrome, or any diagnosis for that matter.Up to this point, I was unaware that a member of my extended family also had Swyer Syndrome. Born in the 1950s, secrecy engulfed her medical treatment and doctors warned her parents against revealing her true chromosomal sex in order to prevent the hysterical panic and depression they [End Page E14] thought the truth would bring. Years later, she sought her medical records and unearthed the truth. Shortly after my father received that dubious phone call, my relative’s endocrinologist provided a referral to his mentor, “Doctor A,” a clinical reproductive endocrinologist.Under Doctor A’s care, I experienced the first of many pelvic exams. Much to my discomfort, Doctor A inspected my semi–clothed body with a male resident in the room. As a people–pleasing teen, I granted permission for his presence; I didn’t voice my preference for a female alternative. Doctor A’s cold hands pressed around each undeveloped breast, pulled a gown away from my hips to inspect a sparse patch of pubic hair, and conducted an examination of my vaginal canal.Shortly after the examination, Doctor A charted Swyer Syndrome as the official diagnosis. Speaking to my father and me, he described my condition as an extremely rare genetic mutation. He told us that Swyer Syndrome was an intersex condition, a group of congenital disorders impacting a person’s internal or external reproductive systems, including endocrine function and genitalia. He explained I had atypical streak gonads instead of ovaries and that, despite having typical male sex chromosomes, I was still very much a girl. He disclosed that my vaginal canal was moderate in length, perhaps further evidence—or consolation—that my body possessed normative female reproductive attributes after all.Next, Doctor A identified a pressing medical concern—golf–ball–sized benign tumors had developed on each streak gonad; if allowed to remain, they would pose an increasing risk of malignancy. We scheduled an appointment for laparoscopic gonadectomy six months later. I left his office with a 3–month prescription for estrogen and progesterone oral tablets. On the way home, we drove to an electronics store where my father... (shrink)

The pelvic exam is used to assess the health of female reproductive organs and so involves digital penetration by a physician. However, it is common practice for medical students to acquire experience in administering pelvic exams by performing them on unconscious patients without prior authorization. In this article, we argue that such unauthorized pelvic exams (UPEs) are sexual assault. Our argument is simple: in any other circumstance, unauthorized digital penetration amounts to sexual assault. Since there are no (...) morally significant differences between UPEs and other instances of digital penetration, UPEs are sexual assault. So, insofar as one is against sexual assault, one should be against UPEs. (shrink)

Summary The study, carried out in a Greek provincial town, focuses on the cultural meaning of university education and of participation in the extremely competitive entrance examinations to university. In spite of graduate unemployment, in relation to the labour market a university degree is seen as giving more possibilities. Also, the transition to university and the degree that follows are rewarded by the community with prestige and status. Moreover, gaining admission is also important in itself in relation to the (...) individual's wish to achieve something with herlhis own strength. Finally, taking part in the examinations is seen as being of the utmost importance in relation to the local values. Regardless of the outcome, it allows the participants to realize a particular set of values among which the ?duty to struggle? seems to occupy, for historical reasons, a central place. (shrink)

Fundamento: La ampliación de matrícula con la diversidad de vías de ingreso ha constituido un reto en la educación médica y la evaluación de graduación implica la certificación de la competencia de los egresados, por eso se hace necesario analizar los resultados obtenidos en estas etapas. Objetivo: Comparar los resultados de los ejercicios prácticos, teóricos y notas finales obtenidas por los estudiantes presentados a Exámenes Estatales Ordinarios de los cursos del 2006 al 2012 de la Facultad de Estomatología en la (...) Universidad de Ciencias Médicas de Camagüey. Métodos: Se realizó una investigación descriptiva con 410 estudiantes presentados a exámenes estatales ordinarios en el período 2006-2012. Se clasificaron los grupos con menos o más de 40 estudiantes por cursos. Se obtuvieron las calificaciones de cada ejercicio y nota final estatal por cursos. Se utilizó el método porcentual, media aritmética y mediana obtenida en cada curso. Resultados: Los cursos del 2006-2009 sumaron 99 estudiantes y en los cursos del 2009-2012 se incrementaron hasta 311 educandos. En los exámenes estatales prácticos, los grupos pequeños obtuvieron calificación media de 99,2 y una mediana de 99 y 100; en los grupos numerosos las calificaciones disminuyeron hasta llegar a una media de 93 y una mediana de 95. En los exámenes teóricos, en los tres primeros cursos la media de calificación fue 83,5 y en el grupo numeroso de 83,7. Conclusiones: En los resultados se mantiene la calidad de la base científica de la actuación en todos los cursos, pero ha disminuido la del desempeño en los cursos con incremento de estudiantes. Background: The extension of registration with the diversity of entrance ways has been a challenge in medical education. Graduation assessment involves the certification of the competence among seniors, therefore it is necessary to analyze the results obtained in these stages. Objective: To compare the results of theoretical, practical exercises and final notes obtained by the students submitted to Regular State examinations in the courses from 2006 to 2012 of the Dentistry Faculty at the Medical Sciences University of Camaguey. Methods: A descriptive research with 410 students submitted to Regular State examination was conducted in the period of 2006 to 2012. The groups were classified with less or more than 40 students per courses. The ratings of each exercise and state final note by courses were obtained. The methods used in each course were the percentage method, arithmetic mean and median obtained. Results: The courses from 2006 to 2009 totaled 99 students and in the courses from 2009 to 2012 the number of students increased up to 311. In the State practical tests small groups obtained qualification average of 99.2 and a median of 99 and 100; numerous groups' ratings fell to an average of 93 and an average of 95. In the theoretical tests, in the first three courses the average rating was 83.5 and in the large group it was 83.7. Conclusions: The results maintain the quality of the scientific basis of the performance in all courses, but the performance in courses with students increase has declined. (shrink)

Mysticism presents a challenge to anyone who is interested in fundamental questions about the nature of reality, knowledge, and how we should live. In this book the author examines questions posed by mysticism. He clarifies the nature of the claims advanced by Western and Asian mystics, and explores the beliefs and values of classical mystical ways of life for their interconnections and reasonableness. Jones discusses whether all mystical experiences and all mystical claims of knowledge are similar, and examines the relation (...) of concepts and experiences in mystics' claims. Also presented are standards for evaluating competing mystical claims, and mystics' problems with language. Whether mystics' arguments are rational is investigated along with the relation of moral and non-moral values and the role of beliefs and values in enlightened mystics' ways of life. Mysticism's relation to the enterprises of science, theology, psychology and ethics is also examined. (shrink)

This is the first book to unpack the legal and ethical issues surrounding unauthorised intimate examinations during labour. The book uses feminist, socio-legal and philosophical tools to explore the issues of power, vulnerability and autonomy. The collection challenges the perception that the law adequately addresses different manifestations of unauthorised medical touch through the lens of women's experiences of unauthorised vaginal examinations during labour. The book unearths several broader themes that are of huge significance to lawyers and healthcare professionals (...) such as the legal status of women and their bodies. The book raises questions about women's experiences during childbirth in hospital settings. It explores the status of women's bodies during labour and childbirth where too easily they become objectified, and it raises important issues around consent. The book highlights links to the law on sexual offences and women's loss of power under the medical gaze. The book includes contributions from leading feminist philosophers, medical professionals, and academics in medicine and law, and offers pioneering analysis relevant to lawyers and healthcare professionals with an interest in medical law and ethics; feminist theory; criminal law; tort law; and human rights law. (shrink)

In this article, I argue that many women lack the epistemic resources that would allow them to recognise the practice of vaginal examinations during childbirth as violent or as unnecessary and potentially declinable. I address vaginal examinations during childbirth as a special case of obstetric violence, in which women frequently lack the epistemic resources necessary to recognise the practice as violent not only because of the inherent difficulty of recognising violence that happens in an ‘essentially benevolent’ setting such (...) as the medical one, but also, and mainly, due to the pervasive sexual reification of women under patriarchy and the pervasive shame to which women are subjected. My argument is that the practice of vaginal examinations is indeed experienced – bodily apprehended – as violent by many women, but that full epistemic recognition of this violence is frequently obstructed because the experience perfectly coincides with the normal phenomenological situation of women within patriarchy and thus cannot really be framed as violent. A phenomenological analysis presenting the embodied experience of women under patriarchy as always already essentially tied to sexual availability and commodification, and to shame, will explain this epistemological impairment. A phenomenological take on Judith Butler’s distinction between ‘recognition’ and ‘apprehension’ informs my analysis: I deploy it to provide a richer, more nuanced response to the question of why vaginal examinations are not fully recognised and expressed as violent – even when they are, frequently, apprehended as such. Furthermore, Butler’s ideas about the epistemic ‘framings’ through which we make sense of different kinds of lives (grievable versus ungrievable) will help me to explain how the patriarchal sexual reification of women in fact already frames sexual violence as not-violence – which ultimately also prevents labouring women (and obstetrics staff) from recognising vaginal examinations during labour as violence. (shrink)

The current study aimed to explore effective strategies for preventing cheating in online examinations by surveying students to determine their cheating strategies. A total of 406 Iranian students at BA, MA, and PhD levels in four programs, including English language teaching, English literature, Linguistics, and English language translation, participated in this study using a convenient sampling technique. The sample was drawn from 83 universities across all 31 provinces of Iran. The researchers developed a 30-item questionnaire and a 4-item interview (...) to collect data. The results revealed that searching in PDFs and using social media groups were the most commonly used cheating strategies. To prevent this form of academic dishonesty, teachers used various strategies, the most effective being the use of conceptual questions and one-by-one oral exams with turned-on webcams. The main reason for students to cheat was their desire to perform better. The implications of this study are relevant for educational stakeholders, particularly teachers, and students, in promoting academic integrity. (shrink)

Examinations form part of the assessment processes that constitute the basis for benchmarking individual educational progress, and must consequently fulfill credibility, reliability, and transparency standards in order to promote learning outcomes and ensure academic integrity. A randomly selected question examination is considered to be an effective solution to mitigate sharing of questions between students by addressing replicated inter-examination questions that compromise examination integrity and sequential intra- examination questions that compromise examination comprehensivity. In this study, a Monte Carlo approach was (...) used to design six examination schemes for the purpose of generating and evaluating 600 RSQEs in order to investigate the effects of RSQE design on replicated inter-examination and sequential and intra-examination questions. Results revealed that the number of randomly selected questions from the pool and the number of sub-pools inversely affected the replication and sequencing of the examination questions. Thus, by designing the RSQE in many sub-pools, in equivalence to the number of examination questions and selecting only one question from each sub-pool, and updating the sub-pools after each examination, the passing of information can be prevented, ensuring the integrity of the examinations. (shrink)

While courtroom examinations are often recognized as a distinct speech-exchange system, little is known about how participants do an examination beyond its unique turn-taking system. This article attempts to shed some light on this issue by studying the question design during the direct examination in an American criminal court case using Conversation Analysis. It shows that attorneys use different question forms compared to casual conversation: declaratives are far less prevalent and questions are often designed as requests for action. In (...) addition, attorneys make use of forms that are not found in other types of interaction, such as the tag correct. The way in which attorneys design their questions additionally shows that the rules of the courtroom have procedural consequences for how the interaction is done. But these rules have to be enacted, and it is in their violation that participants bring about categories such as leading questions. (shrink)

The purpose of this study is to elucidate various practices for the structuring of images on an ultrasound monitor during prenatal ultrasound examinations. This study focuses on the practices that healthcare providers employ to invite pregnant women to differentiate a gray-tone image on the ultrasound monitor from the image’s background. In sequential environments in which pregnant women display difficulty in differentiating an image on the screen in response to the healthcare provider’s invitation, the healthcare provider employs practices that require (...) additional bodily involvement to structure the images on the screen. Furthermore, on certain occasions, the healthcare provider also points to a particular abdominal location with the ultrasound transducer, which is held against the abdomen to produce the very image being differentiated. This study demonstrates that the image on the ultrasound monitor is intrinsically embodied and spatially and modally distributed. In addition, the study suggests an interaction-organizational ground for an aspect of the ‘personification of the fetus’ through obstetric ultrasound. (shrink)

It has been argued extensively that diagnostic services are a general good, but that it is offered in excess. So what is the problem? Is not “too much of a good thing wonderful”, to paraphrase Mae West? This article explores such a possibility in the field of radiological services where it is argued that more than 40% of the examinations are excessive. The question of whether radiological examinations are excessive cries for a definition of diagnostic futility. However, no (...) such definition is found in the literature. As a response, this article addresses the issue of diagnostic futility in five steps. First, it investigates whether the concept of therapeutic futility can be adapted to diagnostics. A closer analysis of the concept of therapeutic futility reveals that this will not do the trick. Second, the article scrutinizes whether there are sources for clarifying diagnostic futility in the extensive debate on excessive radiological examination. Investigating the debate’s terms and definitions reveals a disparate terminology and no clear concepts. On the contrary, the study uncovers that quite different and incompatible issues are at stake. Third, the article examines a procedural approach, which is widely used for settling controversies over utility by focusing on the role of the professionals. On scrutiny however, a procedural approach will not solve the problem in diagnostics. Fourth, a value analysis reveals how we have to decide on the negative value of excessive examinations before we can measure excess. The final and constructive part presents a definition of diagnostic futility drawing upon the lessons from the previous analytical steps. Altogether, too much radiological examination is not a good thing. This is simply because radiological examinations are not unanimously good. Excessive radiological examinations can be defined, but not by one simple general and value-neutral definition. We have to settle with contextually framed value-related definitions. Such definitions will state how bad “too much of a good thing” is and make it possible to assess how much of the bad thing there is. Hence we have to know how bad it is before we can tell how much of it there is in the world. (shrink)

This is an ambitious book, dealing with an issue which deserves much greater attention from historians than it has received heretofore. Only the work of John Roach comes to mind as a precursor, dea...

ABSTRACTNon-suicidal self-injury is commonly used by young adults to regulate emotional responses. Yet, experimental examination of how people who self-injure appraise and respond to emotional stimuli is limited. We examined appraisals of, and responses to, emotive images in young adults who did and did not self-injure, and assessed whether these were impacted by exposure to a stressor. Study 1 examined whether participants differed in their appraisals of emotional images. Study 2 assessed whether appraisals of images changed after exposure to the (...) Trier Social Stress Test. Ratings of emotional valence and arousal were collected in both studies; skin conductance was measured as an indicator of physiological arousal in Study 2. In Study 1 participants reporting NSSI rated positively valenced images as less pleasant than participants not reporting NSSI. In Study 2, after acute stress, participants reporting NSSI displayed dampened physiological reactions to positive images whereas pa... (shrink)

ArgumentTwo medical delegations, one from Palestine and one from the United States, were sent to detainment camps in Cyprus in the summer of 1947. The British Mandatory government had set up these camps in the summer of 1946 to stem the flow of Jewish immigrants into Palestine after World War II. The purpose of the medical delegations was to screen the camps' inhabitants and to propose a mental-health program for their life in Palestine. We examine the activities of these two (...) delegations within the context of their scientific interest in the psycho-pathology of displaced persons after World War II and as part of a broader project of mental hygiene. According to the delegations, the detainees would be a potential source of strength for building a new society if they adapted to life in Palestine. However, they would become a burden if they failed to be absorbed. At the same time, the medical delegations also saw the detainee camps as a potential “living laboratory” for scientific exploration. The case of the two medical delegations in Cyprus is also a story about constructing and transgressing medical borders. Apart from the obvious fact that this case study deals with movement of people, refugees as well as health-care workers, it is also about the transmission of knowledge and professions across the ocean. (shrink)

As the title of the article suggests, “The Burqa Ban”: Legal Precursors for Denmark, American Experiences and Experiments, and Philosophical and Critical Examinations, the authors embark on a factually investigative as well as a reflective response. More precisely, they use The 2018 Danish “Burqa Ban”: Joining a European Trend and Sending a National Message (published as a concurrent but separate article in this issue of INTERNATIONAL STUDIES JOURNAL) as a platform for further analysis and discussion of different perspectives. These (...) include case-law at the international level while focusing attention on recent rulings and judicial reasoning by the ECtHR and the ECJ; critical thought-experiments in religion, morality, human rights, and the democratic public space; a contextualized account of burqa-wearing interventions by federal and state governments and, moreover, various courts in the United States; and philosophical commentary and, in some instances, criticism of the Danish and/or European (French, etc.) approach. The different contributions have different aims. The section on case-law at the international level reports on those central judgments that, in effect, helped to pave the path for the Kingdom of Denmark’s burqa ban. Concerning the concurring judges at the ECtHR, the opinions served to uphold a preexisting ban and to grant a wide margin of appreciation to the national authorities, thereby limiting the Court’s own review. -/- As regards to the ECJ, the legality of company rules that contain a policy of neutrality for the workplace was examined, with a similar outcome. The authors who discuss religion, morality, human rights and the democratic public space are endeavoring to, respectively, appeal to ethics as a testing stone for law and to both challenge and address several forms of “expressivist worry” in connection with face veils. In doing so, the authors ask a number of thought-provoking questions that hopefully will inspire public policymakers to careful analysis. While the section that is devoted to American perspectives highlights a comprehensive survey of political and legal responses to, in particular, full-face veils like the burqa, the relevant author also incorporates public perceptions and, in the course of examining these, draws a parallel to “the fate” of the hoodie. The constitutionality of burqa-wearing in America, so it also appears, is partially an open question, but differentiating between religious, political, or personal reasons is a de jure premise. Given that the Danish legislators who drafted law L 219 to ban burqa-wearing in public places rely on a reference to political Islam, they relegate religious and personal reasons to the private domain, thereby also adopting secularism as a premise. This is explored in the last author response of the article, more precisely, in an account of the underlying materialism that, in turn, is applied to Muslim women. If policymakers and legislators engaged in Thinking Things Through exercises, they could, as a minimum, avoid law-making strategies that are not in the spirit of the theory they themselves invoke, albeit tacitly. While the aim of, as it were, arresting culturally self-contradicting legislators is unique for the section in question, all the authors who contribute to the joint research project have one end-goal in common, namely to inform about important perspectives while at the same time opening up for parameters for (more) fruitful, constructive and (if need be) critical debate in the future. With this in mind, four recommendations are presented by the research director for the project. Legally, politically, socially and culturally, conflict-resolution should not translate the relationship between rulers and the ruled into a separation ideology, an instance of controllers versus the controlled. All things being equal, that is the objective limit for a democratic society. (shrink)