This article draws attention to the ethical complexity researchers may be confronted with during fieldwork should an adult participant with intellectual disabilities disclose that harm or an illegal activity is occurring or has occurred in the past. The need to gain ethical approval and the positioning of people with intellectual disabilities as vulnerable within ethics review procedures can result in the adoption of paternalistic approaches as researchers are encouraged to break confidentiality to report concerns to other professionals. Whilst this may (...) fulfil a researcher’s duty to ensure no harm occurs to participants, if it takes place against the participant’s wishes it may also violate participant autonomy, reinforce unequal relations of power, and may unwittingly contribute to subsequent harm occurring. Whilst the article begins from our experience as two UK-based researchers working with people with intellectual disabilities, it draws on existing literature and guidelines to expose the ethical tensions which may be encountered. It is intended that the paper acts as a starting point for researchers wishing to reflect on their practice and ethical decision-making, whilst contributing to wider debates on the position of people with intellectual disabilities within society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would be (...) the acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

In this issue of the Hastings Center Report, Daniel Brudney suggests that clinicians have an overly deferential attitude toward their patients’ surrogate decision-makers that is rooted in a wrongful investment of moral authority. He maintains that surrogate decision-makers have no moral right to decide for their loved ones and that their value in the decision-making process is limited to their knowledge of their loved one's preferences. If operationalized, Brudney's framework would ease the way for clinicians to remove a surrogate who (...) cannot provide information relevant to the patient's preferences and to resort to a paternalistic model of decision-making. Brudney fails to consider that the value of the surrogate does not flow from the surrogate, but rather from the patient's moral claim to have decisions made for him or her by a loved one. This claim recognizes that surrogates have intrinsic value through their relationship to and knowledge of the patient. Bioethics consultation services can assist clinical teams in engaging with the human crowd that surrounds each patient and navigating conflicting values and goals. This relational approach embraces the “mire and blood” that is endemic to relationships and clinical encounters. (shrink)

It is estimated that 300,000 children 0–14 years of age are diagnosed with cancer worldwide each year. While the absolute risk of cancer in children is low, it is the leading cause of death due to disease in children in high‐income countries. In spite of this, the etiologies of pediatric cancer are largely unknown. Environmental exposures have long been thought to play an etiologic role. However, to date, there are few well‐established environmental risk factors for pediatric malignancies, likely due to (...) technical barriers in collecting biological samples prospectively in pediatric populations for direct measurements. In this review, we propose the use of novel or underutilized biospecimens (dried blood spots and teeth) and molecular approaches for exposure assessment (epigenetics, metabolomics, and somatic mutational profiles). Future epidemiologic studies of pediatric cancer should incorporate novel exposure assessment methodologies, data on molecular features of tumors, and a more complete assessment of gene‐environment interactions. (shrink)

When applied in the health sector, AI-based applications raise not only ethical but legal and safety concerns, where algorithms trained on data from majority populations can generate less accurate or reliable results for minorities and other disadvantaged groups.

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include (...) a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sensemaking processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed. (shrink)

Visual cortical prostheses (VCPs) have the potential to provide artificial vision for visually impaired persons. However, the nature and utility of this form of vision is not yet fully understood. Participants in the early feasibility trial for the Orion VCP were interviewed to gain insight into their experiences using artificial vision, their motivations for participation, as well as their expectations and assessments of risks and benefits. Analyzed using principles of grounded theory and an interpretive description approach, these interviews yielded six (...) themes, including: the irreducibility of benefit to device functionality, mixed expectations for short-term device functionality and long-term technological advancement of visual prostheses, and a broad range of risks, concerns, and fears related to trial participation. We argue that these narratives motivate a nuanced set of ethical considerations related to the complex relationship between functionality and benefit, the intersection of user experience with disability justice, and the import of expectations and indirect risks on consent. (shrink)

Background: Development of professional nursing values is critical within registered nurse–to–bachelor of science in nursing programs to prepare nurses for increasingly complex and diverse work environments. The results of previous studies have been inconsistent, with few studies focusing on online registered nurse–to–bachelor of science in nursing programs. In addition, little is known regarding the effectiveness of the educational methods used to support advancement of professional values and ethical practice. Objective: The object of this study was to gain an understanding of (...) nursing students’ attitudes and beliefs about professional values at entry and exit of an online registered nurse–to–bachelor of science in nursing program that includes a standalone ethics course and integrates American Nurses Association Code of Ethics provisions throughout the curriculum. Research design: For this one-group pretest–posttest, quasi-experimental design, longitudinal matched-pair data were gathered at program entry and exit using the Nurses Professional Values Scale–Revised. Participants and research context: In all, 119 students of an online registered nurse–to–bachelor of science in nursing program at a Midwest public university who completed entry and exit surveys between spring 2015 and spring 2018 were included in this study. Ethical considerations: This study was reviewed and determined to be exempt by the university’s institutional review board. Findings: The results showed a significant increase in total posttest scores when considering all participants. However, students who took the ethics course after the pretest demonstrated a significant increase in posttest scores, while students who took the ethics course prior to the pretest demonstrated a small increase that was not statistically significant. Significant increases were also found in the professionalism, activism, and trust factors. Discussion: This study supports previous study findings where students scored higher on caring and lower on activism and professionalism factors. The largest gains were made after completing the ethics course. Conclusion: The results suggest that requiring a standalone ethics course in the registered nurse–to–bachelor of science in nursing curriculum had a positive impact on self-reported professional values. (shrink)

This letter addresses the editorial decision to publish the article, “Research on group differences in intelligence: A defense of free inquiry” (Cofnas, 2020). Our letter points out several critical problems with Cofnas's article, which we believe should have either disqualified the manuscript upon submission or been addressed during the review process and resulted in substantial revisions.

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of ‘proficiency’ in nurse education—prescribed by the regulator—impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical‐legal challenges posed by sanctioned powers to restrict patients' (...) freedom at the same time as the desire (and obligation) to promote patients' self‐determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain. (shrink)

The practice of recontact in genomic medicine has the power to help rectify long‐standing inequities in genetic testing. However, if not delivered systematically, recontacting practices also have the potential to reinforce these same inequities. Recontact, which occurs when contact between a clinician and patient is reinitiated after a relationship has ended, is often in search of or in response to updated interpretation or results. Currently, recontact is happening in a patient‐driven and ad hoc manner, undermining its potential to benefit all (...) patients. In this paper, the authors position justice as an additional argument in favor of systematic recontact and an argument against the predominantly patient‐initiated model. They argue that patients from equity‐deserving groups should be early beneficiaries of an emerging responsibility to recontact patients. The authors share illustrative clinical vignettes and propose role‐specific and systems‐level solutions to rightfully position recontact as a tool to promote a more equitable clinical genomics future. (shrink)

The “scarred villain” trope, where facial differences like scars signify moral corruption, is ubiquitous in film (e.g., Batman’s The Joker). Strides by advocacy groups to undermine the trope, however, suggest cinematic representations of facial differences could be improving with time. This preregistered study characterized facial differences in film across cultures (US vs. India) and time (US: 1980-2019, India: 2000-2019). Top-grossing films by country and decade were screened for characters with facial differences. We found that the scarred villain trope has actually (...) worsened with time, although in tandem with progress in also representing non-villainous characters with facial anomalies. Country of origin did not predict the presence of facial differences in villains or heroes. “Action” and “fantasy” movies were the most likely genres to depict villains with facial differences. Finally, villains’ facial differences crossed more facial subunits and were more likely to involve lips, chin, and mandible than when present in heroes. Our findings underscore the need for critical reflection on the role of cultural practices—even when seemingly innocuous—in shaping and maintaining negative biases against already stigmatized groups. (shrink)

This book draws on the hermeneutics of Hans-Georg Gadamer to inform a feminist perspective of social identities. Lauren Swayne Barthold moves beyond answers that either defend the objective nature of identities or dismiss their significance altogether. Building on the work of both hermeneutic and non-hermeneutic feminist theorists of identity, she asserts the relevance of concepts like horizon, coherence, dialogue, play, application, and festival for developing a theory of identity. This volume argues that as intersubjective interpretations, social identities are vital (...) ways of fostering meaning and connection with others. Barthold also demonstrates how a hermeneutic approach to social identities can provide critiques of and resistance to identity-based oppression. (shrink)

Research about the Olympic Games has primarily focused on preparing athletes for competition. Less attention has been paid to the post-Olympic-phase and athlete well-being during this time. This study explored Australian Olympic athletes’ experiences following the conclusion of the 2016 Rio Olympic Games, including the factors that may have contributed to or challenged their well-being during this time. Eighteen athletes participated in semi-structured interviews and thematic analysis revealed that when Olympic performance appraisal met prior expectations, when athletes planned for a (...) return to work or study, and when support from a variety of sources was readily available, this positively influenced athletes’ well-being during the POP. When these factors were not in place, more challenging post-Games experiences were present, and well-being was compromised. The findings contribute to the broader literature on elite athlete well-being and at an applied level, may be used to inform targeted programs that focus on supporting athletes after an Olympic campaign. (shrink)

Previous studies have shown a robust bias to express the goal path over the source path when describing events. Motivated by linguistic theory, this study manipulated the causal structure of events and measured the extent to which adults and 3.5- to 4-year-old English-speaking children included the goal and source in their descriptions. We found that both children's and adults’ encoding of the source increased for events in which the source caused the motion of the figure compared to nearly identical events (...) in which the source played no such causal role. However, a goal bias persisted overall for both causal and noncausal motion events. These findings suggest that although the goal bias in language is highly robust, properties of the source influence its likelihood of being encoded in language, thus shedding light on how properties of an event can influence the mapping of event components into language. (shrink)

Despite sustained philosophical attention, no theory of humor claims general acceptance. Drawing on the resources provided by intentional systems theory, this article first outlines an approach to investigating humor based on the idea of a comic stance, then sketches the Dismissal Theory of Humor that has resulted from pursuing that approach. According to the DTH, humor manifests in cases where the future-directed significance of anticipatory failures is dismissed. Mirth, on this view, is the reward people get for declining to update (...) predictive representational schemata in ways that maximize their future-oriented value. The theory aims to provide a plausible account of the role of humor in human mental and social life, but it also aims to be empirically vulnerable, and to generate testable predictions about how the comic stance may actually be undergirded by cognitive architectures. (shrink)

Birds are not commonly admired for emotional expression, and when they are, the focus is typically on negative states; yet vocal behavior is considered a direct reflection of an individual’s emotional state. Given that over 4000 species of songbird produce learned, complex, context-specific vocalizations, we make the case that songbirds are conspicuously broadcasting distinct positive emotional states and that hearing songs can also induce positive states in other birds. Studies are reviewed that demonstrate that that the production of sexually motivated (...) song reflects an emotional state of anticipatory reward-seeking (i.e., mate-seeking), while outside the mating context song in gregarious flocks reflects a state of intrinsic reward. Studies are also reviewed that demonstrate that hearing song induces states of positive anticipation and reward. This review brings together numerous studies that highlight a potentially important role for the songbird nucleus accumbens, a region nearly synonymous with reward in mammals, in positive emotional states that underlie singing behavior and responses to song. It is proposed that the nucleus accumbens is part of an evolutionarily conserved circuitry that contributes context-dependently to positive emotional states that motivate and reward singing behavior and responses to song. Neural mechanisms that underlie basic emotions appear to be conserved and similar across vertebrates. Thus, these findings in songbirds have the potential to provide insights into interventions that can restore positive social interactions disrupted by mental health disorders in humans. (shrink)

The God who runs after your friendship -- A short note on gender and language for God -- Clothing -- Smell -- Bread and vine -- Laboring woman -- Laughter -- Flame -- In this poverty of expression, thou findest that He is all -- Dingbat -- A short note from the women's prison -- A bookshelf.

Storytelling, art and craft can be considered aesthetic expressions of identities. Kalahari identities are not fixed, but fluid. Research with present-day Kalahari People regarding their artistic expression and places where it has been, and is still, practised highlights that these expressions are informed by spirituality. This article explores this idea via two Kalahari case studies: Water Stories recorded in the Upington, Kakamas area, as well as research on a specific rock engraving site at Biesje Poort near Kakamas. The importance of (...) the Kalahari People’s spiritual beliefs as reflected in these case studies and its significance regarding their identities and influence on social change and/or community development projects is discussed. The article thus highlights ways in which spirituality can be considered in relation to social change projects that are characterised by partnerships between local community, non-government and tertiary education representatives and researchers and that highlight storytelling as an integral part of people’s spirituality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Précis of Microaggressions in MedicineLauren Freeman (bio) and Heather Stewart (bio)Microaggressions in Medicine demonstrates that the harms of microaggressions are anything but micro. Guided by diverse patient testimonies and case studies, the book focuses on harms experienced by patients who are marginalized on the basis of race, gender, sexual orientation, body size, and disability. It amplifies their voices, stories, and experiences, which have too often been excluded from mainstream (...) bioethical, medical, and popular discussions. The novel account advanced in Microaggressions in Medicine illustrates that microaggressions in medicine are not rare, but frequent in the healthcare experiences of marginalized patients. Our hope is that the book helps patients better understand and make sense of their experiences. We also hope that it helps current and future healthcare professionals recognize the serious and enduring consequences that microaggressions can have on their patients. Finally, it introduces actionable strategies for healthcare professionals to reduce microaggressions in their practices and institutions.Microaggressions in Medicine argues that healthcare professionals have a moral obligation to prevent microaggressions as much as possible. It aims to make a positive difference in the lives of marginalized patients as they interact with medical practitioners and institutions. It also aims to support healthcare professionals in modifying their practices to ensure that they are always providing high-quality, patient-centered care to all patients. Its ultimate goal is to help increase health equity.More specifically, the book has two broad goals: one theoretical, one practical. The theoretical goal is to reconceptualize how microaggressions have been understood in the literature and to develop this new account within medical contexts. The practical goal is to provide healthcare professionals with a greater understanding of the serious and enduring consequences that microaggressions can have on members of marginalized patient groups and to introduce strategies and tools to help healthcare professionals reduce microaggressions experienced [End Page 142] by patients, thereby diminishing harm caused to patients. To set the context for the critical responses to follow, we briefly summarize each chapter of the book, highlighting the main arguments and novel contributions.Microaggressions can be defined as actions, gestures, or even material environments that subtly and often unintentionally harm members of marginalized groups. They are prevalent in medicine yet often go unnoticed by those who commit them. The introduction outlines the main problem with which the book engages: that there are subtle things that healthcare professionals commonly say and do to patients that do not register as serious to them yet that often cause major harms to patients in the short and long term. To set the stage to unpack this problem, we define what microaggressions are, provide examples of microaggressions in medical contexts, outline the aims and goals of the book, and explain key concepts (e.g., intersectionality, harm, structural oppression) that are necessary for understanding and engaging with the book's arguments. The introduction makes clear how and why a discussion of microaggressions in medicine is valuable to marginalized patients who want to better understand their own experiences interacting with healthcare professionals and institutions. It also underscores the book's value for healthcare professionals who want to improve their clinical interactions with marginalized patients and strategize about how to make their practices more inclusive, welcoming, and just.Chapter 1, "Microaggressions: A Brief History," provides a history of microaggressions. The term was coined in 1970 by a Black Harvard psychologist, Chester Pierce, to describe the "subtle blows" experienced by Black people that are not major or explicit yet that cause real harm. Although little was written about microaggressions for almost four decades, microaggressions gained traction in 2007 through the work of psychologist Derald Sue and his colleagues. We discuss Sue et al.'s work on microaggressions, tracing key revisions and developments the concept has undergone in the last fifteen years. The chapter also summarizes some of the main criticisms that have been launched against microaggressions and considers responses that have been offered. This chapter provides the groundwork for chapter 2, which lays out our novel critique of the dominant understanding of microaggressions. It also motivates our reconceptualization of microaggressions that unfolds over the remainder of the book.Chapter 2, "Microaggressions Reconsidered: A Critique of the Act-Based... (shrink)

The book falls into three parts each of which focuses on one author and the ways in which pluralism manifests itself in his particular genre.

Name der Zeitschrift: Cognitive Linguistics Jahrgang: 26 Heft: 4 Seiten: 583-612.

It has largely been assumed that when an intentional community loses its charismatic leader for one reason or another, the group will most likely disband unless that individual’s charisma has become routinized. The Kashi Ashram in Sebastian, Florida, is a spiritual community that was established, thanks to the vision of their Guru, Ma Jaya Sati Bhagavati. Her students were so devoted to her that her physical death in 2012 could have initiated a crisis in the community. Although bureaucratic offices had (...) been established to carry out some of the necessary functions of the Ashram, no one came close to filling her role as a spiritual teacher. And yet, more than 6 years later, new members are still joining the community and the way they describe Ma’s presence in their lives is little different from how older members that knew Ma in this lifetime talk about her. While I do not disagree that the routinization of charisma is an important step in ensuring the longevity of new religious movements, in this paper, I argue that an individual’s charisma may be transferred to a geographic place such that the Ashram becomes an active agent in the attraction and retention of new members. (shrink)

After introducing some scholarship on the value of Mao Qiling's (1623–1713) works, we present an account of canonization processes in order to understand the hermeneutic context of Mao's battle with the Cheng-Zhu orthodoxy. His work is an attempt to decanonizing Zhu Xi's Four Books, preferring instead an alternative relying on the Old Texts of the Taixue《太學》/Daxue《大學》 and Zhongyong 《中庸》. Mao argues against Zhu Xi's textual changes and interpretations on a number of bases, producing a hermeneutics of suspicion against the Cheng-Zhu (...) orthodoxy. Instead, Mao offers an alternative account of the sagely way, following precedents of Wang Yangming. (shrink)

The complexity of chromium chemistry makes it an ideal example of how the Principle of Expediency, first articulated by sanitary pioneer Earle Phelps, can be used in a standard setting. Expediency, defined by Phelps as “the attempt to reduce the numerical measure of probable harm, or the logical measure of existing hazard, to the lowest level that is practicable and feasible within the limitations of financial resources and engineering skill”, can take on negative connotations unless subject to ethical guidance. In (...) this paper we argue that without ethical principles as a rubric for negotiating environmental regulations, communities run the risk of slipping from the Principle of Expediency as defined by Phelps to the alternative usage of expediency meaning that which does not reflect ethical consideration or concern beyond self-serving interest. Three ethical ideals—justice, mercy and humility—are suggested as values to be considered while resolving regulatory issues related to environmental protection. The Principle of Expediency serves as a working principle, but not as a rigid algorithm, for setting regulatory limits for environmental concentrations of waste products like chromium. (shrink)

This chapter defends the relevance of four themes central to Hans-Georg Gadamer’s hermeneutics for debates about bio-medical enhancement. First, I expose some of the hidden assumptions and “prejudices” motivating certain discussions of bio-medical enhancement in order to avoid platitudes and thus engage a more rigorous philosophical approach. I then provide a brief history of hermeneutics, which derives its names from Hermes, the messenger bridging the distance between gods and humans, that defends the importance of “finitude” as feature crucial to the (...) human condition that proves salient for discussions about enhancement. Next, I argue that “equilibrium,” the state of balance between two opposing forces, is an apt way to describe the human condition of mortals who strive after immortality. I close by examining one more assumption underlying the ethics of enhancement: namely, thinking that experts are the ones who can and should solve our problems. A hermeneutic approach recommends a “dialogue” amongst peers over a panel of experts. (shrink)

This reflective essay is an attempt to organize trends in feedback I have observed during ten years of coursework, conversations, and correspondence with former students associated with the Medical Humanities Program at Baylor University. Over the years, recurrent themes arise when speaking with alumni about whether and how their medical humanities experience intersects with their current training. I have identified five particular domains in which baccalaureate medical humanities training affects students’ subsequent healthcare professions training and practice: context and complementarity, clinical (...) relevance, reflective practice, professional preparedness and vocational calling. I created an instrument of open-ended questions for each of these categories and posted it to social media with an invitation for alumni to respond. This informal survey was conceived as an exploratory exercise with the intent to help generate a foundation for more formal qualitative research in these five domains. In this essay, I offer my own reflections together with those of former students on the impact of baccalaureate-level medical humanities training in order to illustrate the benefits in each domain for subsequent healthcare training and practice. The need for qualitative research that explores the impact of baccalaureate medical humanities merits collaboration between multiple centers of investigation across many disciplines, and across the divide between premedical and medical educators. (shrink)

Autism spectrum disorder affects an estimated 1 in 54 children aged 8 years in the United States. For many of these children, there are concomitant eating and/or behavioral challenges that can make managing their nutritional health challenging. This commentary responds to a particularly challenging case in which a pediatric patient with ASD presented to the local hospital’s emergency department with severe weight loss and malnutrition.