Joseph B. Fanning

Echo Calling Narcissus: What Exceeds the Gaze of Clinical Ethics Consultation?

Guiding our response in this essay is our view that current efforts to demarcate the role of the clinical ethicist risk reducing its complex network of authorizations to sites of power and payment. In turn, the role becomes susceptible to various ideologies—individualisms, proceduralisms, secularisms—that further divide the body from the web of significances that matter to that body, where only she, the patient, is located. The security of policy, standards, and employment will pull against and eventually sever the authorization secured by authentic moral inquiry. Instead of asking “What do I need to know?”, the question animating the drive to standardize will be “What is the policy or standard?” The claims of the authors in this issue of HEC Forum confirm these suspicions.

Religiosity, Spirituality, and Psychological Distress in African-Americans at Risk for Having a Hereditary Cancer Predisposing Gene Mutation

Elevated psychological distress has been observed among people at increased risk for familial cancer. Researchers consider religiosity and spirituality (RS) to be positive coping mechanisms associated with reduced psychological distress. Relatively little is known about the impact of RS on genomic health issues. The objectives of our study were: (1) describe the prevalence of RS and depressive symptoms and (2) explore how RS relates to psychological distress in a cohort of individuals with a ≥25% prior probability of a genetic predisposition to cancer. Participants (n = 99) were drawn from an African‐American, Louisiana‐based kindred with a mutation at the BRCA1 locus. This analysis reports findings from a survey assessing RS and the use of three types of religious coping styles: collaborative, self‐directing, and deferring. Clinically significant depressive symptoms were relatively high (27%); with females (33%) more likely than males (17%) to report symptoms (P < 0.01). The majority of participants reported being highly religious. The most commonly employed religious problem solving style used by participants was collaborative (

Obstacles to Shared Expectations in a Burn Intensive Care Unit

{\rm \bar X = 22}{\rm .9}

Religious and spiritual issues in medical genetics.

; SD = 5.8) versus self‐directing (

Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life:

{\rm \bar X = 12}{\rm .8}

Genetic Counseling: Models and Visions

; SD = 5.1) and deferring (

Genetic Counseling and Nondirectiveness

{\rm \bar X = 19}{\rm .9}

Genetic Counseling and Spiritual Assessment

; SD = 6.3). We did not observe significant associations between RS indicators and psychological distress, nor did we observe appreciable differences related to gender or risk perception. Although RS beliefs and practices are important for many African‐Americans, we did not find evidence that indicators of self‐reported RS are associated with psychological distress prior to genetic counseling and testing.

A Responsibility Model of Genetic Counseling

Critical care patients are dependent on the health care team and their family members to effect care goals that are consistent with their core values and wishes. This study aimed to identify and understand how obstacles to communication affect these two disparate groups. Ten burn intensive care unit (BICU) care team and 20 family members participated in in-depth semistructured interviews. A two-cycle coding, inductive analytical approach was used to derive three obstacle metathemes: family engagement, information exchange, and process transparency and standardization. However, care team and family members’ themes within each metatheme were different. Although the thematic structure was derived inductively, our findings in retrospect appeared to be consistent with Law’s four resistances associated with actor-networks. From this perspective, actor-network theory provides a plausible explanation for perceived obstacles and may, in the future, guide the development of interventions to improve shared agency across networks.

Of goals and goods and floundering about: a dissensus report on clinical ethics consultation.

This article provides an overview of a special issue on the religious and spiritual concerns that arise in the provision of genetic services. It introduces some of the challenges in defining religion and spirituality and provides contexts and summaries for the empirical and normative research that appears in the issue.