Ethical challenges in health care during collective hunger strikes in public or occupied spaces.

Public collective hunger strikes take place in complex social and political contexts, require medical attention and present ethical challenges to physicians. Empirical research, the ethical debate to date and existing guidelines by the World Medical Association focus almost exclusively on hunger strikes in detention. However, the public space differs substantially with regard to the conditions for the provision of health care and the diverse groups of healthcare providers or stakeholders involved. By reviewing empirical research on the experience of health professionals with public collective hunger strikes, we identified the following ethical challenges: (1) establishment of a trustful physician-striker relationship, (2) balancing of medico-ethical principles in medical decision-making, (3) handling of loyalty conflicts and (4) preservation of professional independence and the risk of political instrumentalization. Some of these challenges have already been described and discussed, yet not contextualized for public collective strikes, while others are novel. The presence of voluntary physicians may offer opportunities for a trustful relationship and, hence, for ethical treatment decisions. According to our findings, it requires more attention to how to realise autonomous medical decisions in the complex context of a dynamic, often unstructured and politically charged setting, which ethical norms should shape the professional role of voluntary physicians, and what is the influence of the hunger strikers' collective on individual healthcare decisions. Our article can serve as a starting point for further ethical discussion. It can also provide the basis for the development of potential guidelines to support health professionals involved in public collective hunger strikes.

Flexible Loyalties: How Malleable Are Bicultural Loyalties?

Biculturals are individuals who are acculturated in two cultures and have dual identities. Due to this, many early discussions on biculturalism argued that biculturals may have divided loyalties between their two cultural backgrounds and the identities derived from these backgrounds. This view is further highlighted given historical and contemporary debate regarding immigrants in the European and American political arenas. These concerns illustrate two possibilities. First, that biculturals have a preference for their home or host culture, identifying one as the in-group to express loyalty toward and the other as the out-group. Second, biculturals may alternate between who they identify as their in-group depending upon the circumstances. In a particular cultural environment, a given bicultural may feel greater degrees of loyalty toward that culture, while feeling different loyalties when immersed in a different cultural environment. To-date, few empirical studies have examined these two questions in detail. We proposed two hypotheses: First, biculturals will express higher levels of loyalty for a specific culture if they have been exposed to a prime congruent with that culture than if they have been exposed to a prime associated with a different culture. Second, the magnitude of preferences expressed for the two cultures will differ depending on the cultural prime. We experimentally investigated this phenomenon in a sample of Chinese-Americans (N = 136) using a computer simulated soccer game between the United States and China. This simulation was selected in order to avoid the controversial nature of an immigration or cultural conflict scenario. Past research has shown that support for the sports team of a given country is a form of expressing loyalty. Participants were randomly exposed to one cultural priming condition (American, Neutral, Chinese) using commentaries recorded in different languages: English, no commentary, and Chinese. Participants were then asked to what degree they would cheer for each team. Participants expressed more likelihood to cheer for the Chinese team than for the American team. However, our results indicate that cultural priming does influence the degree to which the participants express loyalty for the Chinese team over the American team in the form of rooting behaviors.

Perceived Parental Functioning, Self-Esteem, and Psychological Distress in Adults Whose Parents are Separated/Divorced.

OBJECTIVE: The objective of this research was to identify retrospectively the alienating behaviors and the parental bonding that occurred in an Italian sample of adults whose had parents separated or divorced and their associations with self-esteem and psychological distress. METHODS: Four hundred seventy adults in Chieti, Italy, completed an anonymous and confidential survey regarding their childhood exposure to parental alienating behaviors (using the Baker Strategy Questionnaire), quality of the parent-child relationship (using Parental Bonding Instruments), self-esteem (using Rosenberg Self-Esteem Scale), and global psychological distress (using Global Severity Index of Symptom Checklist-90-Revised). RESULTS: About 80% of the sample reported some exposure to parental alienating behaviors; about 65-70% of the sample has perceived non-optimal parenting by mother and by father; individuals who experienced affectionless control (low care and high overprotection) reported significantly higher exposure to parental loyalty conflict behaviors. Overall rates of reported exposure to low care, and overprotection and parental loyalty conflict behaviors were statistically significantly associated with self-esteem as well as the measure of current psychological distress. RESULTS revealed that exposure to parental loyalty conflict behaviors and self-esteem were associated with psychological distress over and above the effects of parental bonding and age. CONCLUSION: The pattern of findings supports the theory that children exposed to dysfunctional parenting, and with low self-esteem are at risk for their long-term psychological functioning. Implications for health policy changes and strengthening social services are discussed.

Symptom Checklist-90-Revised scores in adult children exposed to alienating behaviors: an Italian sample.

This study addresses a particular form of child psychological maltreatment, exposing a child to alienating behaviors in the context of a high degree of conflict between the parents. The objective of this research was to identify retrospectively the alienating behaviors that occurred in an Italian sample of children and the reported associated psychosocial symptoms. Seven hundred and thirty-nine adults in Chieti, Italy, completed an anonymous and confidential survey regarding their childhood exposure to parental alienating behaviors and measures of current symptomatology. About 75% of the sample reported some exposure to parental alienating behaviors; 15% of the sample endorsed the item, "tried to turn me against the other parent." The results revealed strong and statistically significant associations between reported exposure to parental alienating behaviors and reports of current symptomatology.

Conflitos interparentais e individuação em jovens adultos portugueses: papel dos conflitos de lealdade / Interparental conflicts and individuation in young portuguese adults: the role of loyalty conflicts

O objetivo do presente estudo foi analisar em que medida os conflitos de lealdade e a triangulação a uma das figuras parentais medeiam a associação entre a percepção de conflitos inter-parentais e o processo de individuação de jovens adultos. Adicionalmente, pretendeu-se testar se dimensões positivas da relação parental moderam a associação antes mencionada. Os participantes foram 538 jovens adultos portugueses entre os 18 e os 30 anos de idade, de ambos os gêneros. Para ambas as figuras parentais, a coligação (mas não a triangulação) medeia o efeito dos conflitos inter-parentais na individuação dos jovens, sendo que a percepção de cuidado recíproco e intimidade na relação parental moderam a relação entre conflitos inter-parentais e individuação dos jovens. Os resultados foram discutidos à luz do paradigma da vinculação e da formação da identidade.

The goal of the present study was to examine whether loyalty conflicts and pressure to side to one of the parents mediate the association between the perception of interparental conflicts and the individuation process in young adults. In addition, we wanted to test whether positive dimensions of the parental relationship moderate the above mentioned associations. Participants were 538 Portuguese man and women with ages between 18 and 30 years. The results indicate that coalition mediates the effect of interparental conflict on the individuation of the young adult, and that the perception of reciprocal care and intimacy in the parental relationship moderates the association between interparental conflicts and individuation. Results were discussed according to the attachment theory and the development of the identity of the young adult.