Individual differences in level of wisdom are associated with brain activation during a moral decision-making task.

INTRODUCTION: Wisdom is reportedly associated with better health and quality of life. However, our knowledge of the neurobiology of wisdom is still in the early stages of development. We aimed to improve our understanding by correlating a psychometric measure of the trait with patterns of brain activation produced by a cognitive task theorized to be relevant to wisdom: moral decision-making. In particular, we aimed to determine whether individual differences in wisdom interact with moral task complexity in relation to brain activation. METHODS: Participants were 39 community-dwelling men and women aged 27-76 years, who completed moral and nonmoral decision-making tasks while undergoing functional magnetic resonance imaging. Brain activation in select regions of interest was correlated with participants' scores on the San Diego Wisdom Scale (SD-WISE). RESULTS: Individual differences in wisdom were found to interact with brain response to moral versus nonmoral and moral personal versus impersonal dilemmas, particularly in regions in or near the default mode network. Persons with higher scores on the SD-WISE had less contrast between moral and nonmoral dilemmas and greater contrast between moral-personal and moral-impersonal dilemmas than individuals with lower SD-WISE scores. CONCLUSIONS: Results confirmed our hypothesis that individual differences in level of wisdom would interact with moral condition in relation to brain activation, and may underscore the relevance of considering one's own and others' actions and experiences in the context of wise thinking. Future studies are needed to replicate these findings and to examine specific neurocircuits.

"Please amputate my child's arms".

Jeremy sustained bilateral complete brachial plexus injuries in an auto collision on an icy road a month before his third birthday. The accident rendered both upper extremities completely flail and insensate: he has no motor or sensory function of his shoulders, elbows, wrists, or digits. Jeremy does, however, have normal function of the lower extremities. Physical therapists have worked with the child for over a year with no noted improvement in arm function. Jeremy falls frequently, causing injury to his face and head, and occasionally, his arms get twisted or caught in his crib and his fingers turn blue. Jeremy's mother, who carries the main responsibility for his daily care, believes that his insensate arms are too heavy and "get in his way," causing the falls. She and Jeremy's father present to the orthopedic clinic at the children's hospital with the request of having both arms amputated. The primary orthopedic surgeon and the orthopedic team disagree with the parents that bilateral upper-extremity amputation offers any medical benefit, but Jeremy's mother tells the surgeon that, if he will not perform the surgery, her family will find a doctor who will. The surgeon, who feels ethically distressed by the parental insistence on this amputation in such a young child, requests an ethics consultation.

Reimagining Human Research Protections for 21st Century Science.

BACKGROUND: Evolving research practices and new forms of research enabled by technological advances require a redesigned research oversight system that respects and protects human research participants. OBJECTIVE: Our objective was to generate creative ideas for redesigning our current human research oversight system. METHODS: A total of 11 researchers and institutional review board (IRB) professionals participated in a January 2015 design thinking workshop to develop ideas for redesigning the IRB system. RESULTS: Ideas in 5 major domains were generated. The areas of focus were (1) improving the consent form and process, (2) empowering researchers to protect their participants, (3) creating a system to learn from mistakes, (4) improving IRB efficiency, and (5) facilitating review of research that leverages technological advances. CONCLUSIONS: We describe the impetus for and results of a design thinking workshop to reimagine a human research protections system that is responsive to 21st century science.

Rethinking the Meaning of Ethics in RCR Education.

Training in the responsible conduct of research (RCR) is meant to ensure that federally funded scientists have the knowledge, skills, and resources necessary to conduct science in line with agreed upon scientific norms and ethical principles. At its institutional best, RCR education begins early, with reinforcement in subsequent stages of career development. Studies suggest, however, that scientists perceive the push to think about ethical matters negatively, narrowly equating ethics with burdensome oversight and regulation, or with controversies in a few highly charged areas. For their part, RCR instructors contribute to this narrow conception of ethics education by placing disproportionate emphasis on the misconduct of the few and its career-destroying consequences. The result is an ethics that is both individualistic and uncritical, an ethics incapable of explaining the threat to scientific integrity posed by a rigidly hierarchical distribution of power, severe competition for funding, a "winner takes all" credit system, and many other features of ordinary science. What is needed is a broader, richer conception of ethics, one that focuses not only on individual instances of misconduct, but also on the growing gap between the normative ideals of science and its institutional reward systems.

Do extratherapeutic factors affect residents' decisions to prescribe medication for erectile dysfunction in ethically challenging scenarios?

PURPOSE: To examine residents' attitudes about prescribing medication for erectile dysfunction in ethically challenging scenarios. METHOD: In 2009, the authors surveyed internal medicine and family medicine residents at the University of California, San Diego, School of Medicine, asking them to indicate how likely they would be to prescribe sildenafil citrate to patients in 10 hypothetical scenarios. Eight scenarios had three nested variables: sexual identity, HIV status, and risk level. Two involved adulterous behavior; these were compared with two with monogamous behavior. The survey included four attitudinal questions about medical care and societal values. RESULTS: Of 128 eligible residents, 81 (63%) responded. Respondents were more likely to prescribe sildenafil to hypothetical patients with low-risk behavior than to those with high-risk behavior (P < .001), more likely to prescribe sildenafil to patients who were HIV negative than to those who were HIV positive (P < .001), and more likely to prescribe sildenafil to monogamous patients than to patients in adulterous relationships (P < .001). Respondents who agreed that physicians are obliged to protect patients from their own risky behavior were likely to prescribe sildenafil in fewer scenarios than those who disagreed (P = .005). CONCLUSIONS: Extratherapeutic factors influenced residents' decisions about prescribing medication for erectile dysfunction. Paternalistic attitude was the only attitudinal factor that affected likelihood of prescribing sildenafil. Residency programs should help trainees understand the balance between respecting patients' rights and protecting society, and between personal values and professional obligations, as well as how biases may affect patient care.

Is the search for alternative sources of human pluripotent stem cells a mistake?

One response to the controversy in the United States over the moral status of the early embryo has been the proposal that scientists search for alternative sources of pluripotent stem cells. Is this a good idea? The present article argues that it is not. Following a brief look at the ethical standing of the four proposals assessed by the President's Council on Bioethics in 2005, the author addresses the fundamental question of the wisdom of pursuing alternatives to current methods of stem cell derivation. The author concludes that, given the poor prospects for finding alternatives that are both scientifically and ethically sound, and the costs of diverting energy and resources from established embryonic methods, further investment in the search for alternative methods is unwise.