Federalism for Bioethics?

In the wake of the Dobbs decision withdrawing federal constitutional protection for reproductive rights, the United States is in the throes of federalist conflicts. Some states are enacting draconian prohibitions of abortion or gender-affirming care, whereas other states are attempting to shield providers and their patients seeking care. This article explores standard arguments supporting federalism, including that it allows for cultural differences to remain along with a structure that provides for the advantages of common security and commerce, that it provides a laboratory for confined experiments, that it is government closer to the people and thus more informed about local needs and preferences, and that it creates layers of government that can constrain one another and thus doubly protect rights. We contend that these arguments do not justify significant differences among states with respect to the recognition of important aspects of well-being; significant injustices among subnational units cannot be justified by federalism. However, as nonideal theorists, we also observe that federalism presents the possibility of some states protecting rights that others do not. Assuming that movement among subnational units is protected, those who are fortunate enough to be able to travel will be able to access rights they cannot access at home. Nonetheless, movement may not be readily available to minors, people without documentation, people with disabilities, people who lack economic resources, or people who have responsibilities that preclude travel. Only rights protection at the federal level will suffice in such cases.

Engaging the AQ10 to Predict Professional Burnout or Poor Work-Related Psychological Wellbeing Among Anglican Clergy in Wales.

The ten-item Autism Spectrum Quotient (AQ10) is a self-report instrument originally designed to identify referrals for professional diagnosis for Autism Spectrum Disorders (ASD). Recent studies suggest that this instrument may also be tapping more generalised affective disorders. Working with this interpretation, this study examines the predictive power of the AQ10 to account for additional variance, after personal and personality factors have been taken into account, on the two scales of the Francis Burnout Inventory. Data provided by 220 Anglican clergy serving in Wales demonstrated that 8.6% of the participants recorded six or more red flags on the AQ10 (and so qualified for referral for specialist diagnostic assessment) and that higher scores on the AQ10 are associated with significantly lower levels of satisfaction in ministry and with significantly higher levels of emotional exhaustion in ministry. These data suggest that screening with the AQ10 may be helpful in identifying clergy vulnerable to professional burnout and to poor work-related psychological wellbeing, in addition to its primary purpose of screening for ASD.

The Effects of Spiritual Wellbeing on Self-Perceived Health Changes Among Members of the Church of England During the COVID-19 Pandemic in England.

This paper tests whether changes in spiritual wellbeing were correlated with self-rated changes in mental and physical health after controlling for changes in psychological wellbeing in a sample from the Church of England taken during the third national COVID-19 lockdown in 2021. During the third lockdown in England an online survey, named Covid-19 and Church-21, was delivered through the Qualtrics XM platform from 22 January to 23 July 2021. The responses included 1878 Anglicans living in England. The change in spiritual wellbeing scale was produced using self-reported changes in the frequency of key spiritual practices (prayer and Bible reading), trust in God, the quality of spiritual life, and spiritual health. Changes in mental and physical health were assessed using single self-report items. Changes in psychological wellbeing were assessed using the Index of Balanced Affect Change (TIBACh). After controlling for changes in psychological wellbeing, better change in spiritual wellbeing was positively correlated with better change in both mental and physical health. Negative affect may have mediated the relationship between spiritual wellbeing and both mental and physical health, and positive affect may also have mediated the relationship with mental health. The results suggest changes in spiritual wellbeing, as defined within a Christian religious context, may have had positive effects in promoting better mental and physical health during a sudden crisis such as the COVID-19 pandemic.

Work-Related Psychological Wellbeing and Conservative Christian Belief Among Methodist Circuit Ministers in Britain: Distinguishing Between Emotional Exhaustion and Satisfaction in Ministry.

Drawing on data provided by 803 Methodist circuit ministers serving in Great Britain, the present study was designed to test the association between conservative Christian belief and work-related psychological wellbeing as operationalised by the balanced affect model proposed by the Francis Burnout Inventory. After taking into account the effects of personal factors, psychological factors, contextual factors, and experience factors, holding conservative Christian belief was associated with a higher level of positive affect (satisfaction in ministry) but independent of negative affect (emotional exhaustion in ministry).

God is in His Heaven, All's Right With the World: Psychological Well-being and Belief in Divine Control During the Third COVID-19 Lockdown Among Anglican Clergy and Laity in England.

Drawing on data provided by 1,841 lay or ordained members of the Anglican Church residing in England during the first half of 2021, this study explores the connection between self-perceived change in psychological well-being during the pandemic and belief in divine control over the pandemic. Change in psychological well-being was assessed by The Index of Balanced Affect Change (TIBACh) that distinguishes between positive affect and negative affect, and divine control was assessed by the God in Control of the Pandemic Scale (GiCoPS). After controlling for personal factors (age and sex), psychological factors (psychological type and emotional volatility), contextual factors (education level and ordination status), and ecclesial factors (conservative doctrine and charismatic influence), the data demonstrated a positive association between belief in divine control and change in positive affect, but no association between belief in divine control and change in negative affect.

Evaluating the Balance Between Privacy and Access in Digital Information Sharing.

OBJECTIVES: Access to personal health records in an ICU by persons involved in the patient's care (referred to broadly as "family members" below) has the potential to increase engagement and reduce the negative psychologic sequelae of such hospitalizations. Currently, little is known about patient preferences for information sharing with a designated family member in the ICU. We sought to understand the information-sharing preferences of former ICU patients and their family members and to identify predictors of information-sharing preferences. DESIGN: We performed an internet survey that was developed by a broad, multidisciplinary team of stakeholders. Formal pilot testing of the survey was conducted prior to internet survey administration to study subjects. SETTING: Internet survey. SUBJECTS: Subjects included English-speaking adults who had an ICU experience or a family member with ICU experience between 2013 and 2016. We used panel sampling to ensure an ethnically representative sample of the U.S. population. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One thousand five hundred twenty surveys were submitted, and 1,470 were included in analysis. The majority of respondents (93.6%) stated that they would want to share present and past medical history, either all or that related to their ICU stay, with a designated family member of their choosing. The majority (79%) would also want their designated family member to be able to access that information from a home computer. Although most respondents preferred to share all types of information, they indicated varying levels of willingness to share specific types of more sensitive information. Information-sharing preferences did not differ by age, sex, ethnicity, or type of prior experience in the ICU (i.e., patient or family member). CONCLUSIONS: In the context of an ICU admission, sharing personal health information with a person of the patient's choosing appears desirable for most patients and family members. Policies and implementation of regulations should take this into consideration.

How Did the Psychological Well-Being of Church of England Clergy and Laity Change From the First to the Third National COVID-19 Lockdowns?

The balanced affect model of psychological well-being conceptualises positive and negative affect as two separate continua and well-being as the function of these two entities. The COVID-19 pandemic lasted over two years in the United Kingdom and initially caused widespread declines in mental health and well-being. This paper tests whether such declines continued or stabilised as the pandemic lockdowns persisted. The psychological well-being of a religiously committed sample was assessed by perceived changes in affect balance (a function of negative and positive affect) using The Index of Affect Balance Change (TIBACh) from the first to the third COVID-19 lockdowns in the Church of England. The 2020 sample in the first lockdown comprised 792 stipendiary parochial clergy and 2,815 laity who were not in licensed ministry in the Church of England. A repeat survey in the third lockdown in England in 2021 collected responses from 401 equivalent clergy and 1027 equivalent laity. Both clergy and lay people showed increased proportions reporting lower positive affect and increased proportions reporting higher negative affect in the second survey, suggesting psychological well-being had continued to deteriorate as lockdowns persisted.

Ethical and public health implications of genetic testing for suicide risk: family and survivor perspectives.

PURPOSE: Death from suicide has an estimated heritability of ~50%. Research may soon allow calculation of polygenic risk scores (PRS) for suicide death, which could be marketed directly to consumers. This raises ethical concerns. Understanding how consumers will utilize this information is urgent. METHODS: We conducted three focus groups involving suicide attempt survivors ("survivors") and family members of suicide decedents ("family members") to gauge their reactions to this technology. Questions focused on positive and negative implications of PRS results. Qualitative research methods were used to summarize studio results. RESULTS: Eight survivors and 13 family members participated. Both groups postulated benefits of suicide PRS, including prevention and reduced stigma. Their concerns ranged from increased stigma to adverse psychological effects. They suggested that suicide PRS should be accompanied by extensive education and counseling. Participants experienced no adverse effects. CONCLUSION: Many ethical, legal, and social implications of genetic testing for suicide risk are highly salient to community stakeholders. Our participants hoped that suicide PRS could have significant individual and community-level benefits, but had concerns about effects in several domains, including stigma, access to insurance and employment, and increased anxiety and depression.

Ethical concerns relating to genetic risk scores for suicide.

Genome-wide association studies (GWAS) provide valuable information in research contexts regarding genomic changes that contribute to risks for complex psychiatric conditions like major depressive disorder. GWAS results can be used to calculate polygenic risk scores (PRS) for psychiatric conditions, such as bipolar disorder or schizophrenia, as well as for other traits, such as obesity or hypertension. Private companies that provide direct-to-consumer (DTC) genetic testing sometimes report PRS for a variety of traits. Recently, the first well-powered GWAS study for suicide death was published. PRS reports that claim to assess suicide risk are therefore likely to appear soon in the DTC setting. We describe ethical concerns regarding the commercial use of GWAS results related to suicide. We identify several issues that must be addressed before PRS for suicide risk is made available to the public through DTC: (a) the potential for misinterpretation of results, (b) consumers' perceptions about determinism and behavior change, (c) potential contributions to stigma, discrimination, and health disparities; and (d) ethical problems regarding the testing of children and vulnerable adults. Tests for genetic prediction of suicidality may eventually have clinical significance, but until then, the potential for individual and public harm significantly outweighs any potential benefit. Even if genetic prediction of suicidality improves significantly, information about genetic risk scores must be distributed cautiously, with genetic counseling, and with adequate safeguards.

Exploring Affect Balance: Psychological Well-being of Church of England Clergy and Laity During the COVID-19 Pandemic.

Psychological well-being was assessed by affect balance (a function of negative and positive affect) during the first COVID-19 lockdown in 2020 among 4449 clergy and laity in the Church of England. Better well-being was promoted by preference for feeling over thinking in the psychological type judging process, being older, belonging to the Evangelical wing of the Church, and living in rural areas. Psychological well-being was lowered among people with a general tendency toward neuroticism, among those with an Epimethean (Sensing-Judging: SJ) psychological temperament, among Anglo-Catholics, among those living in inner cities, among clergy, and among those living with children under 13. The mitigating effects of relevant support were evident for both clergy and lay people. A key finding was that it was those sources of support that were least often rated highly that may have had the strongest positive effects on well-being, particularly on those groups where well-being was lowest.

Commentary: Beyond Common or Uncommon Morality.

In "Medical Ethics: Common or Uncommon Morality,"1 Rosamond Rhodes defends a specialist view of medical ethics, specifically the ethics of physicians. Rhodes's account is specifically about the ethics of medical professionals, rooted in what these professionals do. It would seem to follow that other healthcare professions might be subject to ethical standards that differ from those applicable to physicians, rooted in what these other professions do, but I leave this point aside for purposes of this commentary. Rhodes's view includes both a negative and a positive thesis. The negative thesis is that precepts in medical ethics-understood as the ethics of physicians-cannot be derived from principles of common morality. The positive thesis is two-fold: that precepts in medical ethics must be derived from an account of the special nature of what physicians do, and that this account is to be understood through an overlapping consensus of rational and reasonable medical professionals. While I agree emphatically with, and have learned a great deal from, Rhodes's defense of the negative thesis, I disagree with both claims in Rhodes's positive thesis, for reasons I will now explain after a brief observation about the negative thesis.

The Effect of Emotional Intelligence on Work-Related Psychological Health Among Anglican Clergy in Wales.

This study explores the effect of emotional intelligence (assessed by the Schutte Emotional Intelligence Scale) on work-related psychological health (assessed by the two scales of the Francis Burnout Inventory) among 364 Anglican clergy serving in the Church in Wales (264 clergymen, 93 clergywomen, and 7 who did not disclose their sex). After controlling for personal factors (sex and age) and for personality dimensions (extraversion, neuroticism, and psychoticism), the data suggested that higher levels of emotional intelligence enhanced work-related psychological health both in terms of lowering negative affect (emotional exhaustion in ministry) and in terms of increasing positive affect (satisfaction in ministry). These findings suggest that there may be benefits in professional development programmes designed to develop emotional intelligence among clergy.

Pre-implantation genetic testing: decisional factors to accept or decline among in vitro fertilization patients.

PURPOSE: Embryo testing to improve pregnancy outcomes among individuals who are seeking assisted reproduction technologies is increasing. The purpose of this study was to assess decisional factors through in-depth interviews for why women would accept or decline preimplantation genetic testing for aneuploidy (PGT-A) with in vitro fertilization (IVF). METHODS: Semi-structured telephone interviews were conducted with 37 women who were offered PGT-A with IVF during the summer 2017. Interviews lasted on average 40 min and were audio-recorded, transcribed, and analyzed using a content analysis. RESULTS: Results identified a number of decisional factors related to values about conception, disability, and pregnancy termination, past pregnancy experiences, optimism toward technology, and cost. Other key issues that were identified include the use of expanded carrier screening prior to IVF, maternal age, and limited education about PGT-A due to the complexity about education for IVF alone. CONCLUSION: There is a need to develop decision support tools for the increasing choices of genetic testing options for patients seeking IVF. Including patients' values, past pregnancy experiences and attitudes toward science into the decision-making process may help promote a more informed decision.

A Clinician's Guide to Privacy and Communication in the ICU.

OBJECTIVE: To review the legal issues concerning family members' access to information when patients are in the ICU. DATA SOURCES: U.S. Code, U.S. Code of Federal Regulations, and state legislative codes. DATA EXTRACTION: Relevant legal statutes and regulations were identified and reviewed by the two attorney authors (L. F., M. A. V.). STUDY SELECTION: Not applicable. DATA SYNTHESIS: Review by all coauthors. CONCLUSIONS: The Health Insurance Portability and Accountability Act and related laws should not be viewed as barriers to clinicians sharing information with ICU patients and their loved ones. Generally, under Health Insurance Portability and Accountability Act, personal representatives have the same authority to receive information that patients would otherwise have. Persons involved in the patient's care also may be given information relevant to the episode of care unless the patient objects. ICUs should develop policies for handling the issues we identify about such information sharing, including policies for responding to telephone inquiries and methods for giving patients the opportunity to object to sharing information with individuals involved in their care. ICU clinicians also should be knowledgeable of their state's laws about how to identify patients' personal representatives and the authority of those representatives. Finally, ICU clinicians should be aware of any special restrictions their state places on medical information. In aggregate, these strategies should help ICU managers and clinicians facilitate robust communication with patients and their loved ones.

Religion and Happiness: A Study Among University Students in Turkey.

This study tests the hypothesis that higher levels of positive religious affect are associated with higher levels of personal happiness among a sample of 348 students studying at a state university in Turkey who completed the Ok Religious Attitude Scale (Islam), the Oxford Happiness Inventory, and the short-form Eysenck Personality Questionnaire Revised. The data reported a small but statistically significant association between religiosity and happiness after taking sex and individual differences in personality into account.