The many faces of hedonic adaptation

Limitation of life sustaining therapy in disorders of consciousness: ethics and practice

Clinical conversations surrounding the continuation or limitation of life-sustaining therapies (LLST) are both challenging and tragically necessary for patients with disorders of consciousness (DoC) following severe brain injury. Divergent cultural, philosophical and religious perspectives contribute to vast heterogeneity in clinical approaches to LLST-as reflected in regional differences and inter-clinician variability. Here we provide an ethical analysis of factors that inform LLST decisions among patients with DoC. We begin by introducing the clinical and ethical challenge and clarifying the distinction between withdrawing and withholding life-sustaining therapy. We then describe relevant factors that influence LLST decision-making including diagnostic and prognostic uncertainty, perception of pain, defining a 'good' outcome, and the role of clinicians. In concluding sections, we explore global variation in LLST practices as they pertain to patients with DoC and examine the impact of cultural and religious perspectives on approaches to LLST. Understanding and respecting the cultural and religious perspectives of patients and surrogates is essential to protecting patient autonomy and advancing goal-concordant care during critical moments of medical decision-making involving patients with DoC.

Navigating Love in a Post-Pandemic World: Understanding Young Adults' Views on Short- and Long-Term Romantic Relationships

The uncertain future due to the COVID-19 pandemic and the technological advancements may have altered young adults' experiences of romantic relationships. It is unclear whether individuals will continue to prefer traditional long-term romantic relationships (LTRR) or opt for short-term ones (STRR). This research describes how young adults in Malaysia perceive LTRR and STRR. Using the structured approach of the theory of social representations, data were collected from 512 participants; 238 (46.48%) male; Mage 21.75; majority were heterosexual and students, and analyzed using prototypical analysis to reveal high consensus elements. Five observations were made: (1) females prioritize "love" in both STRR and LTRR, while males prioritize "love" only in LTRR; (2) females prioritize "marriage" in LTRR, while males prioritize "trust," "comfort," and "stability." Males do not consider "marriage" as part of a LTRR; (3) both males and females view STRR positively, while LTRR are viewed more practically; (4) "sex" is a core element in STRR but is absent in LTRR; (5) males differentiate between STRR and LTRR with no overlapping elements. These findings provide insight into the social representations of romantic relationships among young adults in Malaysia and suggest future directions for research in the field.

Ethical Considerations in Neuroprognostication Following Acute Brain Injury

Neuroprognostication following acute brain injury (ABI) is a complex process that involves integrating vast amounts of information to predict a patient's likely trajectory of neurologic recovery. In this setting, critically evaluating salient ethical questions is imperative, and the implications often inform high-stakes conversations about the continuation, limitation, or withdrawal of life-sustaining therapy. While neuroprognostication is central to these clinical "life-or-death" decisions, the ethical underpinnings of neuroprognostication itself have been underexplored for patients with ABI. In this article, we discuss the ethical challenges of individualized neuroprognostication including parsing and communicating its inherent uncertainty to surrogate decision-makers. We also explore the population-based ethical considerations that arise in the context of heterogenous prognostication practices. Finally, we examine the emergence of artificial intelligence-aided neuroprognostication, proposing an ethical framework relevant to both modern and longstanding prognostic tools.

Filial Piety, Generativity and Older Adults' Wellbeing and Loneliness in Denmark and China

The article considers the potential of intergenerational encounters and family and social ties for alleviating loneliness and promoting older adults' wellbeing. Loneliness has been widely recognized as one of the factors that are most deeply and pervasively detrimental to older adults' wellbeing. We combine theoretical reflections with a comparative study of older adults in Denmark and China. Both countries have to deal with an aging population and growing number of cases of isolation and loneliness in an increasingly individualized society. They differ, however, with regard to how far they have developed a system of institutionalized care, as well as with regard to their culture-specific views of family life and parent-child relationships. We apply the notions of filial piety, known from Confucian philosophy but often misinterpreted as conservative and conformist, and generativity, to qualitative studies of older adults in Denmark and China. The great potential of intergenerational ties is confirmed. Our study also shows that filial piety is still highly valued, in both China and Denmark, and can be maintained even in a highly individualized society. There is, however, considerable uncertainty among both older adults and their younger relatives as to what is required and what can be expected; realism, and an emphasis on the quality, rather than the quantity of interaction, may be sensible coping strategies, but can also lead to unnecessary acquiescence and self-abnegation. Our study also serves to distinguish different aspects and effects on wellbeing of intergenerational relationships.