医疗决策的程序公正

由于社会满足不了所有的医疗需求,医疗决策问题变成了确定医疗的限度问题。由于社会对于限度决定很难获得共识,医疗决策要通过公正的程序获得。医疗决策不能由某个人或某个团体或权力机构做出,而应该通过民主协商来做出,否则,人们会质疑医疗决策的合法性。     

Post-decision consolidation in large group decision-making

Decision-makers tend to change the psychological attractiveness of decision alternatives in favor of their own preferred alternative after the decision is made. In two experiments, the present research examined whether such decision consolidation occurs also among individual group members in a large group decision-making situation. High-school students were presented with a decision scenario on an important issue in their school. The final decision was made by in-group authority, out-group authority or by majority after a ballot voting. Results showed that individual members of large groups changed the attractiveness of their preferred alternative from a pre- to a post-decision phase, that these consolidation effects increased when decisions were made by in-group members, and when participants identified strongly with their school. Implications of the findings for understanding of group behavior and subgroup relations are discussed.     

The variability of the delinquent self: Anti-authority attitudes and endorsement of neutralization techniques among incarcerated delinquents in Singapore

This study presents research findings showing that the delinquent social identity is not a fixed entity but varies according to situational factors. Participants were incarcerated Singapore delinquents of both genders, who responded to a vignette of a rule-breaking situation when either their family or their gang social identities are made salient. Another manipulation involves confrontation by authority either in public or in private. Results demonstrate that delinquents' attitude toward authority and their endorsement of the techniques of neutralization vary depending on the salience of their identities and confrontation by authority. This lends support to self-categorization theory's concept of the variable self.     

What is the moral basis of the authority of family members to act as surrogates for incompetent patients?

...The authority of family members should be understood as presumptive; that is, there is a moral presumption that a close family member should serve as surrogate for an incompetent patient. That presumption can be overcome or rebutted in a particular case, either when there is sufficient evidence that the usual reasons supporting this presumption do not hold or when the surrogate's decision exceeds appropriate limits of surrogates' decision-making discretion. In order to clarify these hard cases and appropriate public policy, we need a much deeper and more complex analysis than either the conventional view, or the alternative account that Pearlman and colleagues provide. I have sought here only to point toward some of the other grounds that a full account of family members' authority as surrogates would have to develop and explore in much more detail....     

Exploring Conflict Culture in the Family: Consistency and Continuity of Conflict During Family Meal Discourse

Conflict discourse in the context of everyday activities of families during mealtimes was examined with a view to determining consistency and continuity on two occasions one year apart. In particular, the use of authority, the part played by each member of the family, and the ways in which conflicts were terminated was addressed. Data derived from Jewish families was considered not only to enable comparisons to be made with data derived from the broader community, but to illuminate the issues pertinent to the exploration of conflict within the family. It was observed over a period of time that there was a continuity of conflict culture within each family. Additionally it was found that generally, family conflict interactions terminated in standoffs rather than resorting to full blown conflicts and the outcome was, on the whole, favourable to all parties, with conversations continuing to be pursued without further conflict. In some instances termination of the episode was through an external agent, rather than a family member. The key part that family members play in deflecting conflict, especially the part played by mothers and siblings was noted. The extension of existing conflict coding schema to account for different types of authority moves, so as to discriminate between authority based on status and that which invokes an idea of shared responsibility or a common code of conduct is recommended. A further extension of the coding schema to account for paralinguistic aspects of communication is suggested.     

DISCOVERING PALLADINO'S MEDIUMSHIP. OTERO ACEVEDO,LOMBROSO AND THE QUEST FOR AUTHORITY.

In 1888, the spiritist Ercole Chiaia challenged Cesare Lombroso to go to Naples and study a brilliant though still unknown medium: Eusapia Palladino. At that time Lombroso turned down the challenge. However, in 1891 he became fascinated by the medium's phenomena. Despite the abundant literature on Palladino, there is still an episode that needs to be explored: in 1888, the Spanish doctor Manuel Otero Acevedo accepted the challenge rejected by Lombroso, spent three months in Naples studying the medium and invited the Italian psychiatrist to join his investigations. This unexplored episode serves to examine the role of scientific authority, testimony, and material evidence in the legitimization of mediumistic phenomena. The use Otero Acevedo made of the evidence he obtained in Naples reveals his desire to proclaim himself an authority on psychical research before other experts, such as Lombroso, Richet, and Aksakof.     

Family and school violence: the mediator role of self-esteem and attitudes towards institutional authority

This study analyses the influence of family communication and parental valuation of school on adolescent violent behaviour at school. By means of a structural equation model, both its direct and indirect influence through school and family self-esteem of the adolescent and his attitude towards school authority are analysed. The sample is composed of 665 adolescents whose ages range from 12 to 16 years old. The results confirm the existence of an indirect relationship but not direct influence of the family on school violence. The attitude of the adolescent towards school authority is the mediator variable which shows the strongest direct effect on school violence. Also, the two dimensions of self-esteem considered are significant intermediate variables. These results and their implications are analysed.     

The reinforcement of disagreement in a small group

The present studies were conducted to determine whether differentially reinforcing decisions of a three-person group can modify how often individuals will disagree in making a decision. The results indicate that disagreement is likely to occur more often in groups where reinforcement in achieving a decision is made contingent on disagreement as compared with groups where reinforcement is not contingent on this interaction. Some methodological, theoretical and practical implications of the findings are discussed.     

Art therapy in transcultural family therapy

The increased existence of foreign culture patterns in the child population calls for transcultural comprehension in child psychiatry. This case report describes transcultural aspects in the therapy of an 11 year-old Moslem girl admitted to a child psychiatric department. Her symptoms were abdominal pain, headache, anxiety, and pretended fever. A family therapeutic approach was used together with elements of art therapy and individual therapy in a successful treatment. The family therapeutic approach was based on art therapy as a part of the communication where cultural symbols were an important part. An interpreter was not used. The cultural context where it is acceptable to overstep the borderline between reality and fantasy is seen as an important healing capacity.I would like to acknowledge my debt and my appreciation to Ebba Ernst, psychologist of the department and supervisor in the therapy of the S. family. I would also like to thank professor Kai Tolstrup and child psychiatrist Torben Marner for stimulating support in the process of writing the article. A grant from Enkefrue Hermansens Mindelegat made the participation in the Krakow Congress possible.     

Marginally Represented Patients and the Moral Authority of Surrogates

Abstract

Incapacitated adult patients are commonly divided into two groups for purposes of decision making; those with a surrogate and those without. Respectively, these groups are often referred to as represented and unrepresented, and the relative ethics of decision making between them raises two particular issues. The first issue involves the differential application of the best interests standard between groups. Second is the prevailing notion that representedness and unrepresentedness are categorical phenomena, though it is more aptly understood as a multidimensional and continuous variable based on relational moral authority. This paper examines the nature of representedness as it relates to ethical norms of surrogate decision making.     

Tell Me What I Wanted to Hear: Confirmation Effect in Lay Evaluations of Financial Expert Authority

In real life, people engage in interactive decision processes by consulting with experts. However, before taking advice, they must recognise the authority of an expert to assess the quality of the advice. The main goal of this research was to investigate how the confirmation effect affects lay evaluations of the epistemic authority of financial experts. Experiment 1 showed that lay people tend to ascribe greater epistemic authority to those experts whose advice confirms people's opinions, both measured and manipulated. Experiment 2 revealed that when participants' own opinions are not salient, people tend to evaluate experts' authority as higher when their advice confirms social norms. In Experiment 3 we jointly investigated the effects of participants' own opinions and social norms on the evaluations of authority. When both sources of expertise were made salient, decision‐makers favoured advice confirming their own beliefs and used it to evaluate experts' authority. Three interpretations of the role confirmation plays in the experts' authority evaluations are proposed: (1) self‐defensive strategies; (2) processing fluency; and (3) psychological consequences of naïve realism. The paper discusses practical implications of the results. We propose that increasing consumers' knowledge about biases might protect their evaluations of financial advice from being susceptible to the confirmation effect.     

The psychobiographer's authority: questions of interpretive scope and logic

Two charges are often raised against psychobiographers' authority (as well as popularized analytic case formulations): reductionism and causal overreach. The first pertains to interpretations that rely exclusively on analytic concepts but ignore the essential contributions made by neighboring disciplines, such as history, to the elucidation of lives lived elsewhere or in the past. The second charge is sometimes stimulated by exaggerated interpretive claims, but often reflects the critic's misunderstanding of the logical structure of genetic explanations. Three case studies illustrate reductionism as well as safeguards against it. They also support a critical discussion of the alleged logical defect.     

Realpolitik versus fair process: moderating effects of group identification on acceptance of political decisions

Three studies examined the effects of perceived procedural justice and the favorability of a group-level outcome on the endorsement of a group-level decision and the evaluation of the authority responsible for the decision. Results showed that, contrary to findings usually seen with individual-level decisions, collective outcome favorability was more important than procedural justice in influencing the endorsement of the decision. Furthermore, increased identification with the group reduced the importance of procedural justice but accentuated the importance of collective outcome favorability. With regard to the evaluation of the authority, the results were similar to those obtained in individual-level decisions: Procedural fairness mattered more than collective outcome favorability.     

Does it fit? The relationships between personality,decision autonomy fit,work engagement,and emotional exhaustion in self-managing organizations

The novel organizational form of self-managing organizations decentralizes decision authority, thus promising higher adaptability and sustainability. However, recent practical experiences showed that such organizations struggle with employee turnover and lack of engagement, and thus, levers to improve personnel selection are required. This work investigated the relationship between person-environment fit regarding perceived and ideal decision autonomy and the employee outcomes of work engagement and emotional exhaustion in self-managing organizations. Furthermore, the associations with personality traits were examined. The study relied on cross-sectional survey data from two subsamples of employees working in self-managing and traditional organizations. Group comparison was used to test the elevated level of decision autonomy in self-managing organizations, polynomial regression with response surface analysis was used to investigate the effect of (mis-)fit, and multiple regression analyses evaluated the relationship with personality traits. The findings showed that employees in self-managing organizations experienced higher decision autonomy than those in traditional organizations. Additionally, the fit between ideal and perceived decision autonomy predicted higher work engagement, while extraversion, openness to experience, and low neuroticism predicted higher ideal decision autonomy. As a result, individual person-environment fit regarding decision autonomy and personality requires attention in self-managing organizations to engage employees. The findings imply that the effect of decision autonomy on engagement is not positive per se but depends on the intraindividual characteristics, which must be of concern when decentralizing decision authority organization-wide. Therefore, personnel selection and recruitment processes in self-managing organizations should consider ideal decision autonomy and personality traits as assessment criteria.