All careproviders need more opportunities to share their ethical concerns with others

Attention to the ethical concerns of healthcare aides can provide important information about patients' needs to careproviders, improve the ethical environment of an institution, and benefit aides who suffer from bearing ethical concerns alone. All persons benefit from sharing their ethical concerns with others. Among other benefits, ethics consultation offers careproviders, caregivers, healthcare aides, patients, and patients' loved ones an opportunity to have their concerns heard. John Fletcher tried to follow every ethics consultation with a debriefing for all participants, including patients and family members, to increase the possibility for continued healing after the conclusion of the consultation, and there are good reasons to follow this practice.     

Helping New Acquaintances Make the Right Impression: Balancing Image Concerns of Others and Self

People strategically regulate information about the identities of friends to help those friends create desired impressions on audiences. Are people willing to help acquaintances manage their impressions, and if so, are such efforts moderated by the helper's own self-presentational concerns? Participants were 234 same-sex strangers who went through a structured self-disclosure procedure designed to induce psychological closeness. They later described this partner to an opposite-sex third party who supposedly preferred either extraverts or introverts as ideal dates, and who their partner regarded as attractive and wanted to impress or as unattractive and did not care to impress. As predicted, participants described their partners consistently with the preferences of the attractive other, but only when their own self-presentational concerns about accuracy were low. If the third party was unattractive, participants whose accuracy concerns were low tended to describe their partners opposite the preferences of the other, suggesting they were “not your type.” The results indicated that beneficial impression management occurs even among acquaintances, but is held in check by self-presentational concerns about accuracy.     

A Conceptual Overview of the Self‐Presentational Concerns and Response Tendencies of Focus Group Participants

Focus group respondents are often requested to perform tasks that require them to convey information about themselves. However, despite the potential for respondents to have self‐presentational concerns, research on focus group productivity has virtually ignored extant scholarship on impression management. This shortcoming is addressed by presenting a conceptual overview of the effects of self‐presentational concerns on focus group participation. A product of this overview is a conceptual model that posits that the amount and nature of information that people convey about themselves to others is a function of their eagerness to make desired impressions and their subjective probabilities of doing so. According to the model, when focus group participants are highly motivated to make desired impressions, they may be reluctant to present unbiased images of themselves. However, they are not likely to deceive unless they are confident in their abilities to ascertain and enact desired images. Those who are motivated to make desired impressions but are doubtful of doing so are likely to protect themselves by concealing self‐relevant information or avoiding self‐relevant issues. Implications of this model for research and practice are discussed.     

Cognition as the Cooperative Appropriation of Affordances

Michaels (2000) expressed concerns about the implications of the notion of 2 visual systems (Milner &; Goodale, 1995) for ecological psychology. This leads her to suggest a decoupling of perception and action, by which action is separate from perception. It is suggested that although Michaels noted, on the one hand, that Milner and Goodale's approach to perception is a constructivist one, she mistakenly adopts their view that separates vision for perception from vision for action. An alternative position is presented, based on a recent article (Norman, in press), in which the parallels between the 2 visual systems, dorsal and ventral, and the 2 theoretical approaches, ecological and constructivist, are elucidated. According to this dual-process approach to perception, both systems are perceptual systems. The ecological-dorsal system is the system that picks up information about the ambient environment allowing the organism to negotiate it. It is suggested that this type of perception always processes the relevant information for action and that there is no need to sever the perception-action coupling. Ecological psychology and the 2 visual systems are quite compatible, and there is no need for concern.     

Exploring how people respond to conflicts between self‐interest and fairness: Influence of threats to the self on affective reactions to advantageous inequity

Two studies examined how people deal with conflicts between their self‐interest concerns and their striving for fairness. Specifically, the affective reactions to outcome arrangements in which people receive better outcomes than comparable other persons, were studied. These arrangements of advantageous inequity constitute situations in which fairness and self‐interest concerns are in conflict. Building on the social psychology of the self, it was predicted, and found, in both field and lab experiments that when people experience a self‐threat, they react more positively to arrangements of advantageous inequity than when not experiencing this threat. This supports the view that people's need for positive information about their selves is an important factor in the underlying psychological processes of the way that people deal with conflicts between their fairness and self‐interest concerns.     

Open risk assessment

As criminal justice actors increasingly seek to rely on more evidence-informed practices, including risk assessment instruments, they often lack adequate information about the evidence that informed the development of the practice or the tool. Open science practices, including making scientific research and data accessible and public, have not typically been followed in the development of tools designed for law enforcement, judges, probation, and others. This is in contrast to other government agencies, which often open their processes to public notice and comment. Lack of transparency has become pressing in the area of risk assessment, as entire judicial systems have adopted some type of risk assessment scheme. While the types of information used in a risk tool may be made public, often the underlying methods, validation data, and studies are not – nor are the assumptions behind how a level of risk gets categorized as “high” or “low.” We discuss why those concerns are relevant and important to the new risk assessment tool now being used in federal prisons, as part of the First Step Act. We conclude that a number of key assumptions and policy choices made in the design of that tool are not verifiable or are inadequately supported, including the choice of risk thresholds and the validation data itself. Unfortunately, as a result, the federal risk assessment effort has not been the hoped-for model for open risk assessment.     

Training needs among nonmental health professionals working with service members: A qualitative investigation

Though many service members will not directly seek mental health care due to stigma and other factors, they may interact with the healthcare system in other ways including contact with first responders, nurses, and allied health care professionals. However, little attention has been spent in this regard on the educational needs of these professionals whose contact with service members and Veterans may provide the opportunity to assist Veterans in need with overcoming barriers to accessing mental health care. This qualitative study investigates the educational training needs of first responders and health care professionals in contact with military families and trauma survivors to determine whether, and what type, of additional training is needed. A sample of 42 first responders and health care professionals including emergency medical technicians, police officers, fire fighters, speech language pathologists, occupational therapists, physical therapists, and nurses were recruited to participate in 1 of 6 focus groups. Sessions were audiotaped and transcribed verbatim. Data analysis was guided by a thematic analysis approach. Thematic analyses suggest there is a significant knowledge gap with unmet educational needs of these professionals such as information on the invisible wounds of war, military culture, and screening and referring patients who present symptoms falling outside professionals’ scope of practice. Findings point to a need and desire for more robust education for first responders and health care providers around mental health concerns of military populations, including topics such as trauma, military culture, and screening tools. Efforts to develop curricula addressing these concerns are warranted.     

Factors Influencing Uptake of Genetic Testing For Colorectal Cancer Risk in an Australian Jewish Population

There is a significant excess of colorectal cancer in the Australian Ashkenazi Jewish community. This excess can partially be attributed to inherited factors that are over represented in this population, such as the APC variant I1307K, which is associated with a modest increase in colorectal cancer risk. There is currently only sporadic clinical genetic testing offered for this variant, as neither the exact increase in cancer risk and therefore the appropriate screening strategies for I1307K carriers, nor the acceptability of such testing in Jewish communities have been determined. This study reports a high acceptability of such genetic testing within a community sample of 300 Australian Jewish individuals—94% of participants would have a test for predisposition to colorectal cancer and a majority would make this decision based on the desire for information for their families and to decrease their own cancer risk. Some concerns were noted about genetic testing for cancer predisposition, including insurance discrimination, test accuracy and confidentiality.     

Informing Children of Their Newborn Screening Carrier Result for Sickle Cell or Cystic Fibrosis: Qualitative Study of Parents’ Intentions,Views and Support Needs

Newborn screening for cystic fibrosis and sickle cell disease enables the early identification and treatment of affected children, prolonging and enhancing their quality of life. Screening, however, also identifies carriers. There are minimal or no health concerns for carriers. There are, however, potential implications when carriers reach reproductive age, and thus research attention has been given to how best to convey information about these implications in a meaningful, balanced way which does not raise undue anxieties. Most research focuses on the communication from health professional to parent, yet ultimately this information is of greatest significance to the child. This study examines parents’ intentions to inform their child of newborn screening carrier results. Semi-structured interviews with 67 family members explored their intentions to inform the child, and related views and support needs. Parents almost unanimously indicated they planned to inform the child themselves. Health professionals were expected, however, to provide guidance on this process either to parents through advice and provision of written materials, or directly to the child. Although parents initially stated that they would convey the result once their child had developed the ability to understand the information, many appeared to focus on discrete life events linked to informed reproductive decision making. The results highlight ways in which health care providers may assist parents, including providing written material suitable for intergenerational communication and ensuring that cascade screening is accessible for those seeking it. Priorities for further research are identified in light of the results.     

Designing for Trust: A Case of Value-Sensitive Design

In this paper, we consider the meaning, roles, and uses of trust in the economic and public domain, focusing on the task of designing systems for trust in information technology. We analyze this task by means of a survey of what trust means in the economic and public domain, using the model proposed by Lewicki and Bunker, and using the emerging paradigm of value-sensitive design. We explore the difficulties developers face when designing information technology for trust and show how our analysis in conjunction with existing engineering design methods provides means to address these difficulties. Our main case concerns a concrete problem in the economic domain, namely the transfer of control from customs agencies to companies. Control of individual items is increasingly untenable and is replaced by control on the level of companies aimed at determining whether companies can be trusted to be in control of their business and to be in compliance with applicable regulations. This transfer sets the task for companies to establish this trust by means of information technology systems. We argue that this trust can be achieved by taking into account philosophical analyses of trust and by including both parties in the trust relationship as clients for whom the information technology systems are to be designed.     

Microcomputer Softwarefor Independent Social Work Practice

Social workers engaged in independent practice who are interested in automating their routine office tasks and more specialized management information activities face a number of important issues in, the selection of hardware and software. In the previous issue of the Journal' of Independent Social Work was a discussion of computer hardware for such purposes. Explored in this article are software programs for word processing, data base management, spreadsheets, statistical, integrated, ut~lity and accounting programs. In addition the author addresses special concerns in the selection of software including applications programs versus special purpose and public domain software, user "friendliness," program complexity, and cost.     

Ethical Concerns About Human Genetic Enhancement in the Malay Science Fiction Novels

Advancements in science and technology have not only brought hope to humankind to produce disease-free offspring, but also offer possibilities to genetically enhance the next generation’s traits and capacities. Human genetic enhancement, however, raises complex ethical questions, such as to what extent should it be allowed? It has been a great challenge for humankind to develop robust ethical guidelines for human genetic enhancement that address both public concerns and needs. We believe that research about public concerns is necessary prior to developing such guidelines, yet the issues have not been thoroughly investigated in many countries, including Malaysia. Since the novel often functions as a medium for the public to express their concerns, this paper explores ethical concerns about human genetic enhancement expressed in four Malay science fiction novels namely Klon, Leksikon Ledang, Transgenesis Bisikan Rimba and Transgenik Sifar. Religion has a strong influence on the worldview of the Malays therefore some concerns such as playing God are obviously religious. Association of the negative image of scientists as well as the private research companies with the research on human genetic enhancement reflects the authors’ concerns about the main motivations for conducting such research and the extent to which such research will benefit society.     

Issues Arising in Psychological Consultations to Help Parents Talk to Minor and Young Adult Children about their Cancer Genetic Test Result: a Guide to Providers

The defining difference between genetic and traditional medicine is that genetic findings have implications not just for the patient, but also for their relatives. Discussion of a test result between parent and child is both a transformative and a translational moment in the life of a family. Parents report wanting help in talking to their children. The challenge for genetic counselors and other providers is to be able to recognize which issues are at the core of parental distress and be able to offer recommendations to empower and support parents. The complexity of potential genetic findings, including variants of uncertain significance (VUS) and incidental findings have vastly increased, requiring considerable explanation and leaving less time for discussion of emotional issues. While the nature of the testing (single gene to multigene panel and genomic testing) is dramatically changing, the nature of parent concerns remains remarkably constant. Families differ in many respects, so no “recipe” suffices to answer parents’ questions about how this important task should be approached in each family. Successful consultation to parents requires true counseling, matching parents’ fears and questions with information, exploration and advice specific to their concerns, their circumstances and strengths.     

Reporting ethical practices in journal articles

Little attention has focused on the reporting of ethical research practices in journal articles. In Study 1, published articles in 2 psychopathology journals were reviewed to ascertain the types of ethical research information that were reported. In Study 2, a survey was sent to authors in Study 1 to determine which ethical practices they engaged in, if they reported this information, and reasons for not including this information in their article. In general, there is a great variability regarding the types of ethical research practices reported in journal articles. Commonly cited reasons for not including ethical research practice information in the articles included the need for brevity, belief that it was common practice, and lack of relevance for the project. These results suggest that there is no standard practice for reporting research practices in journal articles and great variability in the implementation of procedures that are generally considered standard.     

Psychological applications on the internet: A discipline on the threshold of a new millennium

The rapid developments in computers and information technology over the past decade has had an impact on psychology, which has moved in this context from local computer applications to network applications that take advantage of the Internet. This article critically reviews various psychological applications in use on the Internet, with special emphasis given to their promises and advantages as well as to their shortcomings and problems. Specifically, 10 types of psychological Internet applications are reviewed: information resources on psychological concepts and issues; self-help guides; psychological testing and assessment; help in deciding to undergo therapy; information about specific psychological services; single-session psychological advice through e-mail or c-bulletin boards; ongoing personal counseling and therapy through e-mail; real-time counseling through chat, web telephony, and videoconferencing; synchronous and asynchronous support groups, discussion groups, and group counseling; and psychological and social research. Following a discussion of ethical and related concerns, a call is voiced for intensive research and international brainstorming.     

Developing an informational tool for ethical engagement in medical tourism

Background

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.

Methods

The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.

Results

The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service.

     

Promoting social responsibility amongst health care users: medical tourists’ perspectives on an information sheet regarding ethical concerns in medical tourism

Background

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism.

Results

According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision.

Conclusions

The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry.

     

Counseling and screening for cystic fibrosis in patients with congenital bilateral absence of the vas deferens: Patient perceptions

Congenital bilateral absence of the vas deferens (CBAVD) occurs in approximately 1.3% of infertile males and is thought to be, in most cases, a primarily genital form of cystic fibrosis (CF). Fourteen males with CBAVD considering microsurgical sperm aspiration from the epididymis (MESA) and in vitro fertilization were seen for genetic counseling and screening for CF. To retrospectively evaluate these patients' perceptions of the counseling and screening information, we conducted structured telephone interviews to assess their recall of information about CF and its impact on their health concerns and reproductive plans. We found that, as the health implications of CF are abstract and not as important to patients as the diagnosis of CBAVD itself, patients tend to view their CF status primarily in terms of their reproductive potential. Retrospective analysis afforded us an opportunity to identify the psychosocial issues of most concern to this unique patient population.     

Exploring the impact of social judgeability concerns on the interplay of associative and deliberative attitude processes

Some recent research applying dual-systems logic suggests that different attitude measures reflect independent modes of evaluation with explicit measures primarily affected by deliberative processes and implicit measures primarily affected by automatic processes. In the current work we hypothesized that explicit attitude measures often do not reflect the outcome of automatic or associative processing because social judgeability concerns prevent people from reporting consciously inexplicable “gut feelings” towards the attitude object. To explore this possibility, we simultaneously presented participants with associative and deliberative information about a target person and manipulated their sensitivity to social judgeability concerns with different sets of task instructions. Although an explicit attitude measure was unaffected by subliminally presented associative information following a standard instruction set, this content did impact explicit judgments when social judgeability concerns were assuaged with a “go with your gut” instruction set.