Altruistic Discourse in the Informed Consent Process for Childhood Cancer Clinical Trials

Scholars have debated the role that altruistic considerations play—and should play—in recruitment and decision-making processes for clinical trials. Little empirical data are available to support their various perspectives. We analyzed 140 audiotaped pediatric informed consent sessions, of which 95 (68%) included at least one discussion of how participation in a cancer clinical trial might benefit: 1) the pursuit of scientific knowledge generally; 2) other children with cancer specifically; and 3) “the future” and other vaguely defined recipients. Clinicians initiated most (80%) of these discussions of altruism. The enrollment rate of children in the clinical trial was high (83%) overall, but not higher among children whose parents were involved in an altruism-oriented discussion. These findings suggest that: (1) clinicians invoke a spectrum of altruistic considerations rather than a single monothematic notion of altruism, and (2) the effect of altruistic considerations on subsequent enrollment decisions is marginal. While further research on this topic is warranted, bioethical debate should strive to reflect the diversity of altruistic discourse in clinical research encounters and to place this discourse in the context of other, including nonaltruistic, considerations.     

Normal and pathological altruism.

The psychoanalytic literature on altruism is sparse, although much has been written on this topic from a sociobiological perspective. Freud (1917) first described the concept in "Libido Theory and Narcissism." In 1946 Anna Freud coined the term "altruistic surrender" to describe the psychodynamics of altruistic behavior in a group of inhibited individuals who were neurotically driven to do good for others. The usefulness and clinical applicability of this formulation, in conjunction with the frequent coexistence of masochism and altruism, encouraged psychoanalysts to regard all forms of altruism as having masochistic underpinnings. Since then, there has been a conflation of the two concepts in much of the analytic literature. This paper reexamines the psychoanalytic understanding of altruism and proposes an expansion of the concept to include a normal form. Five types of altruism are described: protoaltruism, generative altruism, conflicted altruism, pseudoaltruism, and psychotic altruism. Protoaltruism has biological roots and can be observed in animals. In humans, protoaltruism includes maternal and paternal nurturing and protectiveness. Generative altruism is the nonconflictual pleasure in fostering the success and/or welfare of another. Conflicted altruism is generative altruism that is drawn into conflict, but in which the pleasure and satisfaction of another (a proxy) is actually enjoyed. Pseudoaltruism originates in conflict and serves as a defensive cloak for underlying sadomasochism. Psychotic altruism is defined as the sometimes bizarre forms of caretaking behavior and associated self-denial seen in psychotic individuals, and often based on delusion. We consider Anna Freud's altruistic surrender to combine features of both conflict-laden altruism and pseudoaltruism. Two clinical illustrations are discussed.     

Blood donation is an act of benevolence rather than altruism.

OBJECTIVES: Blood donation is described as an archetypal altruistic behavior, and recruitment/retention campaigns emphasize altruism. Here, a benevolence hypothesis for blood donation (both the donor and recipient benefit) rather than the altruism hypothesis (only the recipient gains) is proposed. DESIGN: Three United Kingdom-based studies contrasted benevolence and altruism: (a) a 6-month prospective study of blood donor behavior (Study 1: N = 957), (b) a cross-sectional study of blood donors' intentions (Study 2: N = 333), and (c) an experimental study examining the effect of benevolent and altruistic messages on willingness to help across high- and low-cost helping behaviors for committed and noncommitted blood donors (Study 3: N = 200). MAIN OUTCOME: Donor behavior and intentions-willingness. MEASURES: Beliefs in personal and societal benefit (Time 1) and actual donations (Time 2) were assessed in Study 1; beliefs in benevolence, altruism, hedonism, and kinship along with donation intentions were assessed in Study 2; and empathy, donor commitment, and willingness to donate blood, money, fund-raise, and staff a telephone helpline were assessed in Study 3. RESULTS: Beliefs in personal rather than societal benefit predicted actual future donation. A path model showed that only beliefs in benevolence were associated with intentions to donate. Committed blood donors were more willing to donate blood when exposed to a benevolent message rather than an altruistic one. This effect was not observed for other forms of helping. CONCLUSIONS: The benevolence hypothesis is supported, suggesting that blood donor motivation is partly selfish. Blood donation campaigns should focus on benevolent rather than purely altruistic messages.     

Altruism between romantic partners: Biological offspring as a genetic bridge between altruist and recipient

When the cost of altruism is low, individuals are more likely to help non-kin (i.e., friends and romantic partners) than kin. This trend is thought to reflect the fact that people tend to be emotionally closer with friends and romantic partners than kin. However, as the cost of altruism increases, altruistic preference shifts to kin. The present study highlights this phenomenon by examining altruism between siblings, romantic partners, romantic partners who have biological children together, and romantic partners who have adopted children together. Participants (n = 203) completed a questionnaire about altruism in low-, medium-, and high-cost situations. Participants gave more low-cost help to their romantic partners (regardless of whether they had a child together) than their siblings. More medium-cost help was given to romantic partners who had a child (biological and adopted) than siblings and romantic partners without children. In the high-cost condition, the estimated altruistic tendencies were stronger toward siblings and romantic partners who have a biological child than toward romantic partners with no children and partners with adopted children. Participants also believed they were more altruistic than their siblings and romantic partners.     

Emotional,Cognitive, Behavioral,and Temperament Characteristics of High-Empathy Children

Recent research has suggested that individual differences in young children's capacity for empathy and altruism has heritable components and may be related to early temperament. These individual differences, like other human capacities such as intelligence, may be distributed normally. Thus, high-empathy children may exhibit cognitive, emotional, and behavioral precocity in empathic and altruistic responding, and begin expressing these capacities early in life. Twenty-seven 2- to 8-year-old (M = 53 months), primarily Euro-American high-empathy children (10 male) were identified by childcare center staff. Ethnographically oriented interviews of their mothers provided detailed accounts of the children's empathic and altruistic responding in everyday interactions at home and school. As a group, the children were described as emotionally positive, especially sociable individuals whose empathic and altruistic responses were highly spontaneous, occurred more frequently, and differed from peers in depth, intensity, and persistence. Parallels were drawn between these capacities and temperamental dispositions for self-regulation and emotional reactivity. Limitations of the methodology and directions of future research are discussed.     

Beyond Pro-Social Behaviour: An Exploration of Altruism in Two Cultures

Altruism is primarily defined as behaviour aimed at benefiting others. Recent studies in evolutionary, social and positive psychology have highlighted that altruistic emotions and behaviours significantly contribute to wellbeing, happiness, health and longevity. However, few studies specifically focused on the concept of altruism, its experiential dimensions, cultural variants, meaning and related life domains. Hence, this study aims at exploring: a) how do people define altruism; b) perceived individual and social consequences of altruism; c) perceived difficulties in being altruistic; d) cultural influences on conceptions of altruism and related behaviours. The Altruism Questionnaire was specifically developed to address these issues. Qualitative data were collected among 119 adult participants (60 Indians and 59 Italians). Findings revealed that in both cultures altruism is perceived more than just as pro-social behaviour, emphasising it as human and social value along with its relational and psychological features. Improvement in relationships is reported as the most prominent benefit of being altruistic. Paradoxically, negative social evaluation such as criticism, isolation and misunderstanding is reported as the prominent difficulty. Influences of culture-specific factors were detected in the conceptualization and evaluation of altruism and altruistic behaviours, raising questions for assessment, intervention and further research.     

Digging deeper: A response to commentaries on The roots of human altruism

The current response discusses the insightful commentaries by Dale Hay (2009) and Karen Wynn (2009) on the proposal that human altruism has deep roots both in phylogeny and ontogeny ( Warneken & Tomasello, 2009 ). In particular, I focus on (a) what observational and experimental methods can reveal about altruistic motivations in children, (b) Wynn's idea that early altruism might confer a selective advantage to the infants themselves, and (c) how recent findings on young children's social ontology will enable us to test the hypothesis that ontogeny proceeds from rather global to more differentiated altruistic behaviours.     

WILLINGNESS TO PAY FOR PUBLIC GOODS:

Abstract— This article reports a test of the hypothesis that stated willingness to pay (WTP) for environmental quality follows a contribution model rather than the purchase model that is more congenial to economic thinking In particular, we examine the ability of the Schwartz norm-activation model of altruism to explain six different WTP assessments The Schwartz model explains stated WTP for environmental quality, except when payments are framed as taxes We suggest that models should presume that both altruistic and egoistic considerations may affect stated WTP and that framing may affect their relative contributions     

Nice guys finish first: the competitive altruism hypothesis

Three experimental studies examined the relationship between altruistic behavior and the emergence of status hierarchies within groups. In each study, group members were confronted with a social dilemma in which they could either benefit themselves or their group. Study 1 revealed that in a reputation environment when contributions were public, people were more altruistic. In both Studies 1 and 2, the most altruistic members gained the highest status in their group and were most frequently preferred as cooperative interaction partners. Study 3 showed that as the costs of altruism increase, the status rewards also increase. These results support the premise at the heart of competitive altruism: Individuals may behave altruistically for reputation reasons because selective benefits (associated with status) accrue to the generous.     

Altruistic behavior and cooperation: The role of intrinsic expectation when reputational information is incomplete

Altruistic behavior is known to be conditional on the level of altruism of others. However, people often have no information, or incomplete information, about the altruistic reputation of others, for example when the reputation was obtained in a different social or economic context. As a consequence, they have to estimate the other's altruistic intentions. Using an economic game, we showed that without reputational information people have intrinsic expectations about the altruistic behavior of others, which largely explained their own altruistic behavior. This implies that when no information is available, intrinsic expectations can be as powerful a driver of altruistic behavior as actual knowledge about other people's reputation. Two strategies appeared to co-exist in our study population: participants who expected others to be altruistic and acted even more altruistically themselves, while other participants had low expected altruism scores and acted even less altruistically than they expected others to do. We also found evidence that generosity in economic games translates into benefits for other social contexts: a reputation of financial generosity increased the attractiveness of partners in a social cooperative game. This result implies that in situations with incomplete information, the fitness effects of indirect reciprocity are cumulative across different social contexts.     

The development of future-oriented prudence and altruism in preschoolers

This research tested the hypothesis that prudence and altruism, in situations involving future desires, follow a similar developmental course between the ages of 3 and 5 years. Using a modified delay of gratification paradigm, 3- to 5-year-olds were tested on their ability to forgo a current opportunity to obtain some stickers in order to gratify their own future desires—or the current or future desires of a research assistant. Results showed that in choices involving current desires, altruistic behavior was unrelated to age. However, prudence and altruism involving future situations were correlated with one another and with age. Children under 4 years of age demonstrated significantly less future-oriented prudence than the older children (F(1,49) = 15.75; p < .001) and significantly less altruism involving future situations (F(1,49) = 33.24; p < .001). The data for the 3-year-olds, but not for the older children, also showed age-partialled correlations between the two future-oriented choice situations. These results suggest that between 3 and 4 years, children acquire the ability to deal with future-oriented situations through the development of some common mechanism which affects both future-oriented prudence and altruism.     

利他仅仅利他吗?——进化视角的双路径模型

利他对受助者及社会有弥足珍贵的价值,能提高群体的功能性,增加危机中的生存概率从而保持种群延续;但利他会降低助人者自身的适应性,使其生存与繁殖的可能性较其他个体,尤其是自利者,处于不利地位。利他行为是如何得到进化的这一难题吸引了各领域学者的关注。本文回顾了具有代表性的多水平选择理论与竞争性利他理论,结合利他研究的最新实证证据,提出利他增加助人者适应性的双路径模型。内部路径指利他行为可以通过自激励的内在过程,促进助人者身心的正性互动,带来内部效用增益,从而在某些时刻提高其适应性。外部路径为利他传递展现助人者品质的信号,有助于提升其群体内地位并增加合作、择偶机会。进而,利他行为能够在个体与群体层面的进化选择中得到保存。未来研究可以从身心关系的角度继续探讨利他问题,促成利他的正性循环。     

Altruistic or selfish? Responses when safety is threatened depend on childhood socioeconomic status

Altruism is an effective method of coping with threats. This research explored the relationship between childhood socioeconomic status (SES) and altruism under different situations. The results of five studies provided reliable evidence that safety-threat conditions moderated the relationship between childhood SES and altruism. Individuals with higher childhood SES exhibited higher altruistic intentions (Studies 1 and 2) and behaviors (Study 3) when they were manipulated to imagine a safety threat scenario (Study 1), when viewing pictures of disasters (Study 2), and when they were manipulated to believe that their health was under threat (Study 3). However, their childhood SES had no significant impact on their altruistic intentions and behaviors in relatively safe environments (Studies 1–3). This effect was again tested in more realistic environmental conditions using a large-scale survey in Study 4. In Study 5, we explored the underlying mechanism behind the earlier findings (i.e., temporal discounting).     

the conceptual history of attention deficit hyperactivity disorder: idiocy,imbecility, encephalitis and the child deviant, 1877?1929

This article examines the medical discourse that formed the foundations of what mental health professionals today call Attention Deficit Hyperactivity Disorder (ADHD). The article examines literature from two medical discussions: 1) the discussion of "imbecility" and "idiocy" in the late 19th and early 20th centuries in Western Europe and in the United States; and 2) the diagnosis of encephalitis lethargica in children during the 1920s. The diagnosis of encephalitis lethargica was heavily influenced by the previous discussion of imbecility and occupied a seminal place in the history of medicalizing child behavior. It served as a specific disease category for kids who demonstrated unconventional behavior in a variety of social contexts. It will be argued that the discussion of encephalitis lethargica began a research modality in psychiatry which sought to find neurological bases for childhood deviance, typified by the contemporary discussion of ADHD.     

现实利他行为与网络利他行为对大学生主观幸福感的影响：多重中介模型

为探讨现实利他行为与网络利他行为对主观幸福感的影响,并着力考察现实社会支持、网络社会支持与自尊在其中所起的作用,以1064名在读大学生为被试进行问卷调查,研究结果显示：（1）现实利他行为与网络利他行为均能在一定程度上预测主观幸福感。（2）现实、网络社会支持在现实、网络利他行为对主观幸福感的影响中起中介作用。（3）现实社会支持和自尊、网络社会支持和自尊在现实、网络利他行为对主观幸福感的影响中起多重中介作用。     

内隐和外显测量对利他行为的预测:来自IAT和BIAT的证据

利他行为是指人们自愿付出一定代价做出的有益于他人的行为。该研究以联结性-推理性评价模型为理论基础探讨内隐和外显测量对利他行为的预测效度,研究以193名大学生为被试,将4种内隐利他测量方法和1种外显利他测量方法相结合,以自发性水平不同的3种利他行为为结果变量。结果发现,IAT和BIAT的信度和效度较好,BIAT尤其值得采用。内隐利他自我概念测量能有效地预测真实情境中自发性较高的捐助行为,外显测量则预测了意识控制下自我报告的利他行为。结果表明,只有内隐利他自我概念测量能预测真实情境中快速发生的利他行为。其作用是外显利他测量和内隐利他态度测量所不能代替的。     

组织中利他行为的可持续性及其前因机制：基于主动性动机视角

随着社会经济的快速发展,对于组织及其成员来说,要想更好地在当前快速变化的工作环境中适应和发展,员工利他行为的可持续性愈发重要。新近研究发现利他行为具有动态性,但在理论框架和研究方法上存在严重不足,无法获得利他行为动态可持续性特征的全貌,对其前因机制的研究则更为缺失。因此,本研究基于主动性动机视角,聚焦利他行为可持续性的动态性特征,并在此基础上探索利他行为可持续性的前因机制,以期增进对利他行为本质的理解,并为可持续互利团队与组织建设实践提供参考。