Mentoring: Some ethical considerations

To counter confusion about the term ‘mentor’, and address concerns about the scarcity of mentoring, I argue for an “honorific” definition, according to which a mentor is virtuous like a saint or hero. Given the unbounded commitment of mentors, mentoring relationships must be voluntary. In contrast, the role of advisor can be specified, mandated, and monitored. I argue that departments and research groups have a moral responsibility to devise a system of roles and structures to meet graduate students’ and postdoctoral fellows’ needs for information and advice. An earlier version of this paper was presented at a conference sponsored by the National Science Foundation on Mentoring and Research Values: Students as Vital Human Resources, Chicago, March 1995.     

Family therapy beyond postmodernism: some considerations on the ethical orientation of contemporary practice

Ethics is a subject that is self-evidently important for systemic therapy, as for therapy generally, yet arguably it is one that has not received nearly as much attention in the literature as it warrants. This paper looks at the historical context for the marginalization of ethical discourse and suggests that the contemporary influence of postmodernist and hermeneutic thinking reinforces this tendency. Flaskas' (2002) recent argument for the reclamation of an idea of truth and reality as a social and emotional process is considered, and it is suggested that this needs supplementing with a perspective on truth and reality as an ethical process. Consideration is given to the enduring influence within postmodernist approaches of the modernist Kantian conception of ethics as centred in individual consciousness. I argue that important elements of contemporary systemic practice (for example, the reflecting team approach) are also pointing towards a different formulation of ethics that is focused more specifically on processes of communication. In elaborating this theme the paper draws on the work of the German social theorist Jürgen Habermas who writes on the ethics of communication.     

Collaborative healthcare research: Some ethical considerations

This article reviews some of the ethical aspects of collaborative research. Scientific collaboration has known potential benefits but it’s a challenging task to successfully accomplish a collaborative venture on ethically sound grounds. Current trends in international healthcare research collaboration reflect limited benefits for the majority of world population. Research collaboration between scientists of academia and industry usually has financial considerations. Successful cross-cultural and international collaborations have to overcome many regional and global barriers. Despite these difficulties, many scientific collaborations usually begin with an informal meeting or contact. With advancement in global communications, scientists have greater responsibility towards the world community while considering the impact of their collaborative partnerships. I review the basic factors that are required for forging a collaborative partnership and responsible attitudes to sustain the relationship. Finally I conclude that scientists in healthcare research can play important roles beyond collaborations and contribute to bringing harmony, resolving differences across the nations and countries in today’s troubled world.     

The obesity epidemic: medical and ethical considerations

Obesity is increasingly becoming a problem for Western societies, to the extent that politicians, scientists, patient organisations and the media now refer to it as 'the obesity epidemic'. Concerns about the damaging effect of increasing body weight on public health has led to a strong growth in the amount of scientific work on the condition, with the medical professions leading the way. This article discusses that, first of all, scientific evidence for obesity-associated mortality is at best ambiguous, and proposes that at least some of contemporary medical preoccupation with obesity has a moral origin in that it seeks to correct unwanted or immoral behaviour. It then continues to reflect on the effect of the conceptual transformation of healthy children into patients, and concludes with some reflections on the ethical implications of the obesity disease for the wellbeing of children.     

Sex offenders and actuarial risk assessments: ethical considerations

When assessing the recidivism risk of previously convicted sex offenders, the relevant ethical standards and practice guidelines obligate psychologists to acknowledge numerous limits related to their data and conclusions. For the actuarial instruments used in these assessments, the highest rates of classification accuracy are associated with greater specificity compared with sensitivity. Selecting cut-off scores to maximize sensitivity results in an inordinate frequency of false positive classifications. Attempts at maximizing specificity create an undesirable frequency of false negative classifications.Unfortunately, adjusted actuarial assessment cannot remedy these problems created by the sensitivity-specificity tradeoff. As an unstandardized procedure, the accuracy of adjusted actuarial assessment is severely limited. Consequently, civil proceedings for previously convicted sexual offenders rely on assessments of very limited accuracy. Undertaking these assessments, therefore, may be inconsistent with relevant ethical standards and practice guidelines.     

Sedation before ventilator withdrawal: medical and ethical considerations

...While clinical practice is clearly moving toward more compassionate use of sedatives and analgesics in the care of the dying, the legal system has been lagging behind most ethical opinions in this area. The criminal investigation into the administration of morphine to a patient before ventilator withdrawal in Minnesota was a grim reminder of the hazards sometimes involved in the practice of good medicine. We know of several instances where a nurse was willing to administer sedatives and analgesics at the request of a physician, but without documentation in the medical record, for fear of possible legal repercussions. The fact that the caregivers involved are willing to risk the potentially disastrous consequences of falsifying a medical record can be taken as evidence of their commitment to doing what they perceive to be morally required. Nevertheless, this practice should clearly be condemned, since it gives the impression that caregivers are engaged in an unlawful or unethical practice. Only through continued forthright discussion in the medical literature can we arrive at ethically defensible approaches to administering sedation and analgesia that assure the most compassionate care of the dying patient.     

Future directions in genetic counseling: practical and ethical considerations

The accelerated discovery of gene mutations that lead to increased risk of disease has led to the rapid development of predictive genetic tests. These tests improve the accuracy of assigning risk, but at a time when intervention or prevention strategies are largely unproved. In coming years, however, data will become increasingly available to guide treatment of genetic diseases. Eventually genetic testing will be performed for common diseases as well as for rare genetic conditions. This will challenge genetic counseling practice. The ethical principles that now guide this practice take into account the personal nature of test decision making, the need to respect individual self-determination, and the importance of client confidentiality. Certain of these principles may have to be modified as genetic testing becomes more widespread in order to meet the changing needs of clients and society. This paper offers recommendations to ensure that genetic counselors will take a leading role in the future delivery of ethical genetic services.     

Neuroimaging of emotion and personality: scientific evidence and ethical considerations

Affective neuroscience has seen an explosion of research efforts using modern neuroimaging approaches to uncover the neural basis of emotion and personality. The first section of this paper reviews studies from the domains of affective and forensic neuroimaging. These studies illustrate some of the topics likely to be the subject of future ethical debates. The second section relates limitations of the neuroimaging approach to ethical considerations in predicting future psychopathology on the basis of brain state analysis.     

The ethical assessment of innovative therapies: Liver transplantation using living donors

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide. Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines for the procedure before it was introduced in the United States. We used a process of “research ethics consultation” that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery.     

Objective assessment of covert antisocial behavior: predictive validity and ethical considerations

Although less observable than the overt actions of fighting and assault, covert antisocial behaviors such as stealing and property destruction comprise an important subclass of externalizing behavior patterns, displaying considerable predictive power toward delinquency in adolescence. I discuss a laboratory paradigm for objective observation of such behaviors in children that has shown impressive concurrent and predictive validity among samples of boys with and without attention deficit hyperactivity disorder. Addressed herein are crucial questions regarding the ethics of tempting children to steal objects and small amounts of money and to deface property as well as the types of informed consent and debriefing procedures utilized in research with this paradigm. Weighing ethical considerations alongside the ability to predict delinquent behavior presents provocative issues for those interested in understanding the development of antisocial behavior.     

Parental consent for psychological evaluations: Legal,ethical and practical considerations

This article explores the legal, ethical, and practical considerations underlying the requirement for acquiring parental consent prior to a psychological assessment of children in school settings. Publ. L. 94-142 now mandates that parents for all children potentially labeled as handicapped give permission for a preplacement evaluation. This article reviews in detail specific aspects of that mandate, argues that this procedure be generalized to all situations where psychologists propose to evaluate children by reviewing both current ethical codes and standards for practice and public policy which favors such an undertaking. Finally, the authors indicate methods for implementing the mandate by discussing such issues as who should obtain consent and what information parents should receive prior to giving consent.     

Counseling puerto ri cans: some cultural considerations

Puerto Ricans comprise a significant percentage of potential clients for many counselors. The migration of Puerto Ricans to the mainland over the years has created cultural differences between Puerto Ricans raised in Puerto Rico and those raised in the U.S., but both groups are at a disadvantage in the dominant American culture. Migration back to the island in recent years is creating some problems for Puerto Rico, so Puerto Ricans often find prejudice both here and there. In this article the author, who married into a Puerto Rican family, discusses some values and traits that characterize Puerto Ricans and the behaviors that emerge from these traits. He offers practical suggestions for those counselors who have Puerto Rican clients.     

The transferential chimera II: some theoretical considerations

The author develops here a theoretical model to account for the different levels of organization and functioning of the transference chimera of which he gave a clinical presentation in an earlier article. From his reading of Jung's 'Psychology of the transference' he derives a dynamic model of the chimera and links it to quantum mechanics and chaos theory not so much to describe the reality of the phenomenon, but to offer a model of representation as a conceptual and meditative tool for analysts to use in their practice. The main hypothesis of this work is that the chimera arises from the intimate interplay of the respective de-integrates of the analyst and of the patient, thus constituting a genuine self in the transference. The author concludes with some implications for the analyst's own internal position.     

Prisonomics and the use of psychotropic drugs on incarcerated offenders: ethical considerations

The authors discuss the ethical considerations involved in using psychotropic medications with incarcerated offenders. Medications cannot be used as tool of oppression. Medication cannot be used to justify overpopulation, to quietly terminate prisoners, and must be administered by licensed health professionals. There must be informed consent.     

Informed consent in the psychosis prodrome: ethical,procedural and cultural considerations

Research focused on the prodromal period prior to the onset of psychosis is essential for the further development of strategies for early detection, early intervention, and disease pre-emption. Such efforts necessarily require the enrollment of individuals who are at risk of psychosis but have not yet developed a psychotic illness into research and treatment protocols. This work is becoming increasingly internationalized, which warrants special consideration of cultural differences in conceptualization of mental illness and international differences in health care practices and rights regarding research participation. The process of identifying and requesting informed consent from individuals at elevated risk for psychosis requires thoughtful communication about illness risk and often involves the participation of family members. Empirical studies of risk reasoning and decisional capacity in young people and individuals with psychosis suggest that most individuals who are at-risk for psychosis can adequately provide informed consent; however ongoing improvements to tools and procedures are important to ensure that this work proceeds with maximal consideration of relevant ethical issues. This review provides a discussion of these issues in the context of international research efforts.     

Participation in a bystander intervention experiment and subsequent everyday helping: ethical considerations

This study examines how participation in a bystander experiment involving deception affects later everyday helping. Both subjects who had formerly participated in a bystander intervention experiment and a group of matched controls who had not participated were interviewed in a survey either 6–10 months (early) or 11–20 months (late) after completion of the experiment. Half of the previous subjects were prompted to recall their experimental experience in the interview. After leaving the interview, subjects encountered a needy person. Mere participation in the prior experiment did not influence helping during the early period but enhanced helping after 10 months had elapsed. Participation plus recall inhibited helping during the early period but not later. Compared with controls, past participants helped more with the passage of time. The results suggest that participation in bystander intervention experiments induces both context-specific cognitions about possible inauthenticity of need and generalized beliefs about the value of helping. With the passage of time, the former fade while the latter become more salient. Ethical implications of these findings are discussed.