The family covenant and genetic testing

The physician-patient relationship has changed over the last several decades, requiring a systematic reevaluation of the competing demands of patients, physicians, and families. In the era of genetic testing, using a model of patient care known as the family covenant may prove effective in accounting for these demands. The family covenant articulates the roles of the physician, patient, and the family prior to genetic testing, as the participants consensually define them. The initial argument defines the boundaries of autonomy and benefit for all participating family members. The physician may then serve as a facilitator in the relationship, working with all parties in resolving potential conflicts regarding genetic information. The family covenant promotes a fuller discussion of the competing ethical claims that may come to bear after genetic test results are received.     

Revisiting confidentiality: observations from family therapy practice

Confidentiality has long been recognized as a critical legal and ethical principle for the committed, value‐based practitioner. Vital principles (such as confidentiality) become manifest in material practices and in the language of professional and societal narratives. This articulation into specific practices and performances requires a pragmatic process that transforms the abstract into real‐world activities. This imperfect process has the potential of including the derived practices that in certain ways may extend the principle in unintended or unwanted directions. In the case of confidentiality, the actual practices of confidentiality may be both emancipating and inhibiting – they may protect as well as isolate. Our purpose is to revisit the idea of confidentiality and to deconstruct the way it functions in both positive and negative manners in clinical work.     

Dogmatism,age, and educational level as correlates of feminism for males and females

Male and female subjects completed a dogmatism scale and a feminism scale and provided information about their age, amount of education, and present occupation. The variables correlating with feminism depended upon the sex of the respondent. The more dogmatic individuals of both sexes supported feminism less than the less dogmatic individuals, with the effect being somewhat stronger for the males. The older female supported feminism less than the younger female. Age was unrelated to feminism for the males. The poorly educated female supported feminism less than the better-educated female, but the effect was diminished when dogmatism and age were held constant. Educational level was unrelated to feminism for males. The differences between the sexes are discussed in the context of perceptions of issues and situational ambiguity.The authors would like to thank Joan Joesting for her comments on an earlier version of this paper. Support for the statistical analyses was given by the Maryland State College Information Center.     

Self-objectification, habitual body monitoring, and body dissatisfaction in older European American women: exploring age and feminism as moderators

This study examined the influence of feminist attitudes on self-objectification, habitual body monitoring, and body dissatisfaction in middle age and older women. The participants were 138 European American heterosexual women ranging in age from 40 to 87 years old. Consistent with previous research, self-objectification and habitual body monitoring were positively correlated with body dissatisfaction and, self-objectification and habitual body monitoring remained stable across the lifespan. While age did not moderate the relationship between self-objectification and body dissatisfaction, age was found to moderate the relationship between habitual body monitoring and body dissatisfaction such that the relationship was smaller for older women than for middle-aged women. Interestingly, feminist attitudes were not significantly correlated with body dissatisfaction, self-objectification, or habitual body monitoring, and endorsement of feminist attitudes was not found to moderate the relationship between self-objectification or habitual body monitoring and body dissatisfaction. Potential implications for older women are discussed.     

Validity of the sex-role egalitarianism scale: Discriminating egalitarianism from feminism

To explore and to clarify the discriminant validity of the sex role egalitarianism construct, the Sex-Role Egalitarianism Scale (SRES) was administered in conjunction with the Attitudes Toward Women Scale (AWS) and eight personality trait measures to 108 individuals. Results indicated a hypothesized curvilinear relationship between scores on the SRES and the AWS. When personality traits were individually regressed on SRES and AWS, SRES scores uniquely accounted for variance in achievement locus of control, and AWS scores uniquely accounted for variance in need for autonomy and need for succorance. Findings were supportive of the viability of sex role egalitarianism as an attitudinal dimension having meaning beyond that of a traditional — feminist dimension.     

Reported sleep: needed minus obtained sleep, family resemblance, and age

For a normal population from 13 to 89 yr. of age there was a correlation of .02 between age and sleep obtained, -.07 between age and sleep needed, and -.33 (p less than .01) between age and sleep needed minus sleep obtained. Also, significant family resemblance was found for all three of the above sleep variables.     

Ethics of access: Globalization,feminism and information society

This article explores the ethics of access in relation to globalization, feminism and information society. It argues that the virtual settings of information and communication technologies (ICTs) are beginning to place significant emphasis on sociospatial as well as geospatial understandings of the world and the interactions that take place within it. The article examines the extreme material and other associated inequalities of contemporary globalization, and the concentration of technological development and power in the rich economies. Historical developments related to these factors are discussed, including the gendered nature of technologies and social processes shaping their production, application and use. It is argued that feminist theory and practice is relevant to broad debates about inequality of access in the information age, as well as to those concentrating specifically on gender and women. The tension between liberal/neoliberal focus on ‘equality’ and the ‘grotesque’ levels of contemporary inequality is raised. It is argued that feminism's long-standing and extensive critique of the problematic masculinist and partial nature of liberal/neoliberal theory, and its framing of agency, offers a major contribution in addressing this. Cyberfeminism works in theory and practice on horizontal networks and consciousness-raising about their potential, arguing that the era of the cybercitizen raises new and important risks of marginalization, on the basis of gender and other factors, and new forms of empowerment.     

Personal identity,transformative experiences,and the future self

Phenomenology and the Cognitive Sciences - The article explores the relation between personal identity and life-changing decisions such as the decision for a certain career or the decision to...     

Privacy and the Computer: Why We Need Privacy in the Information Society

For more than thirty years an extensive and significant philosophical debate about the notion of privacy has been going on. Therefore it seems puzzling that most current authors on information technology and privacy assume that all individuals intuitively know why privacy is important. This assumption allows privacy to be seen as a liberal "nice to have" value: something that can easily be discarded in the face of other really important matters like national security, the doing of justice and the effective administration of the state and the corporation. In this paper I want to argue that there is something fundamental in the notion of privacy and that due to the profoundness of the notion it merits extraordinary measures of protection and overt support. I will also argue that the notion of transparency (as advocated by Wasserstrom) is a useless concept without privacy and that accountability and transparency can only be meaningful if encapsulated in the context of privacy. From philosophical and legal literature I will discuss and argue the value of privacy as the essential context and foundation of human autonomy in social relationships. In the conclusion of the paper I will discuss implications of this notion of privacy for the information society in general, and for the discipline of information systems in particular.     

Beyond the politics of positionality: deconstruction and feminism

Abstract

The article commences with a discussion of Derrida's alleged anti-feminist position. We argue that, given his distinction between ‘reactive’ and ‘maverick’ feminism, this is an over-simplification. A correlation is drawn between the latter form of feminism and deconstruction by showing that both maintain a relation to the ‘beyond’ of the established logocentric system. The second section of the article deals with the placing of woman in Derrida's Spurs. It is shown that Derrida affirms Nietzsche's idea of the ‘Dionysiac woman’ who is, like the maverick feminist, not totally determined within the phallogocentric system. Woman, in Derrida's reading, becomes that which is not fully determinable. We conclude that this undecidability, rather than hindering its political activity, helps feminism in dealing with the diversities within the movement.     

Social contract theory and just decision making: lessons from genetic testing for the BRCA mutations

Decisions about funding health services are crucial to controlling costs in health care insurance plans, yet they encounter serious challenges from intellectual property protection--e.g., patents--of health care services. Using Myriad Genetics' commercial genetic susceptibility test for hereditary breast cancer (BRCA testing) in the context of the Canadian health insurance system as a case study, this paper applies concepts from social contract theory to help develop more just and rational approaches to health care decision making. Specifically, Daniel's and Sabin's "accountability for reasonableness" is compared to broader notions of public consultation, demonstrating that expert assessments in specific decisions must be transparent and accountable and supplemented by public consultation.     

International politics and family systems: Some observations on tactics

This paper describes many parallels between the concepts and tactics used in the arena of international politics and those used in the office of a strategic family therapist. Some of the many ideas discussed are: changing the consequences of a behavior, the Kennedy intervention, the use of signals, mystifying clarifications, and vague threats. The paper also suggests that the accumulated wisdom employed by statesmen in managing power struggles can be studied by clinicians to resolve conflict in couples and families more successfully.This article was originally presented as the Third Annual Distinguished Visitor's Lecture, Hunter College, School of Social Work, NY.     

Individual,family, and societal dimensions of genetic discrimination: A case study analysis

Background. As the development and use of genetic tests have increased, so have concerns regarding the uses of genetic information. Genetic discrimination, the differential treatment of individuals based on real or perceived differences in their genomes, is a recently described form of discrimination. The range and significance of experiences associated with this form of discrimination are not yet well known and are investigated in this study. Methods. Individuals at-risk to develop a genetic condition and parents of children with specific genetic conditions were surveyed by questionnaire for reports of genetic discrimination. A total of 27,790 questionnaires were sent out by mail. Of 917 responses received, 206 were followed up with telephone interviews. The responses were analyzed regarding circumstances of the alleged discrimination, the institutions involved, issues relating to the redress of grievances, and strategies to avoid discrimination. Results. A number of institutions were reported to have engaged in genetic discrimination including health and life insurance companies, health care providers, blood banks, adoption agencies, the military, and schools. The alleged instances of discrimination were against individuals who were asymptomatic and sometimes impacted on other asymptomatic relatives. Few surveyed respondents knew of the existence of institutions such as state insurance commissions or the Medical Information Bureau, Inc., which may play roles in redress of grievances or correction of misinformation. Conclusions. Genetic discrimination is variable in form and cause and can have marked consequences for individuals experiencing discrimination and their relatives. The presence of abnormal genes in all individuals makes each person a potential victim of this type of discrimination. The increasing development and utilization of genetic tests will likely result in increased genetic discrimination in the absence of contravening measures. All authors contributed equally to this work. This work was supported by a grant from the U.S. Department of Energy and funding from the Department of Mental Retardation of the Commonwealth of Massachusetts.