Individual differences and risk taking in rock climbing

ObjectivesThe primary objective of the study was to challenge the notion that risk taking populations are homogenous, and that risk taking in sport necessarily reflects the expression of trait sensation seeking. A secondary objective was to examine the potential role of additional individual differences, such as self-efficacy and impulsivity, which have traditionally received limited attention.DesignQuantitative cross-sectional study.MethodsOne hundred and sixteen active rock climbers completed the Impulsive-Sensation Seeking Scale, a domain-specific self-efficacy scale, and behavioral measures of ability, experience and risk taking in rock climbing.ResultsThose high in self-efficacy and male climbers were likely to take greater risks; small associations with age, sensation seeking and impulsivity were also observed, though these were not in the hypothesized direction and failed to predict unique variance in regression analyses.ConclusionsTo challenge themselves, rock climbers may take calculated additional risks when they feel confident in their ability to manage those risks. Researchers should not assume homogeneity within risk taking populations, or that people take risks in all domains due to elevated sensation seeking needs.     

To Recycle or Not to Recycle? An Intergenerational Approach to Nuclear Fuel Cycles

This paper approaches the choice between the open and closed nuclear fuel cycles as a matter of intergenerational justice, by revealing the value conflicts in the production of nuclear energy. The closed fuel cycle improve sustainability in terms of the supply certainty of uranium and involves less long-term radiological risks and proliferation concerns. However, it compromises short-term public health and safety and security, due to the separation of plutonium. The trade-offs in nuclear energy are reducible to a chief trade-off between the present and the future. To what extent should we take care of our produced nuclear waste and to what extent should we accept additional risks to the present generation, in order to diminish the exposure of future generation to those risks? The advocates of the open fuel cycle should explain why they are willing to transfer all the risks for a very long period of time (200,000 years) to future generations. In addition, supporters of the closed fuel cycle should underpin their acceptance of additional risks to the present generation and make the actual reduction of risk to the future plausible.     

Ethical Dilemmas in Protecting Susceptible Subpopulations From Environmental Health Risks: Liberty,Utility, Fairness,and Accountability for Reasonableness

Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we (1) consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; (2) show that these theories often fail to provide specific guidance concerning policy choices; and (3) argue that an approach to public decision making known as accountability for reasonableness can complement theories of justice in establishing acceptable environmental health risks for the general population and susceptible subpopulations. Since accountability for reasonableness focuses on the fairness of the decision-making process, not the outcome, it does not guarantee that susceptible subpopulations will receive a maximum level of protection, regardless of costs or other morally relevant considerations.     

A Case for Greater Risk Tolerance in Internet Use by Adults with Intellectual Disabilities: A Comment on Chalghoumi et al.

This comment argues for increased tolerance of privacy risks in the Internet activity of adults with intellectual disabilities. Excessive caution about such risks denies those individuals not only the great benefits of Internet use but also the difficult but valuable experiences of loss, disappointment, and hurt associated with those risks. A level of risk-aversion appropriate for small children will be disrespectful for adults with intellectual disabilities. To the extent that additional safeguards are justified, they are better achieved through individualized security and privacy settings than through caregiver oversight.     

The Moral Case for Intelligent Speed Adaptation

Speeding is a major problem in road safety. Intelligent Speed Adaptation (ISA) is a potential solution, but the moral acceptability of ISA has been called into question both in the popular media and in academic discussions. In this article, a moral case is made for making warning and limiting versions of ISA obligatory in all cars. The practice of car driving involves frequent speeding, which imposes unacceptable risks of harm on other road users. In this article, I argue that ISA can therefore be justified on the basis of the harm it prevents, as is the current criminalisation of speeding. I defend obligatory ISA against three objections. First, ISA is likely to introduce some additional risk for drivers. However, drivers should accept these risks to reduce the risks from driving for other parties to an acceptable level. Second, although limiting ISA reduces drivers' options for moral agency and exercising self‐restraint to some extent, this consequence is defensible. Third, accepting ISA does not commit us to accepting an entire range of other behaviour‐regulating technologies.     

The Ethics of Dual Relationships in Higher Education

Dual relationships between professors and students have many ethical risks. This article discusses how the professor's role, characteristics of the situation, characteristics of the student, and a set of four decision criteria can be used to assess the risks of dual relationships. The examples of a professor who is involved in a consensual sexual relationship with a student and a professor who has a friend who wants to enroll in his or her class are used to demonstrate how the decision criteria can be applied. Several general characteristics of dual relationships are discussed.     

The physician as fortune teller: a commentary on "The ethical justification for minimal paternalism

...I shall summarize my argument to this point. 1) A new technology -- medicalizing life choices -- introduces additional sources of uncertainty into the physician-patient relationship. The implications for the authority-autonomy tension of that relationship are not fully worked out, as is evidenced by differing views on professional obligations. 2) The warrants for paternalism are complex, ranging from a pragmatic response in the face of uncertainty to a proactive, highly directive determination of the patient's best interests. 3) Although some proponents of autonomy argue that it entails positive rights to intervention and information, the "strong sense" of autonomy is not the prevailing view. 4) The as yet unclear benefits of knowledge about one's genetic makeup are even less clear in the case of HD. Strong circumstantial evidence of risks of harm from disclosure of unfavorable test results have not been dispelled by early experience with use of the HD test. 5) A cautious approach in the use of HD test seems warranted, even at the cost of restricting autonomy. Legitimating that approach by reference to traditional ethical theory is a necessary element in the transfer of the new technology to the wider clinical setting. 6) While PMP [the principle of minimal paternalism] attempts to offer such an approach, some questions do not appear to have been resolved or fully addressed by this formulation.     

The Influence of the Premedication Consult and Preparatory Information about Anesthesia on Anxiety among Patients Undergoing Cardiac Surgery

The present study examines the impact of patients' subjective evaluation of the premedication consult and of preparatory information about anesthesia on preoperative anxiety among patients undergoing cardiac surgery ( N = 93). The preparatory information concerned a flyer that contained information about treatment options, risks of surgery and expected outcomes with respect to anesthesiology. The data did not support the beneficial effect of the information on patients' anxiety levels above the standard procedure in which patients were solely visited by their anesthesiologist for a premedication consult. Anxiety reduction was related, however, to the perceived quality of the premedication consult. The more positively the interaction with the anesthesiologist was evaluated, the stronger the patients' anxiety reduction. In addition, the moderating impact of monitoring/blunting on preoperative anxiety was examined. High levels of monitoring and low blunting were associated with stronger anxiety reduction, regardless of whether patients received additional preparatory information or solely an oral consult. The implications of these findings for clinical practice are discussed.     

Deliberate Microbial Infection Research Reveals Limitations to Current Safety Protections of Healthy Human Subjects

Here we identify approximately 40,000 healthy human volunteers who were intentionally exposed to infectious pathogens in clinical research studies dating from late World War II to the early 2000s. Microbial challenge experiments continue today under contemporary human subject research requirements. In fact, we estimated 4,000 additional volunteers who were experimentally infected between 2010 and the present day. We examine the risks and benefits of these experiments and present areas for improvement in protections of participants with respect to safety. These are the absence of maximum limits to risk and the potential for institutional review boards to include questionable benefits to subjects and society when weighing the risks and benefits of research protocols. The lack of a duty of medical care by physician–investigators to research subjects is likewise of concern. The transparency of microbial challenge experiments and the safety concerns raised in this work may stimulate further dialogue on the risks to participants of human experimentation.     

The Acceptability and the Tolerability of Societal Risks: A Capabilities-based Approach

In this paper, we present a Capabilities-based Approach to the acceptability and the tolerability of risks posed by natural and man-made hazards. We argue that judgments about the acceptability and/or tolerability of such risks should be based on an evaluation of the likely societal impact of potential hazards, defined in terms of the expected changes in the capabilities of individuals. Capabilities refer to the functionings, or valuable doings and beings, individuals are able to achieve given available personal, material, and social resources. The likely impact of a hazard on individuals' capabilities should, we argue, be compared against two separate thresholds. The first threshold specifies the minimum level of capabilities attainment that is acceptable in principle for individuals to have in the aftermath of a hazard over any period of time. This threshold captures the level that individuals' capabilities ideally should not fall below. A risk is acceptable if the probability that the attained capabilities will be less than the acceptable level is sufficiently small. In practice, it can be tolerable for some individuals to temporarily fall below the acceptable threshold, provided this situation of lower capabilities attainment is temporary, reversible, and the probability that capabilities will fall below a tolerability threshold is sufficiently small. This second, tolerable threshold delimits an absolute minimum level of capabilities attainment below which no individual in a society should ever fall, regardless of whether that level of capabilities attainment is temporary or reversible. In this paper, we describe and justify this Capabilities-based Approach to the acceptability and tolerability of risks. We argue that the proposed theoretical framework avoids the limitations in current approaches to acceptable risk. The proposed approach focuses the attention of risk analysts directly on what should be our primary concern when judging the acceptability and the tolerability of risks, namely, how risks impact the well-being of individuals in a society. Also, our Capabilities-based Approach offers a transparent, easily communicable way for determining the acceptability and the tolerability of risks.     

The association between risky driver and pedestrian behaviors: The case of Ultra-Orthodox Jewish road users

This study examines associations between the risky behaviors of two types of road users: drivers and pedestrians. Whereas these behaviors have traditionally been investigated separately, the aim here was to examine the connection between them. The sample consisted of 518 drivers and non-drivers from the Ultra-Orthodox Jewish community in Israel (a sector in which having a driver’s license is not the norm), who completed a series of questionnaires relating to their tendency to take risks as drivers and as pedestrians. Results indicate that individuals who have a driver’s license are more likely to take risks as pedestrians than those who do not. In addition, among those with a driver’s license, strong correlations were found between various driving measures and the inclination for risky behaviors as pedestrians, indicating that the riskier the individual’s driving behavior, the more he or she tended to report dangerous pedestrian behavior. The findings suggest that different kinds of road-use behaviors are not entirely distinct from each other in respect to the degree of risk involved. Thus, the tendency to cross the road dangerously and the tendency to drive dangerously may reflect a more general propensity to take risks, at least in the context of road use.     

The consequences of uncontrolled epilepsy

The consequences of epilepsy can be quite severe and include shortened lifespan, excessive bodily injury, neuropsychological and psychiatric impairment, and social disability. There is evidence that seizures cause brain injury, including neuronal death and physiological dysfunction. Mortality rates are 4-7 times higher in people with medically refractory seizures, and injury rates are substantial, ranging from one per 20 person-years to as much as one per 3 person-years. Quality of life is impaired in epilepsy, and relates to seizure control. Psychosocial disabilities, including lower social interaction with reduced marriage rates and reduced employment levels, are more common in people with refractory seizures. Complete seizure control is desirable, since seizures potentially constitute a serious threat to health and well-being. Therefore, satisfactory seizure control should be defined as having no seizures. Treatment should be directed to preventing seizures whenever possible and achieving control early in the course of illness. The risks of uncontrolled seizures outweigh the risks of aggressive medical or surgical therapy.     

患者拒绝签署紧急手术知情同意书的处理对策

签署手术知情同意书是医方履行告知义务,保障医患双方合法权益的一种重要手段。当患者病情需要紧急手术但患者或其家属拒绝签署手术知情同意书时,医院面临错失抢救时机和巨大的医疗风险,甚至可能因此成为被告。结合我院临床工作中的成功经验,探讨医院如何在尽可能抢救患者生命的情况下,规避相关法律风险。     

The short-term consequences of early onset cannabis use

The associations between early onset (prior to 15 years of age) cannabis use and rates of mental health or adjustment problems during the period from 15 to 16 years of age were studied in a New Zealand birth cohort. Early onset cannabis users were at increased risks of later substance use behaviors, conduct/oppositional disorders, juvenile offending, severe truancy, school dropout, anxiety, depression, and suicidal ideation. Early cannabis users had odds of these outcomes ranging from 2.7 to 30.8 times higher than the odds for those who did not use cannabis prior to age 15. Most of the elevated risks of early onset users were explained by the fact that they were a high-risk group of adolescents characterized by family disadvantages, early adjustment problems, and high affiliations with substance-using or delinquent peers. Nonetheless, even after adjustment for a wide range of confounding factors, early onset users had increased risks of later cannabis use. It is concluded that while most of the elevated risks of early onset users were explained by social, family, and individual characteristics of this group, early onset users were at increased risks of later cannabis use.This research was funded by grants from the Health Research Council of New Zealand, the National Child Health Research Foundation and the Canterbury Medical Research Foundation.     

Cultural-Related, Contextual, and Asthma-Specific Risks Associated with Asthma Morbidity in Urban Children

The objective of this study was to examine associations between specific dimensions of the multi-dimensional cumulative risk index (CRI) and asthma morbidity in urban, school-aged children from African American, Latino and Non-Latino White backgrounds. An additional goal of the study was to identify the proportion of families that qualify for high-risk status on each dimension of the CRI by ethnic group. A total of 264 children with asthma, ages 7–15 (40% female; 76% ethnic minority) and their primary caregivers completed interview-based questionnaires assessing cultural, contextual, and asthma-specific risks that can impact asthma morbidity. Higher levels of asthma-related risks were associated with more functional morbidity for all groups of children, despite ethnic group background. Contextual and cultural risk dimensions contributed to more morbidity for African-American and Latino children. Analyses by Latino ethnic subgroup revealed that contextual and cultural risks are significantly related to more functional morbidity for Puerto Rican children compared to Dominican children. Findings suggest which type of risks may more meaningfully contribute to variations in asthma morbidity for children from specific ethnic groups. These results can inform culturally sensitive clinical interventions for urban children with asthma whose health outcomes lag far behind their non-Latino White counterparts.     

Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks.

This study examined treatment outcomes among smokers with single versus multiple behavioral risks. Data were drawn from smokers (N = 2,326) participating in 3 population-based, multibehavioral studies targeting cigarette smoking, high-fat diets, and high-risk sun exposure. Outcomes were compared for participants at risk for smoking only (13%), smoking plus 1 additional risk factor (37%), and smoking plus 2 additional risk factors (50%). The smoking only group tended to be female, older, more educated, lighter smokers, in the preparation stage of change for smoking, with more previous quit attempts and longer periods of abstinence. At 12 and 24 months follow-up, treatment of 1 or 2 coexisting risk factors did not decrease the effectiveness of smoking cessation treatment, and treatment for the coexisting factors was effective.     

Effects of Describing Long-Term Risks as Cumulative or Noncumulative

It is not known whether carcinogens act cumulatively or are noncumulative risks for which any single exposure may cause a tumor. Subjects in an experimental study w m assigned to take either cumulative or noncumulative risks. Subjects assigned to take cumulative risks took significantly more risks than subjects assigned to take noncumulative risks. Subjects described cumulative risks as roughly normally distributed, with low levels of exposure relatively safe. Noncumulative risks were perceived to he distributed differently, with higher levels of hazard resulting from low levels of exposure. The results imply that if people believe that carcinogens have cumulative effects, they will allow themselves more exposure than if they believe a "one-cell" noncumulative model.     

繁衍线索对风险信息加工的影响

进化理论认为风险行为与求偶有关。研究通过比较求偶信息(异性照片或描述异性的词语)、养育后代(孕妇照片)及奖赏信息(金牌照片等)试图进一步探讨繁衍线索对两性知觉和判断风险信息的影响。研究1中, 被试描述理想约会对象后求偶动机得到激发, 相对于描述晴朗天气的控制组, 求偶动机让两性更慢地从高风险信息(如滑雪、冲浪等)转移注意力, 且两性对风险信息的注意转移与社群性向无关。研究2显示, 相对于养育后代和奖赏信息, 求偶信息更为迅速地促使男性对高风险信息做出判断, 但求偶信息让女性比男性更慢地对高风险信息做出判断。研究结果进一步证实了自然选择理论及性选择理论对两性加工风险信息的认知机制具有预测作用。     

Seizure episodes and death by drowning

473 cases of death by drowning were examined for evidence of previous neurological disorders linked with the occurrence of epileptic fits. It was found that 16 persons (3.4%) were undergoing medical treatment for epilepsy. In a further 10 cases there was evidence of the possibility of previous disorders in which epileptic fits and syncopal attacks played a dominant part. Besides the risks from the previous disorders, additional risk factors are discussed.     

Informed consent and the disclosure of risks of treatment: The Supreme Court of Canada Decides

The requirement for disclosure of risks of treatment as part of informed consent came before the Supreme Court of Canada in two 1980 cases. The Court found the duty of disclosure of risks to be based in negligence and not battery. The scope of the duty is not to be determined by medical evidence alone and requires the physician to disclose the nature of the proposed treatment, its gravity, any material risks and any special or unusual risks as well as answering in a reasonable way all specific questions asked by the patient. Whether the patient would have decided differently if all the information were known is an objective test, based on what the reasonable person in the patient's particular circumstance would do.