Ethical issues in cochlear implant surgery: an exploration into disease, disability, and the best interests of the child

This paper examines ethical issues related to medical practices with children and adults who are members of a linguistic and cultural minority known as the DEAF-WORLD. Members of that culture characteristically have hearing parents and are treated by hearing professionals whose values, particularly concerning language, speech, and hearing, are typically quite different from their own. That disparity has long fueled a debate on several ethical issues, most recently the merits of cochlear implant surgery for DEAF children. We explore whether that surgery would be ethical if implants could deliver close to normal hearing for most implanted children, thereby diminishing the ranks of the DEAF-WORLD. The ethical implications of eugenic practices with the DEAF are explored, as are ethical quandaries in parental surrogacy for DEAF children, and their parallels in transracial adoption.     

Automation bias: decision making and performance in high-tech cockpits

Automated aids and decision support tools are rapidly becoming indispensable tools in high-technology cockpits and are assuming increasing control of"cognitive" flight tasks, such as calculating fuel-efficient routes, navigating, or detecting and diagnosing system malfunctions and abnormalities. This study was designed to investigate automation bias, a recently documented factor in the use of automated aids and decision support systems. The term refers to omission and commission errors resulting from the use of automated cues as a heuristic replacement for vigilant information seeking and processing. Glass-cockpit pilots flew flight scenarios involving automation events or opportunities for automation-related omission and commission errors. Although experimentally manipulated accountability demands did not significantly impact performance, post hoc analyses revealed that those pilots who reported an internalized perception of "accountability" for their performance and strategies of interaction with the automation were significantly more likely to double-check automated functioning against other cues and less likely to commit errors than those who did not share this perception. Pilots were also lilkely to erroneously "remember" the presence of expected cues when describing their decision-making processes.     

Commitment,intimacy, and women's perceptions of premarital sex and contraceptive readiness

A person-perception study was conducted to examine the influence of intimacy and commitment on the acceptability of premarital sex and contraceptive preparedness. Ninety-six women rated a female target's personality and behavior after reading a diary entry describing a couple's initial sexual encounter. The nature of the couple's relationship and who provided the condom were manipulated between participants. Women inferred a committed relationship when intimacy was present. Women rated the target, and her behavior, as more acceptable when she had sex in a relationship with commitment. When she provided a condom, the target was perceived as less nice in the noncommitted than in the committed relationship. When her partner provided the condom, however, commitment level did not influence personality ratings.     

Sexuality education and young people's sexual behavior: a review of studies

Sexuality education for children and young adults is one of the most heavily debated issues facing policy-makers, national AIDS program planners, and educators, provoking arguments over how explicit education materials should be, how much of it there should be, how often it should be given, and at what age instruction should commence. In this context, the World Health Organization's Global Program on AIDS' Office of Intervention Development and Support commissioned a comprehensive literature review to assess the effects of HIV/AIDS and sexuality education upon young people's sexual behavior. 52 reports culled from a search of 12 literature databases were reviewed. The main purpose of the review is to inform policy-makers, program planners, and educators about the impact of HIV and/or sexuality education upon the sexual behavior of youth as described in the published literature. Of 47 studies which evaluated interventions, 25 reported that HIV/AIDS and sexuality education neither increased nor decreased sexual activity and attendant rates of pregnancy and sexually transmitted diseases (STDs). 17 reported that HIV and/or sexuality education delayed the onset of sexual activity, reduced the number of sex partners, or reduced unplanned pregnancy and STD rates Only 3 studies found increases in sexual behavior associated with sexuality education. Inadequacies in study design, analytic techniques, outcome indicators, and the reporting of statistics are discussed.     

Child abuse and neglect by parents with disabilities: A tale of two families

Two families, in which the children had been placed in foster care due to abuse and neglect by parents who had disabilities, were studied. In the first case, the mother was instructed in skills that our assessment suggested were important for her child's survival. The mother readily acquired and applied these skills, a fact reflected both in changes in her behavior and in changes in the child's well-being. In the second case, the parent's incremental resumption of child custody was made contingent upon completion of relevant parenting tasks. Initially, improvements in the completion of such tasks were evident, but over time and with the onset of militating factors, no further progress was made and all parental rights were terminated. The implications of these cases for behavior analysis and the effort to reunite and preserve families are discussed.     

Sacrificing one to save many

Attempts to solve the Trolley Problem by means of a single principle have proved unpersuasive. Nor can the intuition about Transplant be adequately grounded in the hypothetical dissent of rational contractors. It is explained by the initial liability principle, that loss should lie where it falls unless there is sufficient reason to shift it. If we did not think we should accept misfortune in such cases and thought that minimising loss of life was sufficient reason to shift the loss we should not be according others the minimum respect and treatment we feel is their due. The intuition about Trolley is explained by the affinity of that case to the pure case where the choice is between saving many and saving fewer, where minimising misfortune is the only credible option. But these considerations are not yet enough to accommodate the cases that lie between the extremes of Trolley and Transplant. We can handle the intermediate cases by attempting to assimilate them to one or other paradigm and to one another with a sensitivity to morally relevant and irrelevant differences that seeks initially to be faithful to the values reflected by our moral intuitions. Those intuitive judgements are unlikely to survive such an examination wholly unmodified.     

Telling stories: metaphors of the Human Genome Project

Scientists of the Human Genome Project tend to rely on three metaphors to describe their work, each of which implicitly tells much the same story. Whether they claim to interpret the ultimate “book,” to fix a flawed “machine,” or to map a mysterious “wilderness,” they invariably cast the researcher as one who dominates and exploits the Other. This essay, which explores the ways such a story conflicts with feminist values, proposes an alternative.     

Children's capacity to agree to psychological research: knowledge of risks and benefits and voluntariness

A series of studies investigated the capacity of children between the ages of 7 and 12 to give free and informed consent to participation in psychological research. Children were reasonably accurate in describing the purpose of studies, but many did not understand the possible benefits or especially the possible risks of participating. In several studies children's consent was not affected by the knowledge that their parents had given their permission or by the parents saying that they would not be upset if the children refused. In contrast, other studies found that children were much more likely to stop their participation if the experimenter said explicitly that she would not be upset if they stopped. We suggest that experimenters should pay more attention to describing the possible risks and benefits of participation in research, and that they should also make it clearer to children that they are free to stop once they have begun.     

Orienting the finger opposition space during prehension movements

Two experiments are reported that examined the act of prehension when subjects were asked to grasp with their thumb and index finger pads an elongated object resting horizontally on a surface and placed at different orientations with respect to the subject. In Experiment 1, the pad opposition preferences were determined for the six angles of orientation examined. For angles of 90 degrees (object parallel to frontal plane) or less, no rotation of the wrist (pronation) was used; for angles 110 degrees or greater, pronation was systematically employed to reorient the finger opposition space. Only one angle, 100 degrees , produced any evidence of ambiguity in how to grasp the object: Approximately 60% of these grasps involved pronation and 40% did not. Using the foregoing grasp preference data, in Experiment 2 we examined the kinematics of the wrist and elbow trajectories during prehension movements directed at an object in different orientations. Movement time, time to peak acceleration, velocity, and deceleration were measured. No kinematic differences were observed when the object orientation either required (110 degrees ) or did not require (80 degrees ) a pronation. By contrast, if the orientation was changed at the onset of the movement, such that an unpredicted pronation had to be introduced to achieve the grasp, kinematics were affected: Movement time was increased, and the time devoted to deceleration was lengthened. These data are interpreted as evidence that when natural prehension occurs, pronation can be included in the motor plan without affecting the movement kinematics. When constraints are imposed on the movement execution as a consequence of a perturbation, however, the introduction of a pronation component requires kinematic rearrangement.