Consensus, clinical decision making, and unsettled cases

The model of clinical ethics consultation (CEC) defended in the ASBH Core Competencies report has gained significant traction among scholars and healthcare providers. On this model, the aim of CEC is to facilitate deliberative reflection and thereby resolve conflicts and clarify value uncertainty by invoking and pursuing a process of consensus building. It is central to the model that the facilitated consensus falls within a range of allowable options, defined by societal values: prevailing legal requirements, widely endorsed organizational policies, and professional standards of practice and codes of conduct. Moreover, the model stipulates that ethics consultants must refrain from giving substantive recommendations regarding how parties to a moral disagreement in the clinic should evaluate their options. We argue that this model of CEC is incomplete, because it wrongly assumes that what counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible. We illustrate this problem with a recent case on which one of us consulted-a neonate born with trisomy 18 (T18). We try to show that law, policy, and standards of practice reveal no clear answer to the question posed by the case: namely, whether forgoing gastrostomy tube feedings for a baby with T18 is allowable. We suggest there may be other kinds of cases in which it may simply be unsettled whether a given choice falls within the set of allowable options within which consensus is to be facilitated. What should an ethicist do when confronting such unsettled cases? We agree with the facilitation model that an ethicist should remain neutral among the allowable options, when it is clear what the allowable options are. But, in unsettled cases, the role of a consultant should be expanded to include a process of moral inquiry into what the allowable options should be. We end by raising the issue of whether this means an ethicist should share his or her own conclusions or views about the allowability of a given clinical option.     

Ethics of aggression research: Papers from a symposium of International Society for Research on Aggression

Three papers are presented from the first symposium on ethical issues in aggression research of the International Society for Research on Aggression held at the biennial meetings 1980 in Haren, The Netherlands. The symposium reflected a growing awareness of the Society that their research is a matter for public concern and scrutiny, both for its potentially good uses, and for its potential misuse and misinterpretation. A paper by Santiago Genovés, a Mexican anthropologist, outlined some of the issues concerning the dissemination of information and misinformation of aggression to the public, along with an extensive bibliography on the subject. A paper by Paul Brain, a British zoologist, addressed the issues surrounding the use of animals in aggression research and the arguments being used in public attacks upon it. Daniel Wikler, a practitioner of normative ethics from the United States, discussed ethics as theory and as practice and suggested some of the types of actions that the Society could consider undertaking.     

Classical physical abstraction

An informal theory is set forth of relations between abstract entities, includingcolors, physical quantities, times, andplaces in space, and the concrete things thathave them, or areat orin them, based on the assumption that there are close analogies between these relations and relations between abstractsets and the concrete things that aremembers of them. It is suggested that even standard scientific usage of these abstractions presupposes principles that are analogous to postulates of abstraction, identity, and other fundamental principles of set theory. Also discussed is the significance of important disanalogies between sets and physical abstractions, including especiallymodal andtemporal aspects of physical abstractions, which is related to the problem of the characterizingconstancy, of colors, physical attributes, and locations in space.     

Dehumanizing but competent: The impact of gender,illness type,and emotional expressiveness on patient perceptions of doctors

This study is the first attempt to investigate men's and women's anticipated reactions to a consultation with a doctor holding either a dehumanizing or humanistic approach to patient treatment. Participants (N = 375) read a vignette depicting a doctor's treatment philosophy—emphasizing either the metaphor of the body as a machine (dehumanizing condition) or emphasizing individual humanness (humanizing condition). They then imagined consulting the doctor about a psychological or physical illness. Although, medical dehumanization had undesirable consequences, some men rated the dehumanizing doctor as more competent than the humanizing doctor. These were men who were (a) emotionally expressive and seeking help for a psychological illness, and (b) men low in emotional expressiveness seeking help for a physical illness.     

The Gap Between Clinical Trial and Application in Health Behavior Counseling: Can Behavioral Medicine Build a Bridge?

Patients desire to have information about health-related behaviors (e.g., exercise) provided to them by their health care provider. Outcomes of clinical trials in physical activity counseling are modest at best and therefore, the degree of effectiveness of physical activity counseling in the primary care setting remains unclear. We describe what may be considered a real-world example of behavior change counseling aimed at primary or secondary risk factor identification and modification for CHD in women. We examined rates of baseline and follow-up physical activity in our sample of midlife Caucasian and African American women (N = 227) participating in a hospital-based CHD-risk screening. Baseline physical activity levels and rates of return for follow-up appointments were quite low with only negligible achievement of behavior change recommendations. In light of these findings, the potential role of behavioral medicine in training and collaboration with health care providers in primary care behavior counseling is discussed.     

Leadership ratings for male and female military cadets

Ratings of leadership ability for 1096 male and 91 female cadets at the U.S. Military Academy (West Point) were examined for gender differences. Males were rated significantly higher than females for two of the three rating periods. Correlates of these ratings were examined in an effort to explore the meaning of such ratings for males and females. For both male and female cadets, situationally specific correlates of leadership ratings were identified. Physical ability and performance were most highly correlated with leadership ratings during summer training camp, while academic ability and performance were most highly correlated with these ratings during the academic year. These correlations were generally higher for females than for males. The value of such information to organizational newcomers and the means by which such information might be transmitted to them were discussed.