Justice and care: The implications of the Kohlberg-Gilligan debate for medical ethics

Carol Gilligan has identified two orientations to moral understanding; the dominant ‘justice orientation’ and the under-valued ‘care orientation’. Based on her discernment of a ‘voice of care’, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.     

Should physicians be Bayesian agents?

Because physicians use scientific inference for the generalizations of individual observations and the application of general knowledge to particular situations, the Bayesian probability solution to the problem of induction has been proposed and frequently utilized. Several problems with the Bayesian approach are introduced and discussed. These include: subjectivity, the favoring of a weak hypothesis, the problem of the false hypothesis, the old evidence/new theory problem and the observation that physicians are not currently Bayesians. To the complaint that the prior probability is subjective, Bayesians reply that there will be ultimate convergence, but the rebuttal to this is that there will not be uniform convergence. Secondly, since the Bayesian scheme favors a weak hypothesis, theories turn out to be a gratuitous risk. The problem with the false hypothesis comes out in the denominator of the theorem, revealing that a factor which is not a theory at all is being considered in the reasoning. On the old evidence/new theory problem old evidence cannot confirm a new theory so that the posterior probability will equal the prior probability. Finally, empiric studies have shown that current physicians are not Bayesians. But on consideration of Bayesian inference as a system of inference, it can be reasoned that physicians should be Bayesians. However, the problem of physicians' and patients' own subjectivity continue to plague this system of medical decision making.     

Developmental psychology in the real world: A paradigm of parent education

Twenty years ago, William Kessen, Greta Fein and I developed and tested a model of parent education, a model which involved variation in curricular content, didactic approaches, and child outcomes–experimentally contrasted. Our experience yielded some valuable lessons about the extent to which researchers can influence parents' behaviour, and parents their children's development. In the present article I suggest that these lessons might be useful for researchers now as they were for us then. I present some observations about the research that developmental psychologists have done in the intervening two decades and suggest that we could learn much by using such a model of parent education to answer questions about the effets of parents' behaviour on children's development. Carefully done, parent education studies can yield valuable information about many of the questions raised in recent correlational research. Parent training research can suggest hypotheses that can be tested with data collected non-interventively and analysed in causal model analyses–and vice versa. What is more, because one reason for studying parent effects is so that we can offer guidance to parents about rearing their children, this design has a particular advantage; it is both the medium and the message.     

The twisted helix: An essay on genetic counselors,eugenics, and social responsibility

The American eugenics movement had a significant impact on American social history, and analysis of the movement illustrates the relationship among science, scientists, and society. The history of the American eugenics movement as well as more recent examples of eugenic thought and biological determinism are reviewed. The need for genetic counselors to confront eugenic issues in their own profession and in society is discussed.     

Genetics and adoption: Forming a partnership

Genetic issues are demanding more attention in the area of public health. Adoption agencies and policymakers are beginning to address these issues where they relate to the adoption process and to the many families involved in adoption in this country. Genetic counselors need to play an active role as both educators of and consultants for adoption professionals and the families with whom they work. To facilitate a partnership between genetics and adoption we have developed a workshop intended to educate adoption professionals about the lifelong implications of genetic conditions on the adoption triad.     

The effects of baby bath and massage by fathers on the family system: The sunraysia australia intervention project

Instruction in baby massage and the Burleigh Relaxation Bath technique was given to one-half of our sample of 32 couples who had just had their first child. This brief intervention, given at 4 weeks post-partum, led to beneficial behavioural and psychological effects for the family system when assessed at 12 weeks postpartum. Depression and marital satisfaction were assessed with mothers and fathers at 4 weeks and 12 weeks after the birth of their child, and self-esteem was measured at 12 weeks only. The mothers and fathers who were shown baby bathing and massage techniques showed higher degrees of marital satisfaction and self-esteem, as well as lower levels of depression at 12 weeks post-partum, than parents who did not receive instruction. It seems likely that brief interventions which educate new parents concerning functional techniques of baby care may favourably affect their feelings of competence and be of benefit to the entire family system.     

The accuracy of maternal self-reports: Agreement between reports on a computer simulation compared with observed behaviour in the supermarket

The validity of maternal self-reports about their parenting behaviour is evaluated with two studies. In both studies, the mothers were observed shopping in the supermarket with their 2-year-old children. One week later they responded to multiple choice questions on a computer that simulated the experience of shopping with their children. The exact agreement between the two types of data was then assessed. The results from the first study involving 28 mothers revealed some agreement, although it was generally low. In an effort to increase the level of agreement, the computer simulation was revised to allow multiple responses and to clarify some of the simulation vigenettes. A replication study resulted in a considerably higher level of agreement for 22 mothers. Implications of this method for researchers and practitioners are discussed.     

Employee recognition: A procedure to reinforce work attendance

An employee recognition program to improve work attendance was conducted for one year in 1986 as part of a 3-year study using the awarding and posting of attendance certificates as the primary method of employee recognition. Compared to sick leave usage during 1985, those employees in the recognition group decreased their use of sick leave by 28%. In 1987, the year following the end of the recognition program, the average sick leave returned to a level higher than the 1986 level. In addition, the sick leave of a nonintervention control group of employees showed a sequential increase each year from 1985 to 1987, with their use in 1986 being 16% greater than those employees in the employee recognition group.