The physician-patient relationship: Models and criticisms

A review of the philosophical debate on theoretical models for the physician-patient relationship over the past fifteen years may point to some of the more productive questions for future research. Contractual models have been criticized for promoting a legalistic and minimalistic image of the relationship, such that another form of model (such as “convenant”) is required. Shifting from a contractual to a contractarian model (in keeping with Rawls' notion of an original position) provides an adequate response to many criticisms of this type. A deeper criticism, however, is one that advocates a shift to a virtue-based approach. A creative amalgam between a contractarian model and elements of the virtue-based approach, combined with appropriate empirical investigation, may yield richer models in the future.     

Clarifying conflict of interest

As the debate over how to manage or discourage physicians' financial conflicts of interest with the drug and medical device industries has become more heated, critics have questioned or dismissed the concept of "conflict of interest" itself. A satisfactory definition relates conflict of interest to concerns about maintaining social trust and distinguishes between breaches of ethical duty and temptations to breach duty. Numerous objections to such a definition have been offered, none of which prevails on further analysis. Those concerned about conflicts of interest have contributed to misunderstandings, however, by failing to demonstrate when social arrangements leading to temptations to breach duties are in themselves morally blameworthy. Clarifying "conflict of interest" is important if we are eventually going to develop productive modes of engagement between medicine and for-profit industry that avoid the serious ethical pitfalls now in evidence.     

Perceived discrimination and substance use in African American parents and their children: a panel study

The relation between perceived racial discrimination and substance use was examined in a panel of 684 African American families, using the prototype-willingness model of adolescent health risk (F. X. Gibbons, M. Gerrard, & D. Lane, 2003). Discrimination was concurrently and prospectively related to use in the parents and the children (mean age=10.5 years at Wave 1). The discrimination-->use relation in the parents was mediated by distress (anxiety and depression). Among the children, the relation was mediated by distress as well as their risk cognitions (favorability of their risk images and their willingness to use) and the extent to which they reported affiliating with friends who were using substances. Each of these relations with discrimination was positive. In contrast, effective parenting was associated with less willingness and intention to use. Theoretical and applied implications of the results are discussed.     

Mommy and Daddy like you best: perceived family favouritism in relation to affect, adjustment and family process

Perceived family favouritism and disfavouritism were explored in relation to college students' adjustment, affect and family process. The participants included 127 males and females and 62 of their siblings (age range 18–32 years). Sixty-five per cent of the participants reported favouritism in their families; 24% reported disfavouritism. There was modest sibling agreement on the presence of family favouritism/disfavouritism as well as on who in the family was doing the favouring or disfavouring. The presence of disfavouritism was found to relate to lower family cohesion, higher family disengagement and higher family conflict. Participants who perceived themselves to be disfavoured also reported more frequent shame and more intense fear. Participants who perceived themselves to be favoured reported less frequent shame. Results are discussed in the context of the empirical and clinical literature on sibling and family interaction and the differential treatment of siblings by parents. A clinical case example is provided to illustrate the results and to highlight the implications for family therapy.