Prevention ethics: explicating the context of prevention activities

Research and intervention involving primary prevention [related to mental health and psychology] have grown dramatically in the past 10 years. However, little attention has been paid to ethical issues in primary prevention. This article proposes a framework for increasing awareness of such issues. The framework centers on explicating the contexts where prevention activities occur and the roles adopted by interventionists engaging in these activities. Several assumptions underlying primary prevention are stated, and ways of clarifying ethical issues are proposed.     

Psychology ethics down under: a survey of student subject pools in Australia

A survey of the 37 psychology departments offering courses accredited by the Australian Psychological Society yielded a 92% response rate. Sixty-eight percent of departments employed students as research subjects, with larger departments being more likely to do so. Most of these departments drew their student subject pools from introductory courses. Student research participation was strictly voluntary in 57% of these departments, whereas 43% of the departments have failed to comply with normally accepted ethical standards. It is of great concern that institutional ethics committees apparently continue to condone, or fail to act against, unethical research practices. Although these committees have a duty of care to all subjects, the final responsibility for conducting research in an ethical manner lies with the individual researcher.     

Case vignette: premature surrender

Three commentaries are offered on the following case: George, age 57, is a previously healthy man who recently underwent surgery for removal of a low-grade malignant thymoma. At the time of admission to the hospital, George stressed to the staff that he had long ago signed a "living will," which he renewed immediately after he learned of his cancer diagnosis. At the time of surgery, the tumor was found to extend into his mediastinum; although it was removable, this required revision of part of the sternum and grafting of the vessels feeding the heart chambers. Because of the resultant tissue damage and neuronal hyperactivity, George experienced postoperative episodes of cardiac arrhythmia and bronchospasm. Unanimous medical opinion was that this situation was a temporary problem that would resolve itself as the tissues healed. Until that time, however, it will be difficult to wean him from ventilatory support. When his stay in the intensive care unit became prolonged, George and his family began to insist that his status be changed to "do not resuscitate" and reminded the staff about his longstanding living will. All of this is happening despite the fact that the patient and family seemingly comprehend that although the short-term interventions are invasive, there is a high probability of a successful outcome. George's cancer prognosis is excellent, and, although he may well have an episode of life-threatening arrhythmia, he is likely to respond to resuscitation interventions. Once the immediate postoperative period is over, his potential for a long and productive life with full capacities is excellent. Consider the following questions: (a) Should George's expressed wishes be respected, or should the staff take additional steps to help him survive the postoperative period, even if that means violating his stated wishes? and (b) What steps might the staff follow in sorting through this problem?     

The design and use of the Bioethics Consultation Form

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.     

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.     

Developmental sequences in the age of onset of disruptive child behaviors

Retrospective and prospective reports of the onset of disruptive child behaviors were analyzed in a sample of clinic-referred boys. The younger boys (ages 7–9 years), compared with the older boys (ages 10–12 years), showed the highest level of disruptive behavior and, judging from mothers' reports, had the fastest progression of onsets from less serious to more serious problem behaviors. Despite some overlap, developmental sequences in problem behavior within the domains of hyperactivity/inattention, oppositional behavior, and conduct problems were similar across the two age groups. This was also the case for developmental sequences of overt or confrontive problem behaviors and covert or concealing conduct problems. Sequences of the onset of oppositional behavior and conduct problems were validated through prospective data, based on the information from mothers, teachers, and boys themselves. The implications of the findings are discussed for the formulation of developmental pathways of behavior and the analysis of causal factors.     

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.     

Reducing problem behaviors in a residential unit using structural analysis and staff management procedures: A preliminary study

A structural analysis of the problem behaviors of 32 adults with mental retardation living together in a residential facility showed that a disproportionate number of these behaviors were associated with a period of time scheduled for leisure activities. A staff management program was implemented during this time which included activity and staff scheduling, staff inservice training, and staff performance monitoring and feedback. The results showed an 83% decrease in problem behaviors when the program was implemented during the leisure period and no decrease in problem behaviors during adjacent time periods where the program was not utilized. Follow-up assessments indicated maintenance of these decreased levels of behavior at 3 and 6 months. It was concluded that this approach of combining a structural analysis with staff management procedures was effective in reducing a high level of problem behavior in a residential setting. The results are discussed with regard to pragmatic strategies for the pretreatment analysis of problem behaviors in residential settings, and the role of organizational behavior management techniques in habilitative programing for individuals with behavior disorders.