Ethical Issues in Cancer Genetics: 1) Whose Information Is It?

This article presents and discusses four clinical cases that exemplify the complexity of ethical dilemmas concerning the provider's obligation to disclose or withhold genetic information from patients. Case 1: What is the responsibility of the cancer genetics provider to ensure that a positive test results is shared with distant relatives? Case 2: To ensure that results go to at-risk relatives, do we have the right to ignore the wishes of the designated next-of-kin? Case 3: Do we have the right to reveal a familial BRCA1 mutation to a patient's relative, who is at 50% risk? Case 4: Do we have an obligation to reveal that a patient is not a blood relative and therefore, not at risk to have inherited a familial mutation? These cases form the basis for discussing the provider's dual obligations to keeping patient confidentiality and informing patients and families about risk (i.e. duty to warn). We also provide a summary of consensus points and additional discussion questions for each case.     

Goal-directedness and personal identity as correlates of life outcomes

Although much research has been conducted on goal setting, researchers have not examined goal-directedness or propensity to set goals as a stable human characteristic in adults. In this study, a survey was developed and distributed to 104 adult participants to assess their goal-directedness, personal identity, and various life outcomes. A theoretical model was developed and tested using structural equation modeling that proposed that both goal-directedness and personal identity should positivcly influence important life outcomes. Analysis showed that goal-directedness and personal identity are positively related to personal well-being, salary, and marital satisfaction. Further, personal identity was positively related to job satisfaction but, contrary to related research, goal-directedness did not predict job satisfaction.     

Use of latent semantic analysis for predicting psychological phenomena: Two issues and proposed solutions

Latent semantic analysis (LSA) is a computational model of human knowledge representation that approximates semantic relatedness judgments. Two issues are discussed that researchers must attend to when evaluating the utility of LSA for predicting psychological phenomena. First, the role of semantic relatedness in the psychological process of interest must be understood. LSA indices of similarity should then be derived from this theoretical understanding. Second, the knowledge base (semantic space) from which similarity indices are generated must contain “knowledge” that is appropriate to the task at hand. Proposed solutions are illustrated with data from an experiment in which LSA-based indices were generated from theoretical analysis of the processes involved in understanding two conflicting accounts of a historical event. These indices predict the complexity of subsequent student reasoning about the event, as well as hand-coded predictions generated from think-aloud protocols collected when students were reading the accounts of the event.     

论医学仁爱的条件性与有限性

“医学仁爱”是医学道德性质判断的一个常见命题,然而,基于对现实的思考,从个体自爱与爱他人的关系、医学对社会成员的选择性帮助是常态、人类的利他行为表达有诸多影响因素等方面论述了医学仁爱的条件性,又以医学人力资源的有限性、医学科学知识和技术能力的局限性、共情及其两面性、其他医疗资源的稀缺性等角度论证了医学仁爱的有限性。限于医学仁爱的条件性与有限性,需要进行医学德性隐喻祛魅、理解医学道德的有限性,且只有在全社会、医疗卫生系统和公众之间构建和施行其系统的道德行为准则,才能使医学回归其职业德性要求。     

To be or not to be a real object: Monitoring the therapeutic relationship

Psychoanalytic theorists have lately come to acknowledge what practicing clinicians have long recognized: the importance of flexibility in psychotherapeutic technique. Adjusting the transference-countertransference expectations to the developmental level of each particular patient has become increasingly necessary as psychodynamic therapists work in depth with a wider range of difficult patients.     

A PROSPECTIVE STUDY OF SOMATIC AND EMOTIONAL SYMPTOMS OF PREGNANCY

Using a prospective design, this study examined somatic and emotional symptoms of planned pregnancy in a sample of 162 healthy women. All women participated in a baseline (prepregnancy) interview. Seventy women became pregnant and were assessed at each trimester; the 92 nonpregnant controls were interviewed 3, 6, and 9 months after their baseline interview. All participants also completed the Anxiety and Depression subscales of the Symptom Checklist–Revised (SCL 90-R). No significant group differences were found at baseline. As expected, however, pregnant women reported significantly more instances of digestive symptoms (nausea, vomiting, heartburn), fatigue, and moodiness than nonpregnant controls. Discriminant-function analyses found that in the context of all symptom variables, nausea and fatigue were the primary distinguishing features of the first trimester. In the second and third trimester, fatigue and heartburn contributed to the distinction of pregnant and nonpregnant women. Although pregnancy precipitates many physical and psychological changes in this sample of women who had planned pregnancies, our results did not support the notion that pregnancy is either a time of significant emotional turmoil or of heightened emotional well-being.