Clinical ethics consultations: reasons for optimism, but problems exist

[The author identifies] five problems familiar to clinical ethicists. (1) Physicians often do not recognize important ethical issues. (2) Debate exists over whether such consultations should give specific management recommendations. (3) Principles of medical ethics cannot, by themselves, resolve real ethical issues. (4) The patient's interests sometimes conflict with the interests of the family, the health professionals, and the hospital. (5) Clinical ethics consultations take a toll on the consultant....[He] discuss[es] the implications of each problem for clinical ethics consultations and offer[s] a solution to it.     

Differential predictability of preferences and choices

A combined multi-attribute utility and expectancy-value model has repeatedly been found to yield a worse fit to choices than to preference ratings. The present study investigated two possible explanations for this finding. First, people's belief-value structures may change in the choice task as they try to find the best alternative. Second, a difficult choice task may cause the decision maker to use simplifying heuristics. In the first of two experiments, subjective belief-value structures were measured on two occasions separated by about one week. Immediately before the second measurement, different groups of subjects performed a choice task, gave preference ratings, or performed a control task. The results did not support an interpretation of the greater difficulty of predicting choices in terms of changes in belief-value structures. However, the notion of simplifying heuristics received support by the finding that adopting simpler versions of the original model improved the predictions of the choices. In the second experiment, beliefs were measured immediately before or after each of a series of choices or preference ratings. The results indicated that although temporary changes in beliefs may occur, they can hardly provide a full account of the differential predictability of preferences and choices.     

Determinants of Mediator Behavior: A Test of the Strategic Choice Model1

The present study simulated an organizational dispute to test 12 hypotheses about mediator behavior that were derived from the strategic choice model of mediation. This model is based on the assumption that mediators have four basic strategies to resolve disputes: (a) integrate, which involves a search for mutually acceptable outcomes; (b) press, which involves lowering one or both parties' aspirations; (c) compensate, which involves offering positive benefits in exchange for concessions; and (d) inaction, which involves letting the parties handle the dispute by themselves. The major proposition of the model is that two factors, the mediator's assessment of the likelihood of a mutually acceptable agreement and the mediator's concern for the parties' aspirations, interact to predict mediator behavior. Nine of the 12 hypotheses derived from the model were supported. Pressing by mediators occurred most when mediators had a low estimate of the likelihood of agreement in combination with a low concern for the parties' aspirations. Compensating occurred most when mediators had a low estimate of the likelihood of agreement in combination with a high concern for the parties' aspirations. Inaction occurred most when the mediators' estimate of the likelihood of agreement was high and their concern for the parties' aspirations was low. Integrating occurred most when the mediators had a high concern for the parties' aspirations.     

Fundamentalist religion and its effect on mental health

The national self-help group, Fundamentalists Anonymous (F.A.), has focused attention upon mental problems that may be caused or exacerbated by authoritarian religion. In this article we outline assertions about the mental problems caused by membership in fundamentalist religion, illustrate these with two case histories, briefly discuss intervention strategies, and describe conceptual and empirical issues. While former members have presented problems severe enough to warrant professional treatment, a causal link between their symptoms and their religious membership has not yet been established, because there is little empirical work on the subject.An earlier version of this paper was presented at the annual meeting of the American Psychological Association in New York in August 1987.The authors express gratitude to Stephen Strack, Ph.D.; Robert Meagher, Ph.D.; Herman Feifel, Ph.D.; and Ted Schoenberger, M.D., for their helpful comments on previous drafts of this paper.     

The pathological left-handedness syndrome

A clinical syndrome of pathological left-handedness (PLH) is proposed to identify the pattern of correlative changes in lateral development associated with early brain injury in some manifest left-handers. This syndrome is believed to be caused by a hemispheric lesion that is predominantly left-sided (or bilateral asymmetric), which onsets before Age 6, and which encroaches upon the critical speech zones of the frontotemporal/frontoparietal cortex. The pattern of changes may include any or all of the following features: shifts in manual dominance, trophic changes in the extremities, transfer of hemispheric speech, and/or intrahemispheric reorganization of visuospatial cognitive functions. Although some of these correlates of PLH have long been known, they have not been recognized as an interrelated pattern of traits that constitute a clinical syndrome. Identification of these individuals, all manifest left-handers, will be shown to have implications for diagnosis/remediation and for models of recovery of function.     

Statistical consistency and hypothesis testing for nonmetric multidimensional scaling

The properties of nonmetric multidimensional scaling (NMDS) are explored by specifying statistical models, proving statistical consistency, and developing hypothesis testing procedures. Statistical models with errors in the dependent and independent variables are described for quantitative and qualitative data. For these models, statistical consistency often depends crucially upon how error enters the model and how data are collected and summarized (e.g., by means, medians, or rank statistics). A maximum likelihood estimator for NMDS is developed, and its relationship to the standard Shepard-Kruskal estimation method is described. This maximum likelihood framework is used to develop a method for testing the overall fit of the model.     

Response selection strategies and realism of confidence judgments

Two studies were conducted to examine how response selection strategy is related to confidence ratings and to performance on general knowledge questions. In both studies subjects were asked to answer 80 general knowledge questions and to rate their confidence in the correctness of the answer selected. A pilot study, in which subjects thought aloud while answering general knowledge questions, was carried out to identify different response selection strategies. In the first study, 40 subjects were asked to indicate which of four strategies (immediate recognition, inference, intuition, or guessing) they used for selecting an answer. In Study 2, think aloud reports from 20 subjects were coded into the same four strategies. The distribution of strategies differed between the studies, but there were very similar relations among strategy, confidence, and correctness of answer in the two studies. Response selection strategy was related to correctness of answer when confidence was partialed out. More specifically, immediate recognition was associated with higher proportion correct than with the other strategies. It was also found that ratings of how difficult the knowledge questions were to fellow students of the subjects were on a much more realistic level than the confidence ratings were. It is concluded that people could improve their confidence judgments by taking into account (a) how difficult a question is to other people, and (b) the response selection strategy used for answering the question.     

The relations between type A behavior, clinically relevant behavior, academic achievement, and IQ in children

The relation of Type A behavior to IQ, academic achievement, and several clinically relevant dimensions of behavior in children was assessed in 873 fourth, fifth, and sixth graders by means of the Matthews Youth Test for Health (MYTH), the Cognitive Abilities Test (CAT), the Iowa Tests of Basic Skills (ITED), and the teachers' form of the Missouri Children's Behavior Checklist (MCBC-T). The MYTH and its competitiveness and impatience-aggression subscales were found to be differentially related to academic achievement and to account for a small but significant portion of the variance in achievement not accounted for by IQ. The subscales of the MYTH were found to be highly correlated with several clinically familiar dimensions of children's behavior. The significance of these findings for the construct validity of the MYTH is discussed.