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.     

Self-efficacy and depressive affect in college students

In an attempt to extend Bandura's theory of self-efficacy, we investigated the hypothesis that increases in self-efficacy, based on mastery experiences, would lead to improvements in mood and problem solving among dysphoric subjects.College students (N=79), classified as dysphoric or nondysphoric by the Beck Depression Inventory, were randomly assigned to anagram training groups that received bogus bar graphs suggesting either task ease or difficulty. Before and after training, subjects rated themselves on depressive affect (DACL) and self-efficacy. A difficult anagram task and a final DACL rating completed the procedure.Anagram training conditions did not lead to differential self-efficacy. However, multiple regression analyses showed that self-efficacy was related to depressive symptoms. Greater DACL decreases after training were seen in dysphoric subjects who reported higher posttraining self-efficacy. This improved mood is consistent with Bandura's theory. An unexpected finding among dysphoric subjects was that the higher their self-efficacy was, the lower was their final anagram performance. It appears that dysphoric/high self-efficacy subjects may have become more demoralized than dysphoric/low self-efficacy subjects when they encountered a need for much greater effort expenditure on the difficult anagram task.The findings suggest that skills training interventions which raise self-efficacy may be most effective in reducing depressive symptoms. The relevance of effort expenditure to the development of competine in depressed undiriduals appears to merit further investigation.where he served previously as Director of Clinical Psychology and as Chairperson of the Department of Psychology.Jeffrey Schwartz, Ph.D., a clinical psychologist, has been a staff member at the Cliffwood Mental Health Center in Englewood, New Jersey for the past five years. He is also engaged in private practice in New York City.Jefferson M. Fish, Ph.D., is Professor of Psychology at St. John's University in New York City, where he served previously as Director of Clinical Psychology and as Chairperson of the Department of Psychology.This paper is based on the first author's Ph.D. dissertation in Clinical Psychology at St. John's University under the direction of the second author. Both authors wish to thank Jeffrey Nevid and John Hogan for their support and contributions as committee members, and Marc Garcia for his invaluable assistance with data analysis. Requests for reprints should be addressed to the second author, Department of Psychology, St. John's University, Jamaica, New York 11439. All other correspondence should be directed to the first author at the same address.     

Intergroup aggression: its predictors and distinctness from in-group bias

Investigated predictors of intergroup aggression and its relations to in-group bias. In a questionnaire, 156 Israeli adults reported perceptions of their own religious group and of the ultraorthodox Jewish out-group and expressed aggression toward the ultraorthodox (opposing institutions that serve their needs, supporting acts harmful to them, and opposing interaction with them). Respondents showed in-group favoritism in trait evaluations, but this bias was unrelated to aggression. Perceived inter-group conflict of interests, the postulated motivator of aggression, predicted it strongly. The effects of conflict on aggression were partially mediated by 2 indexes of dehumanizing the out-group (perceived value dissimilarity and trait inhumanity) and by 1 index of probable empathy with it (perceived in-group-out-group boundary permeability). These variables related to aggression more strongly among persons who identified highly with their in-group. The variables also mediated the effects of religious group affiliation on aggression. The value dissimilarity finding supports derivations from belief congruence theory.     

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.