Diagnosis: Use and abuse

Examples are given of the logical, moral, philosophical and practical consequences of confusing lay and technical terms; in particular, the tendency to replace normal english-language expressions with psychopathological diagnostic categories.     

Selective mutism in children: A structural family therapy approach to treatment

When children refuse to speak in some social settings, but can understand and speak in other settings, the diagnosis of selective mutism must be considered. A review of the literature describes the disorder, the various types of mutism, and related family dynamics. A family systems approach to treatment using structural family therapy is suggested. The case history presented illustrates one type of mutism as well as the family rules and hierarchy which appeared to be maintaining it. Structural and strategic family systems theory techniques that were used to move the family toward resolution of this problem are discussed.Diane Wolf Tatem, MA, MS, completed graduate work in marriage and family therapy at New Mexico State University, Las Cruces, NM. She is employed at Life Management Center of El Paso's Child Development Services and also has a private practice in marriage and family therapy in El Paso, Texas. Robert L. DelCampo, PhD is a professor of family science at New Mexico State University and maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, NM. Please address all correspondence to Dr. DelCampo at Box 3470, New Mexico State University, Las Cruces, NM, 88003-3470.Appreciation is expressed to Dr. Charles Huber, New Mexico State University in Las Cruces, for his insightful critique of the final draft of this paper. This paper was presented at the Texas Association for Marriage and Family Therapy Annual Conference, January 25–29, 1995 in Dallas, TX.     

Case study: Examining the relationship between self-initiations of an individual with disabilities and directive behavior of staff persons in a residential setting

This case study examines the relationship between self-initiations of an adult woman with severe disabilities and the directive behavior of staff persons in a community residential setting. Hypotheses generated from functional assessment procedures indicated that (a) Susan's low self-initiations were very likely related to high directive behavior of staff persons, and (b) infrequent problem behaviors during the morning routine were maintained by escape from repeated staff demands. An intervention was implemented to enable Susan to increase self-initiation in choice and sequence of activities and simultaneously decrease staff directives. Results and discussion focus on the need for a contextual approach for addressing problematic situations and an affirmation of the effectiveness of the positive behavioral support technology for increasing adaptive behaviors in individuals with severe disabilities.     

Resolving conflicts among principles: ranking, balancing, and specifying.

While much attention has been given to the use of principles in biomedical ethics and increasing attention is given to alternative theoretical approaches, relatively little attention has been devoted to the critical task of how one resolves conflicts among competing principles. After summarizing the system of principles and some problems in conceptualizing the principles, several strategies for reconciling conflicts among principles are examined including the use of single-principle theories (pure libertarianism, pure utilitarianism, and pure Hippocratism), balancing theories, conflicting appeals theories, and lexical ordering. Then a mixed strategy is proposed in which consequentialist principles are balanced between themselves as are nonconsequentialist principles, after which the result of balancing the nonconsequentialist principles is lexically ranked over the result of balancing the consequentialist ones. Finally, strategies involving specifying and rule generation are discussed concluding that most current specification and rule-generating theories must involve some degree of lexical ordering of principles.     

“How dare you sport thus with life?”: Frankensteinian fictions as case studies in scientific ethics

Fictional scenarios involving "hard" science offer what are in effect case studies of scientific ethics. From his analysis of Shelley's novel, biologist Leonard Isaacs constructed a model of a "Frankenstein scenario," applicable to the dilemmas posed by the advancement of science in our time, as well as to fiction about science by such contemporary writers as Robin Cook and Michael Crichton. The special contribution of fiction to the study of ethics is that it both reflects and evaluates reality's infinite permutations. In reflecting and judging, the fictional scenarios engage our moral imagination and compel us to confront our personal ethos in relation to the evolving ethos of science.     

Distributive justice and the minnesota health access initiative

As I have suggested, from the perspective of distributive justice MinnesotaCare's reforms are inadequate. But to coin (and alter slightly) a phrase of Kant's, if its authors do not deserve our moral esteem, perhaps they do merit our encouragement, and it is on a note of the latter that I will conclude. MinnesotaCare is an experiment in systemic incremental change being performed in a complex health care system, the only true laboratory for such an experiment. For this reason, it will provide us important information concerning the ethics, economics, [and] the politics of health care reform while improving the position of some Minnesotans in a significant way. Thus, while MinnesotaCare is susceptible to forceful moral criticism, as an experiment in reform it holds out the promise of providing us some of the data necessary for discovering a just solution.