By-Person Factor Analysis in Clinical Ethical Decision Making: Q Methodology in End-of-Life Care Decisions

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues.

Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix.

Setting: University medical center.

Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center.

Interventions: Presented with four hypothetical cases involving urgent decision making near the end of life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases.

Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r ² < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study.

Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies.     

How fallacious is the consequence fallacy?

Timothy Williamson argues against the tactic of criticizing confidence in a theory by identifying a logical consequence of the theory whose probability is not raised by the evidence. He dubs it “the consequence fallacy”. In this paper, we will show that Williamson’s formulation of the tactic in question is ambiguous. On one reading of Williamson’s formulation, the tactic is indeed a fallacy, but it is not a commonly used tactic; on another reading, it is a commonly used tactic (or at least more often used than the former tactic), but it is not a fallacy.     

License to Ill: The Effects of Corporate Social Responsibility and CEO Moral Identity on Corporate Social Irresponsibility

Although managers and researchers have invested considerable effort into understanding corporate social responsibility (CSR), less is known about corporate social irresponsibility (CSiR). Drawing on strategic leadership and moral licensing research, we address this gap by considering the relationship between CSR and CSiR. We predict that prior CSR is positively associated with subsequent CSiR because the moral credits achieved through CSR enable leaders to engage in less ethical stakeholder treatment. Further, we hypothesize that leaders’ moral identity symbolization, or the degree to which being moral is expressed outwardly to the public through actions and behavior, will moderate the CSR–CSiR relationship, such that the relationship will be stronger when CEOs are high on moral identity symbolization rather than low on moral identity symbolization. Through an archival study of 49 Fortune 500 firms, we find support for our hypotheses.     

Mood and Organizational Citizenship Behavior: The Effects of Positive Affect on Employee Organizational Citizenship Behavior Intentions

This study, involving 139 employees from a variety of industries, organizations, and positions in Singapore, measured the effects of mood on the intentions of employees to contribute actions that are organizationally desirable but are not part of their formal job requirements (organizational citizenship behavior). After effects of established patterns of historical organizational citizenship behavior, demographic characteristics, and employee positive and negative affectivity had been controlled, stepwise regression analysis revealed that the amount of positive affect currently experienced by an employee significantly influenced the employee's intention to perform specific acts of organizational citizenship.     

Single-digit Arabic numbers do not automatically activate magnitude representations in adults or in children: Evidence from the symbolic same–different task

We investigated whether the mere presentation of single-digit Arabic numbers activates their magnitude representations using a visually-presented symbolic same–different task for 20 adults and 15 children. Participants saw two single-digit Arabic numbers on a screen and judged whether the numbers were the same or different. We examined whether reaction time in this task was primarily driven by (objective or subjective) perceptual similarity, or by the numerical difference between the two digits. We reasoned that, if Arabic numbers automatically activate magnitude representations, a numerical function would best predict reaction time; but if Arabic numbers do not automatically activate magnitude representations, a perceptual function would best predict reaction time. Linear regressions revealed that a perceptual function, specifically, subjective visual similarity, was the best and only significant predictor of reaction time in adults and in children. These data strongly suggest that, in this task, single-digit Arabic numbers do not necessarily automatically activate magnitude representations in adults or in children. As the first study to date to explicitly study the developmental importance of perceptual factors in the symbolic same–different task, we found no significant differences between adults and children in their reliance on perceptual information in this task. Based on our findings, we propose that visual properties may play a key role in symbolic number judgements.     

Resilience is associated with better recovery in Chinese people diagnosed with coronary heart disease

This study investigated the impact of personal resilience (a composite measure of optimism, perceived control and self-esteem) on outcome measures in 67 Chinese coronary heart disease patients in response to an 8-week rehabilitation programme. The effect of personal resilience on posttraumatic growth attributed to the onset of heart disease was also examined. Results indicated that coronary heart disease patients high in personal resilience achieved better outcomes than those low in personal resilience, as indicated by higher physical and mental summary measures in SF-36, lower cholesterol levels and better performance on the 6?min walk test. Moreover, personal resilience was demonstrated to be a significant predictor of the level of posttraumatic growth although the rehabilitation programme exerted a weak mediating effect on the link between personal resilience and posttraumatic growth. Findings were discussed in relation to clinical implications of the construct of personal resilience and the intervention programme.     

Symptoms,blood-pressure information and mood effects on symptom recall

Abstract

After completion of an illness symptom checklist (PILL) covering the previous three months, 97 nor-motensives were allocated to either experimental (false pressor feedback, n=42), or information control (accurate pressor feedback, n = 55), groups. The median reported symptom score divided high from low symptom subjects. All were given standard cuff blood pressure (BP) assessment and were normotensive. However, experimental subjects were misinformed that their BP was raised while information control subjects were told their BP was normal. Subsequently, subjects completed the state anxiety form of the State-Trait Personality Inventory, the PILL, and were asked about their belief of the ascribed BP label (normo/hypertensive) and then any perceived causal relationship between their BP and symptoms. Experimental subjects had significantly higher anxiety scores but no change in symptom recall after pressor feedback, whereas control subjects showed lower anxiety scores and decreases in symptom recall.

A post hoc treatment control (no pressor information) group (n = 20) excluded effects of BP labeling on post-BP scores, and a post hoc symptom control group (n = 55) ensured that symptom levels were representative of the normal population. The majority of subjects in both groups rejected any association between BP labels and symptoms. Data are discussed in the light of Leventhal's models of illness representation.     

CONFUCIAN ENVIRONMENTAL ETHICS,CLIMATE ENGINEERING,AND THE “PLAYING GOD” ARGUMENT

The burgeoning literature on the ethical issues raised by climate engineering has explored various normative questions associated with the research and deployment of climate engineering, and has examined a number of responses to them. While researchers have noted the ethical issues from climate engineering are global in nature, much of the discussion proceeds predominately with ethical framework in the Anglo‐American and European traditions, which presume particular normative standpoints and understandings of human–nature relationship. The current discussion on the ethical issues, therefore, is far from being a genuine global dialogue. The aim of this article is to address the lack of intercultural exchange by exploring the ethics of climate engineering from a perspective of Confucian environmental ethics. Drawing from the existing discussion on Confucian environmental ethics and Confucian ethics of technology, I discuss what Confucian ethics can contribute to the ethical debate on climate engineering.     

Cost Sharing and Hereditary Cancer Risk: Predictors of Willingness-to-Pay for Genetic Testing

Increasing use of predictive genetic testing to gauge hereditary cancer risk has been paralleled by rising cost-sharing practices. Little is known about how demographic and psychosocial factors may influence individuals’ willingness-to-pay for genetic testing. The Gastrointestinal Tumor Risk Assessment Program Registry includes individuals presenting for genetic risk assessment based on personal/family cancer history. Participants complete a baseline survey assessing cancer history and psychosocial items. Willingness-to-pay items include intention for: genetic testing only if paid by insurance; testing with self-pay; and amount willing-to-pay ($25–$2,000). Multivariable models examined predictors of willingness-to-pay out-of-pocket (versus only if paid by insurance) and willingness-to-pay a smaller versus larger sum (≤$200 vs. ≥$500). All statistical tests are two-sided (α?=?0.05). Of 385 evaluable participants, a minority (42 %) had a personal cancer history, while 56 % had ≥1 first-degree relative with colorectal cancer. Overall, 21.3 % were willing to have testing only if paid by insurance, and 78.7 % were willing-to-pay. Predictors of willingness-to-pay were: 1) concern for positive result; 2) confidence to control cancer risk; 3) fewer perceived barriers to colorectal cancer screening; 4) benefit of testing to guide screening (all p?p?相似文献   

Association of Depressive Symptomatology and Elder Mistreatment in a U.S. Chinese Population: Findings From a Community-Based Participatory Research Study

Elder mistreatment (EM) is associated with increased morbidity and mortality. The objective of this study is to examine the association between depressive symptoms and EM in a U.S. Chinese population. A community-based participatory research approach was implemented to partner with the Chicago Chinatown population. Self-reported EM was assessed using a modified Vulnerability to Abuse Screening Scale instrument. Depressive symptomatology was assessed using the short form Geriatric Depression Scale. Exact logistic regression was used to assess these associations. Of the 78 participants, mean age was 74.8 (SD = 7.8) years and 52.6% were women. EM was reported in 20.5% of participants. After adjusting for potential confounding factors, higher numbers of depressive symptoms were independently associated with increased risk of EM (Exact OR, 1.99, 95% CI [1.23, 3.41]). Interaction terms analyses suggest that higher educational levels might buffer the risk of EM associated with depressive symptoms. Longitudinal studies are needed to confirm these findings in this U.S. Chinese population.