Ethics in health care and medical technologies

In this paper a case is used to demonstrate how ethical analysis enables health care professionals, patients and family members to make treatment decisions which ensure that medical technologies are used in the overall best interests of the patient. The claim is made and defended that ethical analysis can secure four beneficial outcomes when medical technologies are employed: (1) not allowing any medical technologies to be employed until the appropriate decision makers are identified and consulted; (2) insisting that medical technologies be employed not merely to promote the medical interests of the patient but rather on the basis of their ability to contribute to the overall well-being of the patient; (3) challenging caregivers to reflect on the dynamic interplay between their conscious and unconscious values and consequent determinations of what is in the patient's best interests; and (4) providing a justification for selected interventions which makes possible rational dialogue between caregivers espousing different viewpoints about treatment options.     

Toward a new conceptualization and operationalization of risk perception within the genetic counseling domain

The purpose of this paper is twofold. First, it provides an historical overview of studies of risk, risk perception, and decision making under risk within the genetic counseling domain. Second, it proposes an alternative conceptualization and operationalization for the study of risk perception. The conceptualization involves probability, adversity, incompleteness, and ambiguity. Prior studies of risk perception focus on the recurrence risk and operationalize risk perception by asking for interpretations of the magnitude of the probability of the outcome. Their focus is on the probability of a particular outcome. We formulate the problem in terms of a gamble and suggest that risk perception be operationalized in terms of the riskiness of the gamble. Our focus is on the riskiness of a decision option which entails two or more outcomes.     

Natural ways are better: Adolescents and the ‘anti-obesity’ gene

Empirical research with young people in Finland, Germany, Spain and Britain was carried out as part of the BIOCULT project funded by the European Union. The project focused on their attitudes to biotechnology and, in particular, the formation of arguments about risk and safety. This paper looks at the responses of 14–18 year olds to a story about the so called anti-obesity gene, in the form of advice to a friend who is taking it. The majority advised against taking it with some differences by gender and country. Most reservations were on grounds of safety and the feeling that ‘natural’ ways to lose weight are better: A minority questioned the idea of striving for a ‘perfect’ body. The types of arguments used by the young people reveal underlying perspectives on the place of human beings in the world and whether they have a right to manipulate nature and their own bodies. Marie Levitt is a sociologist with research interests in attitudes and values in relation to biotechnology, health and religion.     

Enhancing Classroom Performance: A Review of Reinforcement Schedules

During the past decade the application of elementary principles of behavior have become a standard in the classroom teacher's repertoire of behavior change strategies. Unfortunately, the application of more advanced principles of behavior derived through basic behavioral research lies as an untapped resource for classroom teachers. Nowhere is this more apparent than in the use of systematic procedures to deliver reinforcers to enhance academic performance. In this paper we provide educators with information on the use of reinforcement schedules in academic settings. Various schedules of reinforcement are presented along with examples of their application in applied settings.     

The specific action of different personality risk factors on cancer of the breast, cervix, corpus uteri and other types of cancer: A prospective investigation

We report the results of a prospective study of a random sample of 1353 elderly but healthy men and women who were followed up for a period of 10 yr, when mortality and cause of death were ascertained. Overall results have been reported elsewhere for mortality from cancer, coronary heart disease and other causes; here we are concerned with the personality factors predicting breast cancer, cervical cancer, cancer of the corpus uteri specifically, as well as other types of cancer in women. Ten specific hypotheses were tested, using specially constructed questionnaires for the purpose, and for most of these statistically significant support was obtained. The results justify belief that specific types of cancer may be related to specific stress/personality factors.     

Apocalyptic Argument and the Anticipation of Catastrophe: the Prediction of Risk and the Risks of Prediction

This essay proposes to extend the model of apocalyptic argument developedin my recent book Arguing the Apocalypse (OLeary, 1994) beyond the study ofreligious discourse, by applying this model to the debate over awell-publicized earthquake prediction that caused a widespread panic in theAmerican midwest in December, 1990. The first section of the essay willsummarize the essential elements of apocalyptic argument as I have earlierdefined them; the second section will apply the model to the case of the NewMadrid, Missouri, earthquake prediction, in order to demonstrate thatcertain patterns of reasoning characteristic of religious apocalyptic arepresent in the discourse over an anticipated local disaster. My ultimatepurpose is to show that predictions of global and local catastrophe mayserve as extreme cases that will illuminate the dynamics of predictiveargument in general. Thus my argument will seek to undercut Daniel Bellsdistinction between prophecy and prediction (Bell, 1973) by establishingthat these discourses share identifiable formal and substantivecharacteristics, and depend for their rhetorical effect on anxiety, hope,far, and excitement as modes of temporal anticipation.     

Courteous service: Its assessment and modification in a human service organization

We evaluated strategies to increase behaviors associated with courteous provision of service by 3 staff members of a human service agency. Training included written instructions, practice, and performance feedback. A lottery procedure was introduced to maintain courteous service after training. The results of a multiple baseline design across the 3 participants showed marked increases in courteous behaviors following training. These effects were maintained at 3-, 5-, and 8-month follow-ups. Consumers' satisfaction with service also increased. These findings suggest that simple training and reinforcement procedures can enhance courtesy afforded those who receive service from public and nonprofit organizations.     

EFFECTS OF A VOICE OUTPUT COMMUNICATION AID ON INTERACTIONS BETWEEN SUPPORT PERSONNEL AND AN INDIVIDUAL WITH MULTIPLE DISABILITIES

We evaluated a means of increasing staff members' interactions with an individual with multiple disabilities through use of a voice output communication aid (VOCA). When activated, the VOCA allowed the individual to communicate through synthesized speech. Results indicated that staff members interacted with the individual more frequently when she had access to the VOCA, suggesting that VOCAs may represent an alternative to more traditional staff management programs for increasing interactions.     

Risk perception and the location of a repository for spent nuclear fuel

This study investigates lay people's reactions to a repository for nuclear waste. Risk perception is seen as a complex concept, comprising both affective and cognitive components. Attitude towards nuclear power and trust in experts and authorities had a substantial impact on risk perception, while personal knowledge about nuclear waste disposal had no effect. Thus, the more positive one's attitude towards nuclear power is and the more trust one has in experts and authorities, the lower one's risk perception is. Also, reactions were expected to vary with distance between the home district and the location of a repository. These variations differed in nature for people with alternative levels of risk judgement. The distance between the home and a repository affected approval of the proposed site. Distance between home and repository also had an effect on risk feelings and somewhat less on beliefs about consequences. Estimated total risk was directly mediated by beliefs about consequences, but even more so by risk feelings. With regard to risk, one can conclude that it is important to make a distinction between an emotional and a cognitive component of risk perception.     

My place,your place,and no place: Behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore,Maryland

Information is sparse on the social context of illicit drug injection behaviors and their relationship to HIV infection. This study examined relationships between injection settings, injecting with others, and HIV risk behaviors of sharing needles and not cleaning contaminated needles in a sample of 630 inner-city injecting drug users in Baltimore, MD. Through open-ended interviews, five primary settings of injection behavior were identified. These settings included one's own, friends' and mother's residence, shooting galleries, and semipublic areas. Most participants reported injecting in their own residence (92%) and friends' residence (86%) in the prior 6 months. In a multiple regression analysis, injecting at friends' residence, in shooting galleries, and in semipublic areas and frequency of injecting with others were significantly associated with frequency of sharing uncleaned needles, “slipping” (i.e., failure to disinfect shared needles), and not always cleaning used needles before injecting. Results suggest that interventions may benefit from targeting settings as well as behaviors to reduce the spread of HIV. This research was supported by grants DA04334, DA05911, DA06313, and DA08985 from the National Institute on Drug Abuse.