自我保护性医疗的伦理扫描--论患方知情同意与医方规避风险

自我保护性医疗是近年来医方为应对医患关系重构而采取的一种行为模式,其本身和影响具有全新特点,充满价值冲突;这种行为模式,客观上是对应医疗风险尤其是重大医疗风险的;主观上同医方免责期待的张扬以及对知情同意的解读直接相关;因而,正当的自我保护性医疗既取决于医方合理的免责期待,以及改变对知情同意的误读,更依赖于自身的医学伦理综合素质的打造和完善。     

“WHITE CRISIS” AND/AS “EXISTENTIAL RISK,” OR THE ENTANGLED APOCALYPTICISM OF ARTIFICIAL INTELLIGENCE

In this article, I present a critique of Robert Geraci's Apocalyptic artificial intelligence (AI) discourse, drawing attention to certain shortcomings which become apparent when the analytical lens shifts from religion to the race–religion nexus. Building on earlier work, I explore the phenomenon of existential risk associated with Apocalyptic AI in relation to “White Crisis,” a modern racial phenomenon with premodern religious origins. Adopting a critical race theoretical and decolonial perspective, I argue that all three phenomena are entangled and they should be understood as a strategy, albeit perhaps merely rhetorical, for maintaining white hegemony under nonwhite contestation. I further suggest that this claim can be shown to be supported by the disclosure of continuity through change in the long‐durée entanglement of race and religion associated with the establishment, maintenance, expansion, and refinement of the modern/colonial world system if and when such phenomena are understood as iterative shifts in a programmatic trajectory of domination which might usefully be framed as “algorithmic racism.”     

Interparental conflict and risk behaviors among Mexican American adolescents: a cognitive-emotional model

This study used a cognitive-emotional model to examine the relations between multiple dimensions of interparental conflict and health risk behaviors among young adolescents. Participants were 151 Mexican American adolescents and their parents. At initial individual interviews, parents reported on conflict with their spouses, and adolescents reported on their parents' conflict, their appraisals of the conflict, their emotional distress, and their acculturation level. At 6-month follow-ups, adolescents reported on their risk behaviors, including substance use and sexual activity. In general, adolescents' acculturation level was not related to their risk behaviors. More frequent conflict, more conflict about the adolescent, more adolescent involvement in the conflict, and poor conflict resolution were related to greater emotional distress. More conflict about the adolescent, mothers being more demanding/dominating during conflict, and more adolescent involvement in the conflict were related to greater risk behaviors. Adolescents' cognitions mediated the link between two dimensions of parental conflict, frequency and resolution, and emotional distress. Adolescents' emotional distress mediated the association between adolescent involvement in parental conflict and adolescents' risk behaviors.     

Dimensions of Early Childhood Behavior Problems: Stability and Predictors of Change from 18 to 30 Months

The prevalence, structure, stability, and predictors of change in early behavior problems were examined in a population-based sample of Norwegian children at 18 and 30 months of age (N = 750). A clear factor structure involving four dimensions emerged at both assessment times: Two factors were characterized by externalizing behaviors and were labeled Social Adjustment and Overactive-Inattentive; one factor tapped internalizing problems and was labeled Emotional Adjustment; and the fourth, related to general immaturity, was labeled Regulation. Specific patterns of child and family risk factors were associated with stability and change over the two time points for each factor. Children with stable problems had the most problematic characteristics on all significant predictors, followed by children with problems at one, but not both, time points. The data suggest that it is possible to identify risk factors for stable problems at 18 months, allowing some prediction of those children whose problems will persist over early childhood. Since specific risk factors emerged for specific types of behavior problems, the results may provide some much-needed guidance to early intervention efforts.     

The Importance of Child and Adolescent Psychopathy

In commenting on the five articles in this special issue, this paper discusses (1) the concept of child and adolescent psychopathy, and whether adolescent psychopaths are qualitatively distinct from other young people; (2) the measurement of adolescent psychopathy; (3) the relationship between psychopathy and other personality dimensions; (4) childhood risk factors for psychopathy; (5) psychopathy in the context of risk factors for delinquency; and (6) the prevention and treatment of adolescent psychopathy. It is argued that the three dimensions of an arrogant, deceitful interpersonal style, deficient affective experience, and an impulsive or irresponsible behavioral style are most important at present in the definition of psychopathy. An ambitious research agenda is recommended, investigating the concept of adolescent psychopathy, developing new measures, conducting new longitudinal studies on development and risk factors, and mounting new randomized experiments on prevention and treatment.     

Trajectories of Peer-Nominated Aggression: Risk Status,Predictors and Outcomes

Developmental trajectories of peer-nominated aggression, risk factors at baseline, and outcomes were studied. Peer nominations of aggression were obtained annually from grades 1 to 3. Three developmental trajectories were identified: an early-onset/increasers trajectory with high levels of peer-nominated aggression at elementary school entry and increasing levels throughout follow-up; a moderate-persistent trajectory of aggression in which children were characterized by moderate levels of physical aggression at baseline; and a third trajectory with stable low levels of aggression. Children following the early-onset/increasers trajectory showed physical forms of aggression at baseline. Male gender and comorbid attention deficit/hyperactivity problems, oppositional defiant problems and poor prosocial behavior plus negative life events predicted which children would follow the early-onset/increasers trajectory of aggression. The outcomes associated with the early-onset/increaser children suggest high risk for chronically high levels of aggressive behavior.     

The Ethics of Type 1 Diabetes Prediction and Prevention Research

There are approximately one million cases oftype 1 diabetes in the US, and the incidenceis increasing worldwide. Given that two-thirdsof cases present in childhood, it is criticalthat prediction and prevention research involvechildren. In this article, I examine whethercurrent research methodologies conform to theethical guidelines enumerated by the NationalCommission for the Protection of Human Subjectsof Biomedical and Behavioral Research, andadopted into the federal regulations thatprotect research subjects. I then offer twopolicy recommendations to help researchersdesign studies that conform to these ethicalrequirements.     

Learning from the law to address uncertainty in the precautionary principle

Environmentalists have advocated the Precautionary Principle (PP) to help guide public and private decisions about the environment. By contrast, industry and its spokesmen have opposed this. There is not one principle, but many that have been recommended for this purpose. Despite the attractiveness of a core idea in all versions of the principle—that decision-makers should take some precautionary steps to ensure that threats of serious and irreversible damage to the environment and public health do not materialize into harm—even one of the most widely endorsed principles needs considerable specification and refinement before it can be used. Moreover, the PP is an approach or guide to utilizing scientific evidence in social or legal decision-making contexts. In this it does not differ in kind from other approaches to using factual information such as in the law. The law provides some models for different strategies to guide decision-making under uncertainty when factual issues cannot be resolved with certainty. These in turn can help guide the formulation of different versions of PP and help clarify some presuppositions of the principle. Once some plausible versions of PP are articulated, I suggest some applications to existing environmental problems.     

Behavioral and pharmacological variables affecting risky choice in rats.

The effects of manipulations of response requirement, intertrial interval (ITI), and psychoactive drugs (ethanol, phencyclidine, and d-amphetamine) on lever choice under concurrent fixed-ratio schedules were investigated in rats. Responding on the "certain' lever produced three 45-mg pellets, whereas responding on the "risky" lever produced either 15 pellets (p = .33) or no pellets (p .67). Rats earned all food during the session, which ended after 12 forced trials and 93 choice trials or 90 min, whichever occurred first. When the response requirement was increased from 1 to 16 and the ITI was 20 s, percentage of risky choice was inversely related to fixed-ratio value. When only a single response was required but the ITI was manipulated between 20 and 120 s (with maximum session duration held constant), percentage of risky choice was directly related to length of the ITI. The effects of the drugs were investigated first at an ITI of 20 s, when risky choice was low for most rats, and then at an ITI of 80 s, when risky choice was higher for most rats. Ethanol usually decreased risky choice. Phencyclidine did not usually affect risky choice when the ITI was 20 s but decreased it in half the rats when the ITI was 80 s. For d-amphetamine, the effects appeared to he related to baseline probability of risky choice; that is, low probabilities were increased and high probabilities were decreased. Although increase in risky choice as a function of the ITI is at variance with previous ITI data, it is consistent with foraging data showing that risk aversion decreases as food availability decreases. The pharmacological manipulations showed that drug effects on risky choice may be influenced by the baseline probability of risky choice, just as drug effects can be a function of baseline response rate.     

Pathways to Risk Among Inner-City African-American Adolescent Females: The Influence of Gang Membership

Differential rates of participation in three categories of risk behaviors (i.e., sexual activity, substance use, violence) were explored, comparing gang members to nonmembers, within a sample of 1,143 inner-city African American adolescent females. The relationship between gang membership and risk behavior also was examined, by exploring the association between a variety of microsystemic influences (e.g., gang, family, school) and participation in risk behaviors. MANOVA analyses indicated that gang members, relative to nonmembers, reported higher rates of participation in each of the three categories of risk behaviors. Stepwise linear regression analyses indicated that gang membership was the variable with the most consistent predictive ability, across all categories of risk, as it entered early in all equations and remained in all three final models after controlling for other statistically significant contextual variables. Findings suggest that intervention efforts aimed at reducing adolescent females' participation in sexual activity, substance use, and violence should consider the influence of gang membership on the participation in these behaviors.