Physicians,entrepreneurism and the problem of conflict of interest

This paper examines the ethical issues of conflict of interest raised by the burgeoning development of physician involvement in for-profit entrepreneurial activities outside their practice. After documenting the nature and extent of these activities, and their potential for conflicts of interest, the paper assesses the major arguments for and against physicians' referral of patients to facilities they own or in which they invest. The paper concludes that an outright ban on such activity seems ethically warranted.     

HIV and the obligation to treat

The paper is an attempt to review the basis for the claim that physicians have a professional obligation to treat AIDS patients. Considered are the historical record, two professional codes of ethics, and several recent articles. The paper concludes that the arguments considered, which attempt to support the claim that physicians have an obligation to treat, fail. It is suggested, rather, that common humanity, which physicians share with those who suffer from AIDS, ought to be the basis for engaging in the care of AIDS patients.     

Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

Child and adolescent services research at the national institute of mental health: Research opportunities in an emerging field

This article describes an important new area of research on services for children and adolescents with mental disorders at the National Institute of Mental Health, the parameters of mental health services research for youth, and the opportunities that are available for grant-funded investigations in this area.     

Linking qualitative and quantitative methods in cross-cultural survey research: Techniques from cognitive science

Survey research with diverse cultural and ethnic minority groups is a complex and challenging endeavor that confronts the researcher with problems related to linguistic and conceptual equivalence and measurement as well as problems related to difficulties that respondents have with the sociocultural dimensions of the survey/interview process. One way to improve the quality of cross-cultural surveys and to insure that the findings are culturally relevant and accurate is to combine qualitative and quantitative methods. This paper proposes that certain qualitative techniques from cognitive science, specifically cognitive anthropology and cognitive psychology, are particularly well suited to being combined with survey research. These techniques provide information corresponding to the underlying thought processes of respondents and enable researchers to better understand how different cultural and ethnic groups construe the world. The information obtained can be used improve the formulation of survey questions, design and structure questionnaire formats to coincide with the way particular groups organize concepts, and help researchers understand difficulties respondents may have with the survey/interview process. In addition, the techniques produce data that are easily codifiable and more manageable than traditional qualitative techniques including participant observation and in-depth interviews.     

Medical education: The training of ethical physicians

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.I wish to thank Dr. Mary Ann Cutter and Melissa M. Amaro for their critical suggestions.     

Brief report: Complex postformal thought in skilled research administrators

Expert research administrators responded to questions to determine to what degree they had postformal thinking skills. Postformal theory suggests that the interpersonal and institutional complexity of work roles would make them likely to exhibit postformal thought. The tests included a questionnaire about the use of postformal operations on the job, and thinking-aloud taped interviews of responses to job-related and standard postformal problems. The respondents demonstrated the use of postformal thinking operations on job-related tests and a more moderate degree of use on the standard problems. The results support prior research and our working hypothesis that a high degree of interaction with people and complex problems is associated with adults' postformal thought.     

Whose Gene Is It? A Case Discussion About Familial Conflict over Genetic Testing for Breast Cancer

A multidisciplinary group of genetic and other professionals discuss a complex case of familial conflict over access to genetic information. One twin wishes to know the results of her deceased mother's tests for BRCA1 mutations; a second twin objects to researchers making this information available. As the case discussion unfolds, the apparent facts of this case are called into question and the lines of ethical certainty become less clear.     

The responsibility of engineers, appropriate technology, and lesser developed nations

Projects importing technology to lesser developed nations may raise five important concerns: famine resulting from substitution of cash crops for subsistence crops, the use of products banned in the United States but permitted overseas, the use of products safe in the U.S. but unsafe under local conditions, ecological consequences of technological change, and cultural disruption caused by displacing traditional ways of life. Are engineers responsible for the foreseeable hunger, environmental degradation, cultural disruption, and illness that results from the project? Are engineers guilty of paternalism if they refuse to accept the project for that reason? Criteria are given to help engineers assess the extent of their responsibility when working in lesser developed nations.