Ethical issues in genetic counseling: A comparison of M.S. counselor and medical geneticist perspectives

New technologies available in the field of medical genetics have increased the importance of responsible ethical decision-making among genetic counselors. A 1985 national survey of M.D. and Ph.D. genetic counselors assessed ethical attitudes using case scenarios designed to simulate dilemmas faced in genetic counseling (Wertz and Fletcher, 1988b). The current study focuses on attitudes of M.S. genetic counselors using similar scenarios, allowing for effective comparisons. M.S. counselors were more willing than M.D. and Ph.D. counselors to maintain patient confidentiality when screening for Huntington's Disease and occupational diseases, and a greater number would agree to counsel patients pursuing prenatal testing for sex selection. A majority of M.S. counselors would disclose an XY karyotype to a phenotypically female patient. M.S. counselors reasoned that respect for patient autonomy and patient confidentiality justified their decisions in many cases. The importance of these principles is discussed and questioned.     

Advance Directives Outside the USA: Are They the Best Solution Everywhere?

This article evaluates the potential role of advance directives outside of their original North American context. In order to do this, the article first analyses the historical process which has promoted advance directives in recent years. Next, it brings to light certain presuppositions which have given them force: atomistic individualism, contractualism, consumerism and entrepreneurialism, pluralism, proceduralism, and American moralism. The article next studies certain European cultural peculiarities which could affect advance directives: the importance of virtue versus rights, stoicism versus consumerist utilitarianism, rationalism versus empiricism, statism versus citizens' initiative, and justice versus autonomy.The article concludes by recognising that autonomy has a transcultural value, although it must be balanced with other principles. Advance Directives can have a function in certain cases. But it does not seem adequate to delegate to advance directives more and more medical decisions, and to make them more binding everyday. It is indispensable to develop other decision-making criteria.     

关于幼儿对损人行为的道德判断及有关情绪预期的初步研究

以幼儿易于理解的有关享用财物的小故事,对４、５、６岁儿童作个别随访,综合考察其已获得的道德知识和道德认知的特点,以及相关情绪预期的情况。结果表明：１．幼儿已经获得了有关社会道德的最初步的知识,并能运用这些日常概念水平的知识对行为作道德判断,其道德认知已出现关心他人利益的成分,自我中心主义不突出;２．幼儿假设自己作为损人者的情绪预期与对故事中损人者的情绪预期之间存在明显差异,道德认知与道德情感脱节的现象在前者未有明显表现,却在后者中显现出来。     

Family history and gender roles: Critical factors in practitioners' views of family interactions

This study examined practitioners' perceptions of family and individual family member functioning in relationship to family roles, gender of family leadership, beliefs about the consequences of maternal employment, and paternal division of responsibility in practitioner family of origin. Practicing counselors and mental health therapists rated two videotaped family interviews, one demonstrating a matriarchal style of family interaction and the second a patriarchal style. Findings indicated that practitioners were vulnerable to view a patriarchal style of family interaction as more healthy in comparison to a matriarchal style and that their perceptions of family members were related to personal beliefs about the consequences of maternal employment and to personal family history. These and other findings suggest that practitioners may be prone to errant perceptions and misguided intervention related to personal history and attitudes.     

Frequency of measurement and data utilization as factors in standardized behavioral assessment of academic skill

A study was conducted to investigate the effects on students' spelling achievement of variations in teacher assessment procedures. Teachers measured student spelling performance at a constant level of task difficulty using different measurement frequencies and different rules to interpret the data. Each teacher wrote two consecutive 3-week goals for improved spelling performance for two sets of 100 spelling words and then measured student performance either daily or weekly by dictating randomly selected words from each 100-word list. Teachers were trained to apply either a predetermined set of decision rules or their own judgment to the data to decide if the spelling program they had implemented for the student was effective. Ineffective programs were changed or modified. Results indicated that daily measurement was significantly more effective than weekly measurement in increasing spelling achievement and that, under certain conditions, decision rules were more effective than teacher judgment in determining when to make program changes or modifications.This research was conducted pursuant to Contract 300-77-0491 between the Bureau of Education for the Handicapped (now called Special Education Programs) and the University of Minnesota Institute for Research on Learning Disabilities.     

医疗纠纷处理中若干伦理问题的思考

医疗纠纷的增势和处理难已成为众所周知的事实。但是,在医疗纠纷处理中存在着医患关系的信任性、医疗事故鉴定的公正性和经济裣的合理笥是思考的伦理问题。只要医患双方、乃至社会对诸如医疗行为是否等同于一般的服务行为、病人权益是否等同于消费者权益、医疗事故鉴定是不是医医相护、经济裣能不能实行等价赔偿原则、医疗差错要不要给予经济补偿等有效为统一的认识,就会有利于医疗纠纷的处理,有利于维护医患双方的合法权益,有利     

Relativist ethics, scientific objectivity, and concern for human rights

This paper comments on the conflict between ethical relativism and anthropologists’ concerns with rights, and tries to show that neither scientific objectivity nor respect for cultural diversity require denying an extracultural stance for ethical judgments. An earlier version of this paper was presented at a symposium entitled “Ethics in Science: Special Problems in Anthropology and Archaeology” held at the 1998 Annual Meeting of the American Association for the Advancement of Science (AAAS), Philadelphia, PA, 15 February, 1998.     

Research ethics committees: a regional approach

Guidelines for Institutional Review Boards (IRBs) or research ethics committees exist at national and international levels. These guidelines are based on ethical principles and establish an internationally acceptable standard for the review and conduct of medical research. Having attained a multinational consensus about what these fundamental guidelines should be, IRBs are left to interpret the guidelines and devise their own means of implementing them. Individual and community values bear on the interpretation of the guidelines so different IRBs attain different levels of effectiveness. In the Caribbean and Pan American regions there are few IRBs. Obstacles to the establishment and function of IRBs are exacerbated in developing regions like these by differences in language, literacy, and local value systems; education, administrative expertise, facilities, and access to information are also limited. A regional IRB network might facilitate more uniform ethical review in developing countries, and simplify IRB procedures. This revised version was published online in August 2006 with corrections to the Cover Date.     

Ethics and Social Science: Which Kind of Co-operation?

The relation between ethics and social science is often conceived as complementary, both disciplines cooperating in the solution of concrete moral problems. Against this, the paper argues that not only applied ethics but even certain parts of general ethics have to incorporate sociological and psychological data and theories from the start. Applied ethics depends on social science in order to asses the impact of its own principles on the concrete realities which these principles are to regulate as well as in order to propose practice rules suited to adapt these principles to their respective contexts of application. Examples from medical ethics (embryo research) and ecological ethics (Leopold's land ethic) illustrate both the contingence of practice rules in relation to their underlying basic principles and the corresponding need for a co-operation between philosophy and empirical disciplines in judging their functional merits and demerits. In conclusion, the relevance of empirical hypotheses even for some of the perennial problems of ethics is shown by clarifying the role played by empirical theories in the controversies about the ethical differentiation between positive and negative responsibility and the relation between utility maximisation and (seemingly) independent criteria of distributive justice in the context of social distributions.