Physicians' Silent Decisions: Because Patient Autonomy Does Not Always Come First

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions—not all—are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time.     

Innovative Approaches to Child Custody and Domestic Violence in New Zealand

Summary

In 1995, as part of a major review of domestic violence law, the New Zealand Parliament amended the legislation under which disputes about custody of and access to children are determined by the Court. Specifically, the amendment introduced a rebuttable presumption that a parent who had used violence against a child or against the other parent would not have custody of, or unsupervised access to the child unless the Court could be satisfied that the child would be safe during visitation arrangements. Three years after the implementation of this legislation, it is timely to reflect on the impact of this major domestic violence law reform initiative. Our findings indicate that there are indeed advances. Psychological violence is now clearly being considered when Courts are assessing the issue of children's safety. As well, the delineation of mandatory risk assessment factors has led many judges to see a continuum of power and control tactics as relevant in domestic violence related visitation proceedings; the previous emphasis on physical violence has given way to an analysis which more closely reflects accords with women's and children's realities of the abuse they are exposed to. Some of the old problems continue to exist despite the law changes. There are still recent cases where perpetrators of serious violence are awarded unsupervised access and where their violence continues to be construed as “out of character,” arising because of the perpetrator's “despair” about the breakdown of his relationship. These and other issues are discussed.     

An Historical Overview of Basic Approaches and Issues in Ethical and Moral Philosophy and Principles

Summary

This article provides a condensed history of ethics development for the purpose of exposing psychologists and other mental health professionals to ethical and moral bases upon which modern psychological ethics are founded. In addition, it focuses on contemporary theories, with an emphasis on professional ethics.     

Confounds in moral/conventional studies

In ‘The nature of moral judgments and the extent of the moral domain’, Fraser (2012 Fraser, B. 2012. “The nature of moral judgements and the extent of the moral domain.” Philosophical Explorations 15 (1): 1–16. doi:10.1080/13869795.2012.647356.[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) criticises findings by Kelly et al. (2007 Kelly, D., S. Stich, K. J. Haley, S. J. Eng, and D. M. T. Fessler. 2007. “Harm, Affect, and the Moral/Conventional Distinction.” Mind & Language 22 (2): 117–131. doi: 10.1111/j.1468-0017.2007.00302.x[Crossref], [Web of Science ®] , [Google Scholar]) that speak against the moral/conventional (M/C) distinction, arguing that the experiment was confounded. First, we note that the results of that experiment held up when confounds were removed (Quintelier, Fessler, and De Smet 2012 Quintelier, K. J. P., D. M. T. Fessler, and D. De Smet. 2012. “The Case of the Drunken Sailor: On the Generalizable Wrongness of Harmful Transgressions.” Thinking & Reasoning 18 (2): 183–195. doi:10.1080/13546783.2012.669738.[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). Second, and more importantly, we argue that attempts to prove the existence of a M/C distinction are systematically confounded. In contrast to Fraser, we refer to data that support our view. We highlight the implications for the moral/conventional theory.     

Adult age differences in subjective and objective measures of strategy use on a sequentially cued prediction task

Differences in strategy use are thought to underlie age-related performance deficits on many learning and decision-making tasks. Recently, age-related differences in learning to make predictions were reported on the Triplets Prediction Task (TPT). Notably, deficits appeared early in training and continued with experience. To assess if age differences were due to early strategy use, neural networks were used to objectively assess the strategies implemented by participants during Session 1. Then, the relationship between these strategies and performance was examined. Results revealed that older adults were more likely to implement a disadvantageous strategy early in learning, and this led to poorer task performance. Importantly, the relationship between age and task performance was partially mediated by early strategy use, suggesting that early strategy selection played a role in the lower quality of predictions in older adults.     

Basic desert of reactive emotions

In this paper, I explore the idea that someone can deserve resentment or other reactive emotions for what she does by attention to three psychological functions of such emotions – appraisal, communication, and sanction – that I argue ground claims of their desert. I argue that attention to these functions helps to elucidate the moral aims of reactive emotions and to distinguish the distinct claims of desert, as opposed to other moral considerations.     

Measuring moral reasoning using moral dilemmas: evaluating reliability,validity, and differential item functioning of the behavioural defining issues test (bDIT)

ABSTRACT

We evaluated the reliability, validity, and differential item functioning (DIF) of a shorter version of the Defining Issues Test-1 (DIT-1), the behavioural DIT (bDIT), measuring the development of moral reasoning. About 353 college students (81 males, 271 females, 1 not reported; age M = 18.64 years, SD = 1.20 years) who were taking introductory psychology classes at a public University in a suburb area in the Southern United States participated in the present study. First, we examined the reliability of the bDIT using Cronbach’s α and its concurrent validity with the original DIT-1 using disattenuated correlation. Second, we compared the test duration between the two measures. Third, we tested the DIF of each question between males and females. Findings reported that first, the bDIT showed acceptable reliability and good concurrent validity. Second, the test duration could be significantly shortened by employing the bDIT. Third, DIF results indicated that the bDIT items did not favour any gender. Practical implications of the present study based on the reported findings are discussed.     

The cultural salience of moral character and virtue declined in twentieth century America

In a large corpus of American books, we tracked how frequently words related to moral excellence and virtue appeared over the twentieth century. Considering the well-established cultural trend in the USA toward greater individualism and its implications for the moral domain, we predicted that terms related to morality and virtue would appear with diminishing frequency in American books. Two studies supported our predictions: Study 1 showed a decline in the use of general moral terms such as virtue, decency and conscience, throughout the twentieth century. In Study 2, we examined the appearance frequency of 50 virtue words (e.g. honesty, patience, compassion) and found a significant decline for 74% of them. Overall, our findings suggest that during the twentieth century, moral ideals and virtues have largely waned from the public conversation.     

Ecological issues of justice

In the first part of this article the author explores the implications for justice of the wider range of parties holding moral standing that environmental ethics has recently disclosed. These implications concern the equitable treatment of future generations and nonhuman creatures, and are relevant both to policies, such as approaches to global warming, and procedures, which may need to be revised to give an equitable voice to unrepresented interests. Later the author considers some radical implications of regarding humanity as stewards of the planetary environment, a view defended in his recent book Creation, Evolution and Meaning. If all adult humans have this role, but many are prevented from discharging it by poverty and related constraints, then those who are thus disempowered need to be empowered to exercise this role. This requirement of equity would arise not from their moral patienthood but from what is involved in respecting them as moral agents. Some approaches to tackling global warming are considered in this connection.