Doctor's Expertise and Managing Discrepant Information from Other Sources in Genetic Counseling: A Conversation Analytic Perspective

The study examines a recurrent interactional pattern in genetic counseling. It describes clinical geneticists' responses in situations in which clients have presented information from other sources that is potentially discrepant with information given by the doctor. The data consists of 12 video-recorded sessions of genetic counseling in Finland, and the method is conversation analysis. There are two primary ways the doctors respond: either they accept the client's information as such, but show that it is not discrepant with the doctor's information, or they reject the client's information. In the latter case they mitigate the ‘wrongness’ of the client's information. The clinical geneticists seem to be working with a dilemma: they need to find a balance between ensuring correct understanding of the information and showing respect for the expertise of others. A particularly complex case is also analyzed and reflected on.     

Care of the Self and Patient Participation in Genetic Discourse: A Foucauldian Reading of the Surgeon General's “My Family Health Portrait” Program

Critics of genetic discourse are concerned that deterministic and discriminatory views of genetics are increasingly becoming adopted. These views argue that current genetic discourse becomes a source of power whereby powerful institutions harm people with so-called “bad” genes. This essay argues that current analyses of the power of genetics discourse are grounded in an improper reading that disempowers patients. Deploying Michel Foucault's concept “care of the self,” this essay claims that genetics discourse is better understood as a way that patients take on power through rhetoric rather than a force that has power over patients. Through a close reading of the “My Family Health Portrait” program, this paper argues that patients experience a process of “subjection” wherein they become agents of and objects of genetics discourse both. This alternative mode of analyzing the power of genetics discourse has implications for our collective understanding of the operations of the care of the self and the uses of genetic information that we propose.     

Differences in Individual Approaches: Communication in the Familial Breast Cancer Consultation and the Effect on Patient Outcomes

This multicenter study aimed to assess (i) whether individual clinical geneticists and genetic counselors vary in their communication skills and (ii) whether this variation in communication impacts on patient outcomes, such as anxiety, depression, genetics knowledge, and satisfaction. One hundred and fifty women from high-risk breast cancer families attending their first genetic counseling consultation completed pre and post-consultation self-report questionnaires. The consultations were audiotaped and transcribed verbatim. Univariate analyses showed highly significant differences between individual clinical geneticists and genetic counselors in: facilitating understanding (p 0.001); facilitating active involvement (p 0.001); facilitating partnership building (p = 0.003); addressing emotional concerns (p 0.001); and discussing prophylactic mastectomy (p = 0.017). Multivariate linear regressions showed that this variation in communication resulted in a greater change in patients depression 4 weeks after the counseling session (p = 0.017). These findings suggest clinical geneticists and genetic counselors have achieved some standardization in communicating information, but showed diversity in their facilitation skills. Communication skills may be a useful area to explore further in this field.     

Ethical Instrumentalism

The present essay offers a sketch of a philosophy of value, what I shall here refer to as ‘ethical instrumentalism.’ My primary aim is to say just what this view involves and what its commitments are. In the course of doing so, I find it necessary to distinguish this view from another with which it shares a common basis and which, in reference to its most influential proponent, I refer to as ‘Humeanism.’ A second, more general, aim is to make plausible the idea that, given the common basis, ethical instrumentalism provides a more compelling picture of the philosophy of value than Humeanism does.     

Government Subsidized Academic Research: Economic and Ethical Conflicts

Justification for public funding of academic research is based on the linear model of technological advance first proposed by Francis Bacon. The model hypothesizes that government subsidized science generates new technology which creates new wealth. Mainstream economics supports Bacons model by arguing that academic research is a public good. The Bayh–Dole Act allows universities to privatize federally funded research and development (R&D) which is in direct conflict with the public good argument. Diminishing returns to university R&D, challenges to Bacons linear model and the labor exploitation of young scientists by research universities suggest that policy makers may want to reconsider the system for allocating federal R&D to universities and colleges.     

Towards a research programme for ethics and technology

In this editorial contribution, two issues relevant to the question, what should be at the top of the research agenda for ethics and technology, are identified and discussed. Firstly: can, and do, engineers make a difference to the degree to which technology leads to morally desirable outcomes? What role does professional autonomy play here, and what are its limits? And secondly, what should be the scope of engineers' responsibility; that is to say, on which issues are they, as engineers, morally obliged to reflect? The research agendas proposed by the authors contributing to this special section, implicitly, give different answers to these questions. We suggest that an explicit discussion of these issues would greatly help in constructing a common research agenda.     

The ‘Medical Body’ As Philosophy's Arena

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: (i) as a salutary reminder of the extent to which thereality even of the human body is constructed; and (ii) as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy's traditional (and traditionally abstract) questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate.     

Book Reviews

Books reviewed: Joshua I. Miller, Democratic Temperament: The Legacy of William James Ellen Kappy Suckiel, Heaven's Champion: William James's Philosophy of Religion Ruth Anna Putnam (ed), The Cambridge Companion to William James David L. Hall and Roger T. Ames, Democracy of the Dead: Dewey, Confucious, and the Hope for Democracy in China Dale Jacquette, Wittgenstein's Thought in Transition Michael T. Chiselin, Metaphysics and the Origin of Species Richard Swinburne, Is There a God? Evert van der Zweerde, Soviet Historiography of Philosophy Rem B. Edwards (ed), Ethics of Psychiatry: Insanity, Rational Autonomy, and Mental Health Care Jennifer Radden, Divided Minds and Successive Selves: Ethical Issues in Disorders of Identity and Personality     

勒维纳斯和利科的伦理学的异同

法国现代哲学把伦理学作为一个核心问题。在现象学的框架之下,勒维纳斯和利科重新思考了主体的自由及其责任。该文简单地介绍这两位哲学家的基本观念。勒维纳斯比较强调个人对他人的无限伦理责任,而利科更强调美德,把它当作为伦理生活的出发点。虽然这些伦理立场不同而很难协调,可是它们都提供很必要的资源来思考现代伦理生活所面的困境和它的未来的可能。     

Effectiveness of the GOFER course in decision making for high school students

The paper describes and evaluates the GOFER course in decision making for high school students (Mann, Harmoni and Power, 1988). The course was based on principles from the conflict theory of decision making (Janis and Mann, 1977) and was designed to provide adolescents with an understanding of factors that produce good and poor decision making as well as knowledge and practice of sound decision skills. Two evaluation studies were conducted to examine effectiveness of the course. Study 1 was conducted with young adolescents (12 year olds). It found a significant difference between students trained in the course and a control group on measures of self-esteem as a decision maker, self reported decision habits and knowledge of decision strategy. Study 2 was conducted with mid-adolescents (15 year olds). It, too, found a significant difference between students who took the course and a control group on measures of self esteem as a decision maker and self-reported decision habits. It is concluded that while the evaluation study fell short of an ideal test, the GOFER course met the criteria of improving student knowledge, raising confidence in decision making and changing self reported decision habits.