Informed Consent Revisited: Japan and the U.S.

Informed consent, decision-making styles and the role of patient–physician relationships are imperative aspects of clinical medicine worldwide. We present the case of a 74-year-old woman afflicted with advanced liver cancer whose attending physician, per request of the family, did not inform her of her true diagnosis. In our analysis, we explore the differences in informed-consent styles between patients who hold an “independent” and “interdependent” construal of the self and then highlight the possible implications maintained by this position in the context of international clinical ethics. Finally, we discuss the need to reassess informed-consent styles suitable to the needs of each patient regardless of whether he or she resides in the United States or in Japan.     

“The Smarts That Counts?”: Psychologists' Decision-Making in Personnel Selection

An exploratory approach was taken to examine personnel psychologists' use of sources of information when making a decision regarding candidates' fit to managerial positions. The main focus was on the process, based on actual information used to make real-life decisions about real-life candidates. Different types of information, available to the psychologists were used to predict their actual final decision regarding a sample of 434 managerial candidates. Results suggest a preference to indices of cognitive skills in making decisions about candidates. It seems that even when other non-cognitive indices were used, they were tainted by the cognitive indices, suggesting a halo effect. Implications for practice and further research are discussed.     

How Japanese students reason about agricultural biotechnology

Many have claimed that education of the ethical issues raised by biotechnology is essential in universities, but there is little knowledge of its effectiveness. The focus of this paper is to investigate how university students assess the information given in class to make their own value judgments and decisions relating to issues of agricultural biotechnology, especially over genetically modified organisms (GMOs). Analysis of homework reports related with agricultural biotechnology after identification of key concepts and ideas in each student report is presented. The ideas were sorted into different categories. The ideas were compared with those in the reading materials using the same categories. These categories included: concern about affects on humans, affects on the environment, developing countries and starvation, trust in industry, responsibility of scientists, risk perception, media influence, need for (international) organizations or third parties, and information dissemination. What was consistent through the different years was that more than half of the students took a “neutral” position. A report was scored as “neutral” when the report included both the positive and negative side of an issue, or when the student could not make a definite decision about the use of GMOs and GM food. While it may be more difficult to defend a strong “for” or “against” position, some students used logical arguments successfully in doing so. Sample comments are presented to depict how Japanese students see agricultural technology, and how they value its application, with comparisons to the general social attitudes towards biotechnology.     

Parental refusals of medical treatment: the harm principle as threshold for state intervention

Minors are generally considered incompetent to provide legally binding decisions regarding their health care, and parents or guardians are empowered to make those decisions on their behalf. Parental authority is not absolute, however, and when a parent acts contrary to the best interests of a child, the state may intervene. The best interests standard is the threshold most frequently employed in challenging a parent's refusal to provide consent for a child's medical care. In this paper, I will argue that the best interest standard provides insufficient guidance for decision-making regarding children and does not reflect the actual standard used by medical providers and courts. Rather, I will suggest that the Harm Principle provides a more appropriate threshold for state intervention than the Best Interest standard. Finally, I will suggest a series of criteria that can be used in deciding whether the state should intervene in a parent's decision to refuse medical care on behalf of a child.     

Negotiating Responsibility: Case Studies of Reproductive Decision-Making and Prenatal Genetic Testing in Families Facing Huntington Disease

Three case studies are presented to further our understanding of how responsibility is negotiated in families when making decisions about genetic risk. These draw on a model of responsibility generated in a study of reproductive decision-making in families facing Huntington disease (HD) to illustrate the impact of prenatal testing on this process. This involves analyzing: how people present themselves as acting responsibly whether or not they utilize genetic testing; who they feel responsible to in their family and elsewhere; the impact that testing has on these relationships; and, how negotiating responsibility changes over time with repeated use of prenatal testing, changing risk status and maturational changes. Two key findings are: how decision-making is perceived can become as important as what is decided; and, how responsibility is negotiated depends on which of these relationships are prioritized. Implications of the findings for clinical practice are noted and suggestions made for further applications of the model.     

Emotional engagement in professional ethics

Recent results from two different studies show evidence of strong emotional engagement in moral dilemmas that require personal involvement or ethical problems that involve significant inter-personal issues. This empirical evidence for a connection between emotional engagement and moral or ethical choices is interesting because it is related to a fundamental survival mechanism rooted in human evolution. The results lead one to question when and how emotional engagement might occur in a professional ethical situation. However, the studies employed static dilemmas or problems that offered only two choices whose outcome was certain or nearly so, whereas actual problems in professional ethics are dynamic and typically involve considerable uncertainty. The circumstances of three example cases suggest that increasing personal involvement and uncertainty could have been perceived as changes, threats, or opportunities and could therefore have elicited an emotional response as a way to ensure the reputation, integrity or success of oneself or a group to which one belongs. Such emotional engagement is only suggested and more studies and experiments are required to better characterize the role of emotional engagement in professional ethics.     

从儿童赌博任务看热执行功能的发展

为考察热执行功能的发展,本研究通过儿童赌博任务检测了60名3～4岁儿童(男女各半)的情感决策。实验结果表明,3岁和4岁儿童在此任务上存在显著的年龄差异,4岁组在各试验组的分数呈上升趋势,他们在试验组2、尤其在试验组4和5中选择有利纸牌的次数显著多于3岁儿童,这反映出情感决策在3～4岁期间发展迅速。此外,儿童在此任务上的成绩存在很多可变性,可能掩盖了性别差异,因而,尽管男孩在最后两个试验组的成绩优于女孩,但性别差异在统计上并不显著。     

Risk-Reduction Surgery Decisions in High-Risk Women Seen for Genetic Counseling

Women at greatest risk for hereditary breast and ovarian cancer may consider prophylactic removal of breasts or ovaries as a risk-reduction measure. This report describes uptake of risk-reduction mastectomy (RRM), risk-reduction oophorectomy (RRO), and related factors in 62 high-risk women who received genetic counseling. Seven (11%) participants underwent RRM and 13 (21%) underwent RRO. Of these women, 37% did not have BRCA testing, suggesting other factors influence decisions to undergo surgery. Women who had indicated (pre-genetic counseling) their intent not to have surgery chose not to have surgery. Information received during genetic counseling that women perceived as being most important for influencing risk-reduction surgery decisions was BRCA test result (positive or negative), followed by discussion of family cancer history. Reasons for indecision about risk-reduction surgery included genetic testing results, concerns about surgery, timing in life, and early menopause. The findings enhance our understanding of information that is helpful to women considering this surgery.     

不确定情境中的决策心理——适应与认知

不确定情境中的决策问题广受经济学家和心理学家关注,但他们对人的决策行为有不同的解释。该简要回顾了经济学和心理学视野中的决策理论,包括预期效用理论、主观预期效用理论和前景理论。主要介绍了“生态理性”观对人的决策心理的研究,着重介绍了研究发现的几种启发式策略,如“一个理由策略”,并探讨了他们在人适应过程中的作用。中最后分析了决策问题的研究现状。     

Human risky choice under temporal constraints: tests of an energy-budget model

Risk-sensitive foraging models predict that choice between fixed and variable food delays should be influenced by an organism's energy budget. To investigate whether the predictions of these models could be extended to choice in humans, risk sensitivity in 4 adults was investigated under laboratory conditions designed to model positive and negative energy budgets. Subjects chose between fixed and variable trial durations with the same mean value. An energy requirement was modeled by requiring that five trials be completed within a limited time period for points delivered at the end of the period (block of trials) to be exchanged later for money. Manipulating the duration of this time period generated positive and negative earnings budgets (or, alternatively, "time budgets"). Choices were consistent with the predictions of energy-budget models: The fixed-delay option was strongly preferred under positive earnings-budget conditions and the variable-delay option was strongly preferred under negative earnings-budget conditions. Within-block (or trial-by-trial) choices were also frequently consistent with the predictions of a dynamic optimization model, indicating that choice was simultaneously sensitive to the temporal requirements, delays associated with fixed and variable choices on the upcoming trial, cumulative delays within the block of trials, and trial position within a block.