The patient-physician relationship and the allocation of scarce resources: a law and economics approach

Patients with insufficient financial resources place physicians in a conflict of interest between the patients' needs and the financial interests of the physician, other patients, and society. Not only must physicians act ethically, but they must avoid liability for violating their legal duties to their patients. The traditional rules of contract and malpractice law that govern the patient-physician relationship do not provide satisfactory guidelines. Better answers are found in the rules of fiduciary law, but only with regard to direct conflicts between patients and physicians and only at the risk of reducing patient access to care. Certain types of legislative action can resolve these conflicts by altering the traditional legal rules, but care must be taken to preserve patient-physician trust, which the legal rules were designed to enhance.     

Changes in older Dutch adults’ role networks after moving

Using the convoy model (R. L. Kahn & T. C. Antonucci, 1980), this study examined the differential impact of relocation, depending on the distance moved, on the size of 3 types of role networks. A total of 890 Dutch nonmovers and 445 movers (aged 55–86 years) were selected from the Longitudinal Aging Study Amsterdam. Results of analyses of variance showed that the neighbor networks changed most after relocation. Long‐distance movers discontinued the largest number of relationships with fellow club members. As expected, moving did not affect coworker networks. The findings show that, consistent with the convoy model, role networks proved to be unstable. Older adults, however, restored their partial networks at the second observation by starting new relationships.     

An empirical update (1969-1989) of D. L. Krantz's thesis that the experimental analysis of behavior is isolated

Citation data from 1970 to 1989 were examined in order to determine whether the "isolation" of the experimental analysis of behavior (EAB) that was originally documented by Krantz (1971, 1972) has persisted beyond the early 1970s. Our findings from analyses of the Journal of the Experimental Analysis of Behavior (JEAB) and of related journals support the following conclusions: (1) In the 20-year period since 1969, JEAB has continued to cite its own articles ("self-cite") at a higher rate than related journals; (2) JEAB's self-citation rate decreased by a larger amount since 1969 than did that of related journals; and (3) JEAB was cited with diminishing frequency by some related journals during the 20-year period. These findings and other disciplinary comparisons provide information relevant to the issue of the health of behavior analysis and related specialties.     

Intrinsic conflicts of interest in clinical research: a need for disclosure

Protection of human subjects from investigators' conflicts of interest is critical to the integrity of clinical investigation. Personal financial conflicts of interest are addressed by university policies, professional society guidelines, public standards, and government regulation, but "intrinsic conflict of interest"--conflicts of interest inherent in all clinical research--have received relatively less attention. Such conflicts arise in all clinical research endeavors as a result of the tension among professionals' responsibilities to their research and to their patients and both academic and financial incentives. These conflicts should be disclosed to research subjects and managed as assiduously as are financial conflicts of interest.     

Genetic enhancement: plan now to act later

All three main articles in the issues of the Kennedy Institute of Ethics Journal endorse the view that genetic enhancement should be permitted, including human germ-line genetic enhancement. However, unregulated, wealth-based access to genetic enhancement in general, and germ-line enhancement in particular, would create intolerable risks for society. Although there are a number of practical problems raised by proposals to regulate or restrict access to genetic enhancement, which will make it difficult if not impossible to muster support for any effective restrictions until we begin to experience the societal problems that genetic enhancement will create, it is important to consider now what restrictions would be appropriate, how they would be imposed, and what changes would be needed in existing laws and institutions to facilitate them. Without this type of groundwork, there is no way society will be in a position to act in time.