The design and use of the Bioethics Consultation Form

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.     

Differential predictability of preferences and choices

A combined multi-attribute utility and expectancy-value model has repeatedly been found to yield a worse fit to choices than to preference ratings. The present study investigated two possible explanations for this finding. First, people's belief-value structures may change in the choice task as they try to find the best alternative. Second, a difficult choice task may cause the decision maker to use simplifying heuristics. In the first of two experiments, subjective belief-value structures were measured on two occasions separated by about one week. Immediately before the second measurement, different groups of subjects performed a choice task, gave preference ratings, or performed a control task. The results did not support an interpretation of the greater difficulty of predicting choices in terms of changes in belief-value structures. However, the notion of simplifying heuristics received support by the finding that adopting simpler versions of the original model improved the predictions of the choices. In the second experiment, beliefs were measured immediately before or after each of a series of choices or preference ratings. The results indicated that although temporary changes in beliefs may occur, they can hardly provide a full account of the differential predictability of preferences and choices.     

Nonconvergence,improper solutions,and starting values in lisrel maximum likelihood estimation

In the framework of a robustness study on maximum likelihood estimation with LISREL three types of problems are dealt with: nonconvergence, improper solutions, and choice of starting values. The purpose of the paper is to illustrate why and to what extent these problems are of importance for users of LISREL. The ways in which these issues may affect the design and conclusions of robustness research is also discussed.     

The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.     

Political Extremism and a Generalized Propensity to Discriminate Among Values

Research exploring the psychological differences between people supporting extreme versus moderate ideologies is growing. However, this research has rarely examined the domain of values. Here, we explore this domain by assessing the possibility that political extremists discriminate more among values compared to moderates, namely, that extremists exhibit strong commitment toward some values at the expense of other values, whereas moderates would acknowledge a multiplicity of values as equally important. First, we propose a model positing that a value discriminability parameter captures a general tendency to discriminate among values. Second, we test empirically the prediction that, compared to moderates, political extremists exhibit a higher discriminability parameter. This prediction is supported by four studies (including one based on the European Social Survey where representative samples from 29 European countries are examined) where participants reported their ideological orientation and rated the importance of basic human values (we focused on basic values because these transcend the political domain, thus highlighting general effects). Specifically, in all studies we observed a positive correlation between political extremism and residual variability in ratings, a hallmark of a higher discriminability parameter. These findings highlight the value domain as critical to understanding differences between political extremists and moderates.     

“What matters to us”: The portrait values questionnaire to measure couple values

No previous studies have analyzed values as qualities of relational microsystems, such as the romantic couple. Based on Schwartz's Theory of Human Values, this study examines the psychometric properties of the Portrait Couple Values Questionnaire (PCVQ). It measures four couple value dimensions: conservation, openness to change, self-enhancement, and self-transcendence. Five hundred and forty-six Italian respondents (54.1% women), aged 41.52 years (SD = 7.19; range 23–63) and having a couple relationship, have filled in an anonymous online questionnaire. The results show the good psychometric properties of the PCVQ. The Confirmatory Factor Analysis Magnifying Glass Strategy shows good indexes of fit for each value dimension, except for the Root Mean Square Error of Approximation (RMSEA) for openness to change, thus confirming that the PCVQ measures the four values with satisfactory internal consistency. The Multidimensional Scaling results, by showing a Stress-1 index of 0.07, confirm the circular structure of values because the four value dimensions are in the position predicted by Schwartz's model. Participants' personal and couple values are highly but not perfectly correlated, suggesting that couple values are a related but distinct construct compared to personal values. This study's contribution lies in introducing an innovative construct into the literature on values and couples, proposing a scale to assess it.     

All's well that ends well? Outcome bias in pilots during instrument flight rules

The objective of the present study was to examine if the Outcome Bias also occurs in pilots flying under instrument flight rules (IFR). In a scenario-based survey, 60 pilots evaluated weather-related decisions made by hypothetical pilots. Participants rated the decisions as better, less risky, and regarded the probability that they would have made the same decision as higher when they were followed by a positive outcome, than when they were followed by a negative outcome. This effect showed likewise for novice pilots and for experienced pilots. These findings could be relevant for the flight-related decision-making of pilots, which sometimes is affected by the decisions made by third-party pilots. In particular, decisions made by other pilots that have led to positive outcomes might be hastily followed, whereas those that have led to negative outcomes might be hastily rejected.     

Cognitive rehabilitation of chronic alcohol abusers

The current literature suggests that individuals who chronically abuse alcohol exhibit a wide variety of cognitive deficits resulting from cerebral dysfunction that is either directly or indirectly related to their alcohol consumption history. Cognitive deficits have been hypothesized as having implications for standard alcohol treatment efficacy as they may directly affect cognitively impaired individuals’ abilities to utilize various treatment modalities. Although evidence is accumulating that suggests this is actually the case, the majority of alcohol treatment programs neither directly consider the impact cognitive deficits have on treatment efficacy nor do they employ cognitive rehabilitation treatment strategies to remediate identified cognitive deficits. Few studies exist that investigate the remediability of neurobehavioral deficits or the efficacy of integrating cognitive rehabilitation strategies into more traditional treatment programs. Empirical investigations conducted to date indicate that some cognitive deficiencies secondary to alcoholism are amenable to cognitive rehabilitation and this remediation is generalizable. Rigorous well-controlled treatment outcome investigations are needed in order to determine the efficacy of cognitive rehabilitation techniques in naturalistic settings using ecological outcome measures. Also, emphasis should be placed on integrating cognitive rehabilitation techniques with proven efficacy into traditional alcoholism treatment programs.     

B.F. SKINNER AND THE GRAND INQUISITOR

Abstract. B.F. Skinner allures us with the possibilities of turning the stones of materialistic rewards into the bread of human values. He tempts us by assuring success in achieving our goals through behavioral science, if only we give up our autonomy. He offers the power of complete control over our behaviors, on condition that we relinquish responsibility for our lives to a technological elite. Is B. F. Skinner a flesh-and-blood Grand Inquisitor? This essay tries to persuade the reader that Skinner's offers are worth considering.