The friendship model of physician/patient relationship and patient autonomy

A model of the physician patient relationship based on friendship is evaluated in terms of how it serves the interests of patients. The author maintains that this model violates the autonomy of patients who do not want to be friends with their physicians and also diminishes the autonomy of those who seek friendship with their physicians because such a desire is based on "psychological oppression," that is, the "internalization of intimations of inferiority." Ilingworth concludes that an autonomy enhancing model would be one that is open-ended, that accommodates individual patient preferences, and that embraces patient participation.     

Competition between Homophily and Information Entropy Maximization in Social Networks

In social networks, it is conventionally thought that two individuals with more overlapped friends tend to establish a new friendship, which could be stated as homophily breeding new connections. While the recent hypothesis of maximum information entropy is presented as the possible origin of effective navigation in small-world networks. We find there exists a competition between information entropy maximization and homophily in local structure through both theoretical and experimental analysis. This competition suggests that a newly built relationship between two individuals with more common friends would lead to less information entropy gain for them. We demonstrate that in the evolution of the social network, both of the two assumptions coexist. The rule of maximum information entropy produces weak ties in the network, while the law of homophily makes the network highly clustered locally and the individuals would obtain strong and trust ties. A toy model is also presented to demonstrate the competition and evaluate the roles of different rules in the evolution of real networks. Our findings could shed light on the social network modeling from a new perspective.     

Sick autonomy

Complex social and economic forces have placed patient autonomy at the center of medical ethics, and thereby displaced an older ethic of physician beneficence. This development arose, and is sustained, by waning trust in the traditional doctor-patient relationship. As patients have increasingly become clients and consumers, a contract basis for medical care has put the ancient covenant of care in jeopardy. Here, a philosophical approach to harmonize the apparent conflicting claims of patient autonomy and physician beneficence is offered by demonstrating that autonomy need not be understood as protecting a threatened identity. If persons are regarded as atomistic, certain defensive notions of individualistic rights-based autonomy prevail; if a relational construction of personal identity is employed instead, then respect for autonomy becomes part of a wider morality of relationship and care. By reconfiguring trust within this latter understanding of personhood, bioethics better balances its concerns over choices and actions with those of relationship and responsibility. Neither atomistic autonomy nor the ethics of responsibility can claim hegemony, for they are mutually interdependent, and a complete account of medicine's moral axis requires that they be integrated. This reorientation is crucial for reasserting the ethos of clinical medicine, whose fundamental mandate remains the care of others.     

The role of tracking and tolerance in relationship among friends

Friendship is a core aspect of human social life. Friends form long-term, cooperative relationships, and provide material and emotional support for one another. Previous research in social psychology suggests that people prefer balanced relationships over unbalanced relationship with friends, but at the same time, friendship is defined by an absence of direct reciprocity and careful tracking of favors given and received. The goal of this study was to distinguish between differences in tracking and tolerance of imbalances among friends and strangers. We conducted parallel behavioral economic experiments in three different urban cultural settings, USA, Japan and China, in an effort to expand our understanding of the dynamics of human friendship. Across all sites, we found that subjects monitored their friends less carefully than they monitored strangers, were more generous to friends than to strangers and that friends were more tolerant of imbalances in payoffs than strangers were. Although there were differences in the extent of tracking among friends and strangers, tracking did occur among friends. Our study extends the understanding on the dynamics of human friendship and emphasizes the need for further investigation on how friends balance vigilance and tolerance in real-life interactions.     

It's the attention that counts: interpersonal attention fosters intimacy and social exchange

Human friendship poses an evolutionary puzzle, since people behave more generously toward their friends than the tit-for-tat strategy stipulates. A possible explanation is that people selectively behave in a generous manner toward their true friends, but not toward fair-weather friends. Social psychological studies have suggested that people use a partner's attentiveness toward them as a cue to distinguish these two types of friends. Accordingly, it was hypothesized that people would increase their intimacy with a partner who was attentive to them. This hypothesis was tested by disentangling the frequent confounding between a partner's attention and the benefits provided by the attentive partner in two scenario experiments (studies 1a and 1b) and three laboratory experiments (studies 2a to 2c). In study 1, a partner's attentiveness was manipulated independently of the benefit provided by the partner. In study 2, the partner's attention was experimentally dissociated from any potential benefit. These studies consistently showed that the participants increased their intimacy with a partner when they received attention from the partner. This result implies that models of the evolution of friendship must incorporate information exchange regarding the valuation of the relationship, as well as the exchange of fitness-related costs and benefits.     

The Alliance Hypothesis for Human Friendship

Background

Exploration of the cognitive systems underlying human friendship will be advanced by identifying the evolved functions these systems perform. Here we propose that human friendship is caused, in part, by cognitive mechanisms designed to assemble support groups for potential conflicts. We use game theory to identify computations about friends that can increase performance in multi-agent conflicts. This analysis suggests that people would benefit from: 1) ranking friends, 2) hiding friend-ranking, and 3) ranking friends according to their own position in partners'' rankings. These possible tactics motivate the hypotheses that people possess egocentric and allocentric representations of the social world, that people are motivated to conceal this information, and that egocentric friend-ranking is determined by allocentric representations of partners'' friend-rankings (more than others'' traits).

Methodology/Principal Findings

We report results from three studies that confirm predictions derived from the alliance hypothesis. Our main empirical finding, replicated in three studies, was that people''s rankings of their ten closest friends were predicted by their own perceived rank among their partners'' other friends. This relationship remained strong after controlling for a variety of factors such as perceived similarity, familiarity, and benefits.

Conclusions/Significance

Our results suggest that the alliance hypothesis merits further attention as a candidate explanation for human friendship.     

Friendship,bitching, and the making of ethical selves: what it means to be a good friend among girls in a London school

This article explores the relationship between friendship, personhood, and ethics among girls in a London school. While a Western ideal of friendship is posited as a personal, private, and spontaneous relationship between autonomous individuals, I argue that girls’ friendships are a complex entanglement and interaction between forensic and mimetic dimensions of the self. Girls’ ideals of friendship, and practices of making friends, suggest forensic pre‐constituted selves acting with volition in order to become closer to other selves. However, bitching, exclusion, and breaking friendships foreground mimetic dimensions as girls shape each other and themselves according to gendered ethical criteria. Examining these analytical strands offers insight into how individuality is produced through sociality in everyday life.     

Qualities and Inequalities in Online Social Networks through the Lens of the Generalized Friendship Paradox

The friendship paradox is the phenomenon that in social networks, people on average have fewer friends than their friends do. The generalized friendship paradox is an extension to attributes other than the number of friends. The friendship paradox and its generalized version have gathered recent attention due to the information they provide about network structure and local inequalities. In this paper, we propose several measures of nodal qualities which capture different aspects of their activities and influence in online social networks. Using these measures we analyse the prevalence of the generalized friendship paradox over Twitter and we report high levels of prevalence (up to over 90% of nodes). We contend that this prevalence of the friendship paradox and its generalized version arise because of the hierarchical nature of the connections in the network. This hierarchy is nested as opposed to being star-like. We conclude that these paradoxes are collective phenomena not created merely by a minority of well-connected or high-attribute nodes. Moreover, our results show that a large fraction of individuals can experience the generalized friendship paradox even in the absence of a significant correlation between degrees and attributes.     

Autonomy in the Obstetrician/Gynecologist-Patient Relationship as a Predictor of Patient Satisfaction

A considerable amount of recent medical research focuses on factors involving patient satisfaction. This study attempts to examine the role of autonomy in the gynecologist-patient relationship as it relates to patient satisfaction. Fifty-five patients at a women’s clinic completed measures assessing autonomy preference (API) before the medical visit and patient-perceived autonomy support (HCCQ) and patient satisfaction (MISS) after the visit. Analyses revealed patients prefer a more equal level of decision making with their doctor (a medium level of autonomy) when asked general questions about medical decisions but preferred less autonomy when presented with actual scenarios. Results show a significant relationship between scenario-based autonomy preference level and visit satisfaction for both satisfaction measures. A significant relationship between perceived autonomy support and visit satisfaction was also found for both satisfaction measures. The findings of this study suggest autonomy is important to the gynecologist-patient relationship and worthy of future study.     

Are open‐Label Placebos Ethical? Informed Consent and Ethical Equivocations

The doctor‐patient relationship is built on an implicit covenant of trust, yet it was not until the post‐World War Two era that respect for patient autonomy emerged as an article of mainstream medical ethics. Unlike their medical forebears, physicians today are expected to furnish patients with adequate information about diagnoses, prognoses and treatments. Against these dicta there has been ongoing debate over whether placebos pose a threat to patient autonomy. A key premise underlying medical ethics discussion is the notion that the placebo effect necessitates patient deception. Indeed, the American Medical Association guidelines imply that placebo treatment necessary entails a form of deception. As a consequence of this assumption, the fulcrum of debate on the use of placebo treatment has hinged on whether that deception is ever justified. Recently performed experiments with open‐label transparently prescribed placebos have begun to challenge the notion that deception is necessary in eliciting the placebo effect and such effects necessarily involve a binary distinction between autonomy and beneficence. In this article we focus on the content of disclosures in distinctive open‐label, transparently disclosed placebo studies and inquire whether they might be said to invoke deception in clinical contexts, and if so, whether the deception is unethical. We find that open placebos may be said to involve equivocation over how placebos work. However, drawing on surveys of patient attitudes we suggest that this equivocation appears to be acceptable to patients. We conclude that open placebos fulfil current American Medical Association guidelines for placebo use, and propose future research directions for harnessing the placebo effect ethically.     

Sex (similarities and) differences in friendship jealousy

Friendships provide material benefits, bolster health, and may help solve adaptive challenges. However, a recurrent obstacle to sustaining those friendships—and thus enjoying many friendship-mediated fitness benefits—is interference from other people. Friendship jealousy may be well-designed for helping both men and women meet the recurrent, adaptive challenge of retaining friends in the face of such third-party interference. Although we thus expect several sex similarities in the general cognitive architecture of friendship jealousy (e.g., it is attuned to friend value), there are also sex differences in friendship structures and historical functions, which might influence the inputs of friendship jealousy (e.g., the value of any one friendship). If so, we should also expect some sex differences in friendship jealousy. Findings from a reanalysis of previously-published data and a new experiment, including both U.S. student and adult community participants (N = 993), provide initial support for three predicted sex differences: women (versus men) report greater friendship jealousy at the prospective loss of best friends to others, men (versus women) report greater friendship jealousy at the prospective loss of acquaintances to others, and men's (but not women's) friendship jealousy is enhanced in the context of intergroup contests.     

Sex differences in friendship preferences

Friendships can help us solve a number of challenges, increasing our welfare and fitness. Across evolutionary time, some of the many challenges that friendships helped to solve may have differed between men and women. By considering the specific and potentially distinct recurrent problems men's and women's friendships helped them solve, we can derive predictions about the qualities that would have made men's and women's same-sex friends ideal partners. This logic leads to several predictions about the specific friend preferences that may be differentially prized by men and women. Across three studies (N = 745) with U.S. participants—assessing ideal hypothetical friends, actual friends, and using a paradigm adapted from behavioral economics—we find that men, compared to women, more highly value same-sex friends who are physically formidable, possess high status, possess wealth, and afford access to potential mates. In contrast, women, compared to men, more highly value friends who provide emotional support, intimacy, and useful social information. Findings suggest that the specific friendship qualities men and women preferred differed by sex in ways consistent with a functional account of friendship.     

First tests of Euclidean preference integration in friendship: Euclidean friend value and power of choice on the friend market

Close friendships are associated with greater happiness and improved health; historically, they would likely have provided beneficial fitness outcomes. Yet each friendship requires one's finite time and resources to develop and maintain. Because people can maintain only so many close relationships, including friendships, at any one time, choosing which prospective friends to pursue and invest in is likely to have been a recurrent adaptive problem. Moreover, not all friends are created equal; some might be kind but unintelligent, some intelligent but disloyal, and so on. How might people integrate their friend preferences to make friend choices? Work using a Euclidean model of mate preferences has had significant success in elucidating this integration challenge in the domain of mating. Here, we apply this model to the domain of friendship, specifically exploring same-sex best and close friendships. We test and find some support for several critical predictions derived from a Euclidean integration hypothesis: People with higher Euclidean friend value (a) have best friends who better fulfill their best friend preferences, (b) have higher friend-value ideal best friends, and (c) have higher friend-value actual best friends. We also (d) replicate existing similar findings with regard to mating and (e) additionally provide a first test of whether people's Euclidean friend value (versus mate value) is a better predictor of their friend outcomes, and vice versa, finding some, albeit mixed, support for the dissocialbility of these constructs.     

The medical decision-making process and the family: the case of breast cancer patients and their husbands

Objectives:  The objectives of the study were (1) to assess similarities and differences between breast cancer patients and their husbands in terms of doctor-patient/spouse relationships and shared decision making; and (2) to investigate the association between breast cancer patients and husbands in terms of preference of type of doctor, doctor-patient relationship, and shared decision making regarding medical treatment.
Method:  Fifty-seven women with breast cancer, and their husbands, completed questionnaires measuring doctor-patient/spouse relationships (paternalism, autonomy), and decision making regarding medical treatment.
Results:  Patients believe they have a key role in the medical decision-making process (93%) and that the participation of their husbands, and their agreement with the decision, is important (84% and 89%, respectively). Both breast cancer patients and their husbands prefer a shared decision-making process to paternalistic or autonomy-based approaches.
Conclusion:  In contrast to legal and bioethical approaches, which focus on the patient as the primary decision maker, this study reflects a practical recognition of the role of the breast cancer patient's husband in the decision-making process. It also reflects a relational rather than an individualistic perception of patient autonomy.     

What’s in a Friendship? Partner Visibility Supports Cognitive Collaboration between Friends

Not all cognitive collaborations are equally effective. We tested whether friendship and communication influenced collaborative efficiency by randomly assigning participants to complete a cognitive task with a friend or non-friend, while visible to their partner or separated by a partition. Collaborative efficiency was indexed by comparing each pair’s performance to an optimal individual performance model of the same two people. The outcome was a strong interaction between friendship and partner visibility. Friends collaborated more efficiently than non-friends when visible to one another, but a partition that prevented pair members from seeing one another reduced the collaborative efficiency of friends and non-friends to a similar lower level. Secondary measures suggested that verbal communication differences, but not psychophysiological arousal, contributed to these effects. Analysis of covariance indicated that females contributed more than males to overall levels of collaboration, but that the interaction of friendship and visibility was independent of that effect. These findings highlight the critical role of partner visibility in the collaborative success of friends.     

On Social and Cognitive Influences: Relating Adolescent Networks,Generalized Expectancies,and Adolescent Smoking

We examine the moderating role of friendship and school network characteristics in relationships between 1) youths’ friends smoking behavior and youths’ own generalized expectancies regarding risk and future orientation and 2) generalized expectancies of youths’ friends and youths’ own generalized expectancies. We then relate these constructs to smoking. Using a longitudinal sample from the National Longitudinal Study of Adolescent Health (N = 15,142), the relationship between friends’ generalized expectancies and youths’ expectancies is stronger for those more central in the network, with more reachability, or stronger network ties, and weaker for those with denser friendship networks. Risk expectancies exhibited an inverted U shaped relationship with smoking at the next time point, whereas future orientation expectancies displayed a nonlinear accelerating negative relationship. There was also a feedback effect in which smoking behavior led to higher risk expectancies and lower future orientation expectancies in instrumental variable analyses.     

Attractiveness and Rivalry in Women’s Friendships with Women

Past research suggests that young women perceive their same-sex friends as both facilitating the pursuit of desirable mates and competing for access to desirable mates. We propose that similar levels of physical attractiveness between young adult female friends might be one explanation for the opposing forces in their friendships. Forty-six female friendship pairs completed questionnaires about themselves, their friend, and their friendship; in addition, each woman’s picture was rated by a set of nine naive judges. Friends were similar in both self-rated and other-rated level of attractiveness. Within-pair analyses revealed that women agreed on which friend was more attractive, and the less attractive members of each friendship pair (by pair consensus as well as outside judges’ ratings) perceived more mating rivalry in their friendship than did the more attractive members of each friendship pair. We offer directions for research on women’s friendships over the lifespan.     

Trust,Identity, and Civic Hope

This article concerns the phenomenon of trust-in others who are familiar and in humanity in general. I make a case that the foundations of both forms of trust are rooted in formative experiences. Trust springs from the sense of security we develop in early nurturing relationships. In friendships and peer relationships we learn about loyalty, accountability, and the reciprocity between trust and trustworthiness. However, trust among friends is an insufficient basis for social trust. To nurture a faith in humanity, children need to interact and cooperate with people who are different from them and values of equality, tolerance, and empathy have to be high priorities in their families.     

From maternal tending to adolescent befriending: The adolescent transition of social support

Attachment theory holds that parental relationships have lifelong effects on offspring social lives. The tend-and-befriend hypothesis posits that female friendships among humans evolved as part of a primate-wide coping mechanism to mediate stress by relying on social support. Here we bridge developmental and evolutionary frameworks to examine adolescent girls’ perception of their reliance on female friendship for social support, how perceptions of parental relationships affect peer relationships, and the extent to which parent and peer relationships buffer depressive symptoms. We predict perceived maternal relationship quality will be positively associated with close female friendships, and maternal relationships, paternal relationships, and female friendship will buffer depressive symptoms. Participants were adolescent girls from a summer science camp (N = 95). Participants filled out demographic information, social network surveys, the Parent-Adolescent Communication Scale, and the Center for Epidemiology Depression Scale. Data was analyzed with Pearson's correlations, t tests, and path analysis. Adolescent girls with few female friends, compared with girls who had more than two very close female friends, experienced more depressive symptoms (t = 3.382, p = .001, D = 0.784). Adolescent girls with few female friends experienced more depressive symptoms compared to girls with two or more very close female friends (t = 3.382, p = .001, D = 0.784). Stronger maternal and paternal relationships were associated with having more female friends (maternal: t = −3.213, p = .003, D = 0.837; paternal: t = −2.432; p = .017). In the path analysis model, only maternal relationship quality significantly predicted female friendship category (β = .33, CR = 2.770, p < .006). Furthermore, participants with two or more very close female friends and higher paternal relationship quality had significantly fewer depressive symptoms (friends; β = −.19, CR = −2.112, p = .035; paternal: β = −.33, CR = −3.220, p < .001), and older participants had more depressive symptoms (β = .17, CR = −1.931, p = .036). These results provide additional support for the tend-and-befriend hypothesis, suggesting that maternal tending sets the stage for close female friendships.     

Generation,ethnic and religious diversity in friendship choice: exploring interethnic close ties in Britain

Abstract

Interethnic friendships can reflect intergroup relations and immigrants' integration into host societies. Using pooled 2007–09 Citizenship Surveys, this study investigates interethnic friendship patterns and determinants of friendship choice in Britain. The paper focuses on generational, ethnic and religious diversity in forming interethnic close ties. The most common friendship pattern is having co-ethnic close friends. This ethnic boundary in interethnic ties, however, weakens across generations whereby those born in or migrated to Britain at young ages have a higher chance of having close friends from other ethnic groups. We find that interethnic friendships are formed in a ‘pan-ethnic’ pattern by which those with similar ethnic/racial and religious background such as Muslim Indians and Pakistanis, or mixed white and black Caribbean and black Caribbean, are more likely to nominate one another as close friends.