Ethical dilemmas in malaria control.

Because the term "malaria control" specifies an anti-malaria activity rather than an outcome of that action, progress has been evaluated in terms of the effort expended. Plans that specify goals and time lines tend to lack irreversible endpoints. Anti-malaria interventions that are stimulated by economic considerations focus on sites in which the residents enjoy some employment advantage, while interventions based on humanitarian objectives serve the neediest residents of broad regions. Site-specific interventions are conducted by industrial or municipal agencies, while regional interventions are conducted by public agencies. Industry contributes an element of sustainability by injecting the possibility of gainful employment into the site. Efforts that distribute assets mainly to the richest-of-the-poor may fail to preserve lives that would otherwise have been preserved, while those that serve the poorest-of-the-poor may fail to create sustainable cycles of health and wealth. Progress in relieving the burden imposed by malaria requires economically motivated as well as humanitarian contributions, and both should specify realistically time-limited goals that ultimately permit deintensification.     

Influence of wording and framing effects on moral intuitions

This research considers biasing effects on the expression of moral intuitions. Participants in Study 1 were asked to resolve some hypothetical moral dilemmas that involved the death of one or another set of individuals. For half of the participants, the problems were phrased using a Kill wording and for the other half a Save wording, although the outcomes were identical in each case. In Study 2, framing effects were produced by posing dilemma problems in different orders and in different contexts. In Study 1, the Kill-Save wording difference strongly influenced the resolution of the problems. In Study 2, if the problems involved a single kind of dilemma, the order in which the dilemmas were presented affected the pattern of response, whereas order had no major effect for another two series using different dilemmas. Thus, there were framing effects produced by differences in wording and order that could influence the decisions people make when presented with dilemmas, but the effects were not always large nor did they always appear. The presence and strength of the effects seem to depend on a variety of psychological factors that the problem sets activate. These findings are considered within the perspective of the evolution of cognitive strategies.     

Social observation increases deontological judgments in moral dilemmas

A concern for positive reputation is one of the core motivations underlying various social behaviors in humans. The present study investigated how experimentally induced reputation concern modulates judgments in moral dilemmas. In a mixed-design experiment, participants were randomly assigned to the observed vs. the control group and responded to a series of trolley-type moral dilemmas either in the presence or absence of observers, respectively. While no significant baseline difference in personality traits and moral decision tendency were found across two groups of participants, our analyses revealed that social observation promoted deontological judgments especially for moral dilemmas involving direct bodily harm (i.e., personal moral dilemmas), yet with an overall decrease in decision confidence and significant prolongation of reaction time. Moreover, participants in the observed group, but not in the control group, showed the increased sensitivities towards warmth vs. competence traits words in the lexical decision task performed after the moral dilemma task. Our findings suggest that reputation concern, once triggered by the presence of potentially judgmental others, could activate a culturally dominant norm of warmth in various social contexts. This could, in turn, induce a series of goal-directed processes for self-presentation of warmth, leading to increased deontological judgments in moral dilemmas. The results of the present study provide insights into the reputational consequences of moral decisions that merit further exploration.     

Ethical problems in feeding patients with advanced dementia.

Aged patients with dementia if not stricken by an acute disease sooner or later approach a terminal phase that is distinguished by a failure of spoon feeding. This condition induces great anxiety in the workers who care for these patients. The interaction between patient and care-worker during spoon-feeding failure is described by the psychological model of double-binding. Two serious consequences of double-binding are the distancing of the care-workers from the patient and scapegoating among the care-workers. It is essential that the pressure of double-bindings in the wards should be reduced.     

Cancer: improving early detection and prevention. A community practice randomised trial.

OBJECTIVE--To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN--A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS--Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS--The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early detection. The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services. These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets. MAIN OUTCOME MEASURES--The proportions of patients provided the cancer prevention and early detection services indicated annually according to the US National Cancer Institute. RESULTS--Based on cross sectional patient surveys, the office system intervention was associated with an increase in mammography, the recommendation to do breast self examination, clinical breast examination, faecal occult blood testing, advice to quit smoking, and the recommendation to decrease dietary fat. Education was associated only with an increase in mammography. Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing. CONCLUSION--Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services.     

Ethical aspects of statistical practice

This paper embodies a personal view of the ethical considerations that the author believes should be continuously in the mind of any applied statistician or biometrician whose work involves extensive collaboration with other persons and organizations. It looks particularly at the contribution of the International Statistical Institute to the codification of principles, the duties of the statistician in relation to data and the interests of his employer or client, his responsibilities to his professional colleagues and towards society as a whole, and, by no means least; the responsibility of the client towards the statistician who works with him.     

Structural imaging in early pre-states of dementia

In this review focus is on structural imaging in the Alzheimer's disease (AD) pre-states, particularly cognitively normal (CN) persons at future dementia risk. Findings in mild cognitive impairment (MCI) are described here only for comparison with CN. Cited literature evidence and commentary address issues of structural imaging alterations in CN that precede MCI and AD, regional patterns of such alterations, and the time relationship between structural imaging alterations and the appearance of symptoms of AD, issues relevant to the conduct of future AD prevention trials. This article is part of a Special Issue entitled: Imaging Brain Aging and Neurodegenerative disease.     

Ethical and legal dilemmas arising during predictive testing for adult-onset disease: the experience of Huntington disease.

The goal of predictive testing is to modify the risk for currently healthy individuals to develop a genetic disease in the future. Such testing using polymorphic DNA markers has had major application in Huntington disease. The Canadian Collaborative Study of Predictive Testing for Huntington Disease has been guided by major principles of medical ethics, including autonomy, beneficence, confidentiality, and justice. Numerous ethical and legal dilemmas have arisen in this program, challenging these principles and occasionally casting them into conflict. The present report describes these dilemmas and offers our approach to resolving them. These issues will have relevance to predictive-testing programs for other adult-onset disorders.     

Killing for the greater good: Action aversion and the emotional inhibition of harm in moral dilemmas

Moral judgment is influenced by both automatic and deliberative processing systems, and moral conflict arises when these systems produce competing intuitions. We investigated the role of emotional arousal in inhibiting harmful action in a behavioral study of utilitarian tradeoffs in a 3D digital simulation of two classic “trolley” scenarios in which participants decided whether to harm one person in order to avert harm to five others. Physiological arousal was measured via skin conductance response in real time. Results showed that physiological arousal is increased in situations in which using personal harm is necessary to achieve a utilitarian outcome relative to when the same outcome can be achieved with impersonal harm, and is linked to a decreased likelihood of engaging in harmful action, though a test of mediation was not statistically significant. In addition, when the use of personal harm was required to save lives, arousal was higher pre-action relative to post-action. Overall, our findings suggest that physiological arousal may be part of an affective system that functions to inhibit harmful action against others.     

Indicators of early Alzheimer dementia in family practice. Development and validation of the Observation List of Early Symptoms of Dementia (OLD)

Aim of the study was the development and validation of a short observation list of possible early signs of dementia (OLD) for use in general practice. A stepwise development was carried out using reviews of publications and expert consensus. Experimental observations were carried out by 22 general practitioners in 19 Dutch practices. A field study (with interviews and family forms) was conducted out afterwards, to evaluate reliability and validity. Data reduction techniques were used to construct a short version. The first two patients seen on 15 working days (N = 470) were observed. Inclusion criteria: age > 75, without a known diagnosis of dementia. Exclusion: psychiatric treatment, severe depression, acute illness with confusion. The patients were divided into three groups with no, intermediate, and the most signs (total of interviewed patients n = 60; family forms n = 39). Cronbach's alpha and factor-analysis were used to evaluate the reliability. The Cognitive Screening Test (CST), the Word Learning Test (WLT; total and retention), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Groningen Activities Restriction Scale (GARS), and an IADL scale were used to evaluate convergent validity. The Geriatric Depression Scale (GDS) was used to evaluate discriminant validity. Construct validity was evaluated using PRINCALS. Incremental validity was evaluated using the intuitive opinion of the GP (McNemar test). The reliability in the total group was 0.88, the first factor explained 42.5% of the variance. Convergent validity (2-side ANOVA) results: CST (p = 0.00), WLT-total (p = 0.001), WLT retention (p = 0.00), IQCODE (p = 0.09). No statistically significant differences were found for GARS and IADL. The GDS (p = 0.30) showed no difference. The first factor of PRINCALS explained 48% of the variance. The OLD added to the GP opinion (McNemar p = 0.00). Reliability of the short version (12 items) was 0.89 (interviewed group), and 0.86 (total group). The conclusion is that the OLD is a valid and reliable method to detect early signs of dementia in general practice. (Partly adapted from: Hopman-Rock M, Tak ECPM, Staats PGM. Development and validation of the Observation List for early signs of Dementia (OLD). Int J Geriatr Psychiatry 2001 (in press)).     

滇西北县域生物多样性本底调查与评估

中国是世界上生物多样性最丰富的国家之一, 同时也是生物多样性受威胁最严重的国家之一。为了有效保护生物多样性, 2010年国务院批准实施了《中国生物多样性保护战略与行动计划(2010-2030年)》, 划定了32个陆地生物多样性保护优先区, 并设定了开展优先区生物多样性本底调查的战略目标、优先领域与优先行动。为此, 2010-2011年, 环境保护部联合中国科学院和高校的科研人员, 在滇西北开展了18个县的以县域为单元的生物多样性本底示范调查与研究。调查内容包括生态系统(植被类型)和物种两个层次。生态系统主要调查县域内植被类型的多样性, 完成了以群系为单位的植被类型编目; 物种层次主要调查县域内高等植物、脊椎动物、大型真菌的物种多样性组成、数量和用途等, 分析了特有物种和珍稀濒危物种数量等, 完成了县域物种编目。本文基于调查结果, 比较研究了不同县域间的生物多样性组成, 发现植被类型(108个群系)和物种(高等植物4,481种、脊椎动物625种、大型真菌222种)最丰富的县均为玉龙县。同时, 与历史记录对比研究发现, 滇西北的生物多样性分布数据十分欠缺, 严重影响了生物多样性保护的客观有效决策。生物多样性本底调查是生物多样性保护的一项基础工作, 本研究为中国未来开展大规模的生物多样性本底调查与评估提供了案例。     

Bioethics for clinicians: 12. Ethical dilemmas that arise in the care of pregnant women: rethinking "maternal-fetal conflicts".

When a pregnant woman makes a decision or acts in a manner that may be detrimental to the health and well-being of her fetus, her physician may be faced with an ethical dilemma. Is the physician''s primary duty to respect the woman''s autonomy, or to promote behaviour that may be in the best interest of the fetus? The controversial concept of "fetal rights" or the "fetus as a patient" contributes to the notion that the pregnant woman and her fetus are potential adversaries. However, Canadian law has upheld women''s right to life, liberty and security of the person and has not recognized fetal rights. If a woman is competent and refuses medical advice, her decision must be respected even if the physician believes that her fetus will suffer as a result. Coercion of the woman is not permissible no matter what appears to be in the best interest of the fetus.