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PubMed1998

Vulnerability: reflection on its ethical implications for the protection of participants in SAMHSA programs.

The vulnerability of participants in Substance Abuse and Mental Health Services Administration (SAMHSA) programs is a consequence of the illnesses that they are experiencing; ethical guarantees must be in place that ensure the dignity of the persons involved in such programs. Dignity is more than an individual concern; it has individual, institutional, and societal dimensions. An ethical framework is proposed that involves the interrelated vulnerabilities and needs of individuals and communities and our societal response to them. Among the issues given particular attention are individual and community stigmatization, target population involvement in program planning, balance with regard to confidentiality and privacy, the place of proportionality grounded in a rich sense of community as a guiding ethical priniciple, and guidelines for SAMHSA programs.

Alcoholism↗
PubMed2003

Intellectual freedom and editorial responsibilities within the context of controversial research.

The primary purpose of this article is to explore the limits that an agent, such as the government or the American Psychological Association, may place on one's right to pursue a program of research or to share the findings of a research project. The primary argument that evolves here is that researchers' rights to pursue an interesting hypothesis, and their freedom of expression, are conditional. The author examines the potential pragmatic and epistemological barriers to a program of research and the responsibilities that researchers bear to address epistemological and nonepistemological matters while reviewing the implications of their work.

Behavioral Research↗
PubMed2005

Judgments of the fairness of using performance enhancing drugs.

Undergraduates (total N=185) were asked about performance-affecting drugs. Some drugs supposedly affected athletic performance, others memory, and other attention. Some improved performance for anyone who took them, others for the top 10% of performers, others for the bottom 10%, and finally, yet other drugs worked only on the bottom 10% who also showed physical abnormalities. Participants were asked about the fairness of allowing the drug to be used, about banning it, and about whether predictions of future performance based on testing with or without the drug were better. The study found that participants appreciated the "interaction effect," that they felt it was less unfair to allow the drug if it affected the bottom 10% than if it affected everyone, and they were more eager to have the drug banned if it affected everyone. Participants were least tolerant of drugs that affected athletic performance and most tolerant of those that affected attention.

Analysis of Variance↗
PubMed2006

A nonconformist account of the Asch experiments: values, pragmatics, and moral dilemmas.

This article offers a new approach to Asch's (1956) influential studies relating physical and social perception. Drawing on research on values, conversational pragmatics, cross-cultural comparisons, and negotiation, the authors challenge the normative assumptions that have led psychologists to interpret the studies in terms of conformity. A values-pragmatics account is offered that suggests that participants attempt to realize multiple values (e.g., truth, social solidarity) in an inherently frustrating situation by tacitly varying patterns of dissent and agreement to communicate larger scale truths and cooperative intentions. Alternative theories (e.g., embarrassment, attribution) are compared and empirical implications of the values-pragmatics account are evaluated. The possibility of multiple strategies promoting group survival and the proper role of moral evaluation in social psychological research are considered.

Cross-Cultural Comparison↗
PubMed1998

Protecting patient welfare in managed care: six safeguards.

The public is very suspicious and fearful that managed care threatens their health because of its interest in reducing costs. Because physicians' decisions control 75 percent of all health care spending, managed care organizations are focusing their cost-cutting strategies on influencing physician decision making through financial incentives and guidelines. These two techniques have had some important contributions, especially in enhancing efficiency and standardizing care to a high level. Nevertheless, they pose a threat--and are perceived by the public to pose a threat--to patients' health and well-being. How can we mitigate the threats to patient welfare posed by financial incentives and guidelines? We propose and analyze six safeguards. These safeguards are not an attempt to revive the fee-for-service system, but an effort to make managed care ethical and to focus it on improving patient welfare. They are designed to work together to ensure that patient welfare remains the primary focus of managed care organizations; they try to create institutional structures that emphasize quality over mere cost reductions.

Advisory Committees↗
PubMed1998

Money and trust: relationships between patients, physicians, and health plans.

In response to three articles on managed care by Allen Buchanan, David Mechanic, and Ezekiel Emanual and Lee Goldman (this issue), I discuss doctor-patient and organization-member trust and the moral obligations of those relationships. Trust in managed care organizations (providers of and payers for health care) stands in stark contrast to the current contractual model of health insurance purchase, but is more coherent with consumer expectations and with the provider role of such organizations. Such trust is likely to differ from that between doctors and patients. Financial reimbursement systems for physicians, one example of organizational change in our health system, can be evaluated for their impact on both kinds of trust according to their intrusiveness, openness, and goals. Although involving managed care enrollees in value-laden decisions that affect them is commendable, restrictions on or regulation of physician incentive systems may be better accomplished on a national level.

Advisory Committees↗
PubMed1979

Accountability in health care: an essay on mechanisms, muddles, and mires.

This paper presents a critical evaluation of several theories of accountability and their applicability to health care concerns. The authors first provide a preliminary refinement of the imprecise concept of accountability itself and then examine four major types (political; bureaucratic; professional; and economic-consumer). Then, by using disciplinary perspectives provided by several schools of thought in political science (legislative supremacy; general manager theory; government by bureaucracy; objective responsibility; citizen participation), they discuss the degree of accountability presently found in various American health policies. After identifying the inherent dilemmmas within any credible accountability approach to health care programs as now utilized in the United States, the authors recommend that all types of accountability be integrated and strengthened by relying more explicitly on practices characteristic of development administration.

Delivery of Health Care↗
PubMed1979

Public choice in health: problems, politics and perspectives on formulating national health policy.

Development of health policy goals necessitates a choice among normative premises--an accommodation of conflicting values. Any debate that does not identify underlying assumptions or link policy prescriptions to a theoretical perspective is destined to degenerate into uncommunicative and unproductive rhetorical posturing. A sensible approach toward formulating national health policy requires that competing values be identified and discussed explicitly. This article will examine the effect that selection of different theoretical perspectives can have on the identification of problems and on the formulation of prescriptive policies in the health field. It will also focus on the different values that are promoted by different policy perspectives and consider alternative models for implementing value choices.

Attitude to Health↗
PubMed1983

Invisible hand or fatherly hand? Problems of paternalism in the New Perspective on health.

This article examines the charge that the "New Perspective" on health (as exemplified by the Lalonde Report in Canada, by Prevention and Health in the United Kingdom) represents an abandonment of liberal principles in favor of a collectivist and paternalistic role for the state. It looks first at the problems confronting modern health policy, and at the reasoning behind the New Perspective's approach. It then explores whether and how the charge of paternalism applies to that approach, and just what such a charge implies. The article concludes with a discussion of the "liberal paternalist" viewpoint towards health policy, a viewpoint that combines respect for individual liberty with an interest in taking effective public action to improve the health status of modern populations.

Canada↗
PubMed1984

Professionalism and nonprofit organizations.

Many professionals prefer to work in nonprofit organizations, rather than in either for-profit or bureaucratic organizations. This preference suggests that nonprofits may be successful in reducing the tension between professional principles and institutional requirements. Professionals in for-profit organizations must submit to the control of a manager who is motivated to overrule them whenever their decisions come into conflict with the goal of profit maximization. Bureaucratic organizations stress predictability of results and adherence to rules as the overriding criteria of evaluation and control. This paper argues that nonprofits are on the whole superior from the point of view of professional ideology and practice. Thus, given a commitment to the values of professionalism, the preference for the nonprofit form becomes understandable, even without the usual assumptions about income-maximizing behavior.

Health Facilities, Proprietary↗
PubMed1986

New birth technologies: a social work approach to researching the psychosocial factors.

Developments in reproductive technology, notably in vitro fertilization and artificial insemination using donor sperm, are occurring at a rapid rate. Research into the psychosocial aspects of these developments has been minimal, as has been the contribution of social workers to this research. This paper reports the author's research and discusses a number of issues that have emerged as a result of a social work attempt to investigate the psychosocial factors.

Attitude of Health Personnel↗
PubMedDate not supplied

Scientific and ethical conflicts in cancer studies involving human subjects.

Cancer studies involving human subjects present ethical conflicts which require a delicate balance to be struck between respect for fundamental human rights and the need to obtain sufficient data to satisfy study goals. Scientific and ethical conflicts at all stages of application of the scientific method are discussed. Legislative safeguards and ethical guidelines continue to evolve. Both must form an integral part of considerations regarding the feasibility of conducting cancer studies involving human subjects. Researchers, administrators, and legislators must be educated in and remain sensitive to two competing forces in epidemiologic research: the need to know versus respect for the individual's right to privacy, safety, dignity, and autonomy. An enhanced role for Institutional Review Boards to include an interactive monitoring function with ongoing studies is proposed.

Confidentiality↗
PubMed1984

Misconceptions of homophobia.

Recent studies and analyses of social reactions to homosexuality are examined with the goal of linking them to general theories of deviance in the mainstream of sociology and social psychology. Homosexuality as an attitudinal object is classified as person, trait, and characteristic of collectivities and culture. The assumption of homosexuality as a "master status trait" is questioned. Foci of investigation are categorized as cognitive stereotypes, perceptions of threat to others and to valued aspects of society and culture, and the management of homosexuality. Ego-alien and phobic responses are distinguished. General problems of attitudinal research in the field are identified; chiefly, the overemphasis of cognitive elements and the neglect of affective and behavioral elements. The potential of this imbalance for the reification of homophobia among subjects and for the general public is noted. Other problems include the confounding of cognitive and affective dimensions and the assumption of stability of attitudes in different social settings. The need for concrete observations of responses to homosexuality in varying social settings and for the study of various types and phases of the disclosure process is specified. We call for grounded empirical observations of reactions to homosexuality within a model of the "social construction of reality" in order to place such studies within the mainstream of sociology and social psychology.

Attitude↗
PubMed1995

Policing "perversions": Depo-Provera and John Money's new sexual order.

The use of the drug Depo-Provera (medroxyprogesterone acetate [MPA]) in the treatment of sexual minorities, such as sadomasochists, transvestites, sexually active children and teenagers, and adults sexually attracted to minors, is the latest development in a long tradition of dangerous and crude experimentation by psychiatrists and clinical psychologists with biodeterministic and reductionist views of human sexuality. Among them is clinical psychologist John Money, whose zealous advocacy of such treatments ignores or downplays critical issues of ethics, informed consent, and the side effects of the drug. The U.S. Food and Drug Administration has failed to effectively regulate such uses of Depo-Provera. Public outcry, more stringent regulation, and a new acceptance of the rights of sexual minorities are necessary to forestall the imposition of a repressive, new sexual order.

Adolescent↗