bluuebunny/crossref_metadata_2025 huggingface dataset:
Male and female offending trajectories
Authors: FERGUSSON DAVID M. , HORWOOD L. JOHN
Published: November 2002

This paper uses a latent class modeling approach to examine gender related variations in
offending trajectories from adolescence to young adulthood. This approach is applied to data
gathered over the course of a longitudinal study of 896 New Zealand children studied from birth
to age 21 years. The analysis identified five trajectory groups: a group of low-risk offenders, three
groups of adolescent-limited offenders who varied in the timing of the onset of offending (early,
intermediate, and late onset), and a group of chronic offenders. Identical offending trajectories
applied for males and females. However, probabilities of trajectory group membership varied with
gender, with females being more likely to exhibit low-risk or early onset adolescent-limited
offending and males later onset and chronic offending. Examination of social, family, and
individual factors associated with these trajectories suggested the presence of a series of common
etiological factors relating to family functioning and early adjustment that discriminated between
trajectory groups. These risk factors appeared to operate in a similar fashion for both males and
females. Implications of these findings for trajectory theories of offending are discussed.
The temporal binding deficit hypothesis of autism
Authors: BROCK JON , BROWN CAROLINE C. , BOUCHER JILL , RIPPON GINA
Published: November 2002

Frith has argued that people with autism show “weak central coherence,” an unusual bias toward piecemeal rather than configurational processing and a reduction in the normal tendency to process information in context. However, the precise cognitive and neurological mechanisms underlying weak central coherence are still unknown. We propose the hypothesis that the features of autism associated with weak central coherence result from a reduction in the integration of specialized local neural networks in the brain caused by a deficit in temporal binding. The visuoperceptual anomalies associated with weak central coherence may be attributed to a reduction in synchronization of high-frequency gamma activity between local networks processing local features. The failure to utilize context in language processing in autism can be explained in similar terms. Temporal binding deficits could also contribute to executive dysfunction in autism and to some of the deficits in socialization and communication.
Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation
Authors: OSTERLING JULIE A. , DAWSON GERALDINE , MUNSON JEFFREY A.
Published: November 2002

Previous work based on observations of home videotapes indicates that differences can be detected between infants with autism spectrum disorder and infants with typical development at 1 year of age. The present study addresses the question of whether autism can be distinguished from mental retardation by 1 year of age. Home videotapes of first birthday parties from 20 infants later diagnosed with autism spectrum disorder, 14 infants later diagnosed with mental retardation (without autism), and 20 typically developing infants were coded by blind raters with respect to the frequencies of specific social and communicative behaviors and repetitive motor actions. Results indicated that 1-year-olds with autism spectrum disorder can be distinguished from 1-year-olds with typical development and those with mental retardation. The infants with autism spectrum disorder looked at others and oriented to their names less frequently than infants with mental retardation. The infants with autism spectrum disorder and those with mental retardation used gestures and looked to objects held by others less frequently and engaged in repetitive motor actions more frequently than typically developing infants. These results indicate that autism can be distinguished from mental retardation and typical development by 1 year of age.
Mother–infant and father–infant attachment among alcoholic families
Authors: EIDEN RINA DAS , EDWARDS ELLEN PETERSON , LEONARD KENNETH E.
Published: November 2002

This study examined the association between fathers' alcoholism and other risk factors such as parental depression, family conflict, infant temperament, and parent–infant attachment. The quality of parent–infant interactions was hypothesized to be a proximal mediator of the associations among alcoholism and other risk factors and attachment. The participants were 223 families (104 nonalcoholic families and 119 alcoholic families) with 12-month-old infants recruited through birth records. Infants in families with two parents with alcohol problem had significantly higher rates of insecure attachment with both parents. Structural Equations Modeling indicated that the fathers' alcohol problem was associated with lower paternal sensitivity (higher negative affect, lower positive engagement, and lower sensitive responding) during father–infant play interactions, and this in turn was associated with higher risk for infant attachment insecurity with fathers. The association between the fathers' alcohol problem and infant attachment security with the mother was mediated by maternal depression, and maternal alcohol problems and family conflict were associated with maternal sensitivity during play interactions. These results indicate that the fathers' alcoholism is associated with higher family risk including the quality of the parent–infant relationship; infant attachment develops in a family context; and this context has a significant association with attachment security.
Infant–mother attachment security, contextual risk, and early development: A moderational analysis
Authors: BELSKY JAY , FEARON R. M. PASCO
Published: November 2002

In light of evidence that the effects of attachment security on subsequent development may be contingent on the social context in which the child continues to develop, we examined the effect of attachment security at age 15 months, cumulative contextual risk from 1 to 36 months, and the interaction of attachment and cumulative risk to predict socioemotional and cognitive linguistic functioning at age 3 years, using data from the National Institute of Child Health and Human Development Study of Early Child Care. Results indicated that early attachment predicts both socioemotional development and language skills, but not cognitive functioning as indexed by a measure of school readiness, and that the effect of attachment on socioemotional development and expressive language varied as a function of social-contextual risk. Insecure–avoidant infants proved most vulnerable to contextual risk, not children classified as secure or insecure more generally, although in one instance security did prove protective with respect to the adverse effects of cumulative contextual risk. Findings are discussed in terms of risk and resilience and in light of the probabilistic nature of the relation between early attachment and later development.
Early intervention for low birth weight, preterm infants: The role of negative emotionality in the specification of effects
Authors: BLAIR CLANCY
Published: November 2002

This study examined the relation of negative emotionality in infancy to child social and cognitive developmental outcomes among low birth weight (LBW) preterm infants participating in the Infant Health and Development Program (IHDP), a comprehensive compensatory education intervention beginning in infancy and lasting through age 3 years. In this analysis, intervention effects at age 36 months on maternal report of child behavior as assessed by the Child Behavior Checklist externalizing and internalizing scales and on intelligence as measured by the Stanford–Binet scale were largest among children characterized by higher levels of negative emotionality in infancy. Findings indicate that for LBW preterm infants characterized by negative emotionality at age 12 months the intervention was associated with a twofold decrease in the occurrence of clinically meaningful levels of behavior problems at age 3 years and a fourfold decrease in the occurrence of a high-risk profile in which both internalizing and externalizing scores are in the clinically meaningful range. The intervention was also associated with a fivefold decrease in the occurrence of IQ ≤ 75 at age 3 years among children with higher levels of negative emotionality and heavier LBW (2001–2500 g). However, specific aspects of temperamental difficulty such as fearfulness and anger were related to internalizing and externalizing, respectively, in both the intervention and control groups. Findings are consistent with research linking negative emotionality in infancy with social and cognitive developmental outcomes in early childhood among normal birth weight infants. Results suggest the need for further attention to child temperament in early intervention research.
Stress hormone levels of children of depressed mothers
Authors: ASHMAN SHARON B. , DAWSON GERALDINE , PANAGIOTIDES HERACLES , YAMADA EMILY , WILKINSON CHARLES W.
Published: November 2002

Research suggests that disruptions in early caretaking can have long-term effects on the hypothalamic–pituitary–adrenal (HPA) axis, which mediates the stress response. Children of depressed mothers are at increased risk for developing internalizing problems in part because of disruptions in their caretaking environment. The present study investigated whether children of depressed mothers exhibit elevated salivary cortisol levels. Salivary cortisol samples were collected from 45 7- to 8-year-old children of mothers with a history of depression and 29 children of nondepressed mothers. Samples were collected soon after arrival to the laboratory and after a mild laboratory stressor and at home after wakeup and before bedtime. Children who had elevated levels of internalizing symptoms and whose mothers had a history of depression showed elevated laboratory baseline cortisol levels. Children who were reported to have clinically significant internalizing symptoms were also more likely to show an elevated stress response to a mild laboratory stressor. When the longitudinal history of maternal depression was examined, maternal depression during the child's first 2 years of life was the best predictor of elevations in baseline cortisol at age 7 years. This study provides evidence that internalizing symptoms exist in conjunction with a more reactive hormonal stress system in children of depressed mothers. The results also provide preliminary evidence that exposure to maternal depression in the first 2 years of life may be related to children's cortisol levels later in life.
Maternal smoking during pregnancy and conduct problems in high-risk youth: A developmental framework
Authors: WAKSCHLAG LAUREN S. , HANS SYDNEY L.
Published: November 2002

Smoking during pregnancy is associated with adverse consequences for children. Most recently, it has been established as a risk factor for developmental psychopathology, specifically Conduct Disorder (CD). Although this association has been shown to be robust, developmental pathways from exposure to CD have not been established. We examined how prenatal exposure to cigarettes interacts with child and family factors to increase risk of CD symptoms in a longitudinal study of 10-year-old urban, African-American youth (N = 77). The effects of prenatal exposure at school age were moderated by child sex. Boys whose mothers smoked during pregnancy were significantly more likely to develop CD symptoms, but exposure did not increase risk in girls. A similar trend was found during infancy: prenatal smoking was associated with low sociability/negative emotionality only for boys. The effects of smoking during pregnancy were also moderated by the quality of the early caregiving environment. Exposed boys whose mothers were unresponsive during infancy were at increased risk of CD symptoms, but exposed boys with early responsive mothers were not. Prospective studies, with developmentally based measures of behavior across time, are critical for further elucidating pathways from prenatal exposure to cigarettes to the development of clinical disorder. The identification of a potentially modifiable, prenatal risk factor for early onset developmental psychopathology has important implications for prevention.
Discrimination, crime, ethnic identity, and parenting as correlates of depressive symptoms among African American children: A multilevel analysis
Authors: SIMONS RONALD L. , MURRY VELMA , MCLOYD VONNIE , LIN KUEI-HSIU , CUTRONA CAROLYN , CONGER RAND D.
Published: November 2002

This study investigated the correlates of childhood depressive symptoms in an African American sample. We included processes that are likely to operate for all children, regardless of race or ethnicity, as well as events and circumstances that are largely unique to children of color. These various constructs were assessed at both the individual and community level. The analyses consisted of hierarchical linear modeling with a sample of 810 African American families living in Iowa and Georgia. Three individual-level variables were associated with childhood depressive symptoms: uninvolved parenting, racial discrimination, and criminal victimization. At the community level, prevalence of both discrimination and criminal victimization were positively related and community ethnic identification was negatively related to depressive symptoms. Further, there was evidence that community ethnic identification and neighborhood poverty serve to moderate the relationship between criminal victimization and depressive symptoms. Overall, the findings underscore the importance of considering factors unique to the everyday lives of the cultural group that is the focus of study, while demonstrating the dangers of a “one model fits all” approach to studying children of color.
Sex differences in the genetic and environmental influences on the development of antisocial behavior
Authors: JACOBSON KRISTEN C. , PRESCOTT CAROL A. , KENDLER KENNETH S.
Published: November 2002

The present study uses a population-based sample of 6,806 adult twins from same-sex and opposite-sex twin pairs to examine sex differences in the underlying genetic and environmental architecture of the development of antisocial behavior (AB). Retrospective reports of AB during three different developmental periods were obtained: prior to age 15 years (childhood), age 15–17 years (adolescent), and age 18 years and older (adult). Structural equation modeling analyses revealed that there was no evidence for sex-specific genetic or sex-specific shared family environmental influences on the development of AB; that is, the types of genetic and environmental influence were similar for males and females. For both sexes, a model that allowed for genetic influences on adolescent and adult AB that were not shared with childhood AB fit better than a model with a single genetic factor. In contrast, shared environmental influences on adolescent and adult AB overlapped entirely with shared environmental influences on childhood AB. Genetic factors played a larger role in variation in childhood AB among females, whereas shared environmental factors played a larger role among males. However, heritability of AB increased from childhood to adolescence and adulthood for both sexes, and the magnitude of genetic and environmental influences on adolescent and adult AB was approximately equal across sex. We speculate that sex differences in timing of puberty may account for the earlier presence of genetic effects among females.
Editorial: Multiple levels of analysis
Authors: CICCHETTI DANTE , DAWSON GERALDINE
Published: November 2002

In a recent article, Cowan, Harter, and Kandel (2000) concluded that much of the success and excitement engendered by modern neuroscience can be attributed to the incorporation of several previously independent disciplines into one intellectual framework. During the 1950s and 1960s, neuroanatomy, neurochemistry, neuropharmacology, and neurophysiology, disciplines that had largely functioned in a separate and distinct fashion, gradually merged into a unified field of neuroscience. The penultimate step in the coalescence of neuroscience occurred in the early 1980s, when neuroscience integrated with molecular biology and molecular genetics. The confluence of these fields enabled scientists to understand the genetic basis of neurological diseases for the first time without requiring foreknowledge of the underlying biochemical abnormalities. The final phase of the merger of neuroscience into a single discipline took place in the mid-1980s, when cognitive psychology joined with neuroscience, leading to the formation of cognitive neuroscience.
A relational view of causality in normal and abnormal development
Authors: GOTTLIEB GILBERT , HALPERN CAROLYN TUCKER
Published: November 2002

An understanding of developmental phenomena demands a relational or coactive concept of causality, as opposed to a conceptualization that assumes that singular causes can act in isolation. In this article we present a developmental psychobiological systems view of relational (bidirectional, coactional) causality, in which it is proposed that developmental outcomes are a consequence of at least two specific components of coaction from the same or different levels of a developmental system. The levels are genetic, neural, behavioral, and environmental; the latter level includes the cultural, social, and physical aspects of an organism's environment. We show the applicability of this view to the understanding of the development of normal and abnormal behavioral and psychological phenotypes through illustrations from the existing animal and human literature. Finally, we discuss future possibilities and potential stumbling blocks in the implementation of a more fully realized bidirectional, coactional perspective in developmental psychopathological research.
Levels of analysis in psychiatric research
Authors: KOPNISKY KATHY L. , COWAN W. MAXWELL , HYMAN STEVEN E.
Published: November 2002

Most of the major psychiatric disorders have been analyzed at each of several different levels. For example, at the broadest level, epidemiological studies have served to establish the incidence of disorders like schizophrenia and major depression in a number of different populations. Family and twin studies have been important in determining the heritability of certain mental illnesses, and chromosomal and linkage analyses have identified a number of discrete loci that appear to be implicated in disease susceptibility or, even directly, in the pathogenesis of some disorders. In a few cases, specific genes have been found to be mutated or polymorphic and proteins they encode are currently being analyzed. This article reviews how these different levels contribute to our understanding of a number of psychiatric disorders, including drug addiction, which has been the focus of much of our own work.
Neuroimaging of typical and atypical development: A perspective from multiple levels of analysis
Authors: JOHNSON MARK H. , HALIT HANIFE , GRICE SARAH J. , KARMILOFF–SMITH ANNETTE
Published: November 2002

To date, research involving functional neuroimaging of typical and atypical development has depended on several assumptions about the postnatal maturation of the brain. We consider evidence from multiple levels of analysis that brings into question these underlying assumptions and advance an alternative view. This alternative view, based on an “interactive specialization” approach to postnatal brain development, indicates that there is a need to: obtain data from early in development; focus more on differences in interregional interactions rather than searching for localized, discrete lesions; examine the temporal dynamics of neural processing; and move away from deficits to image tasks in which atypical participants perform as well as typically developing participants.
Converging evidence for brain stem injury in autism
Authors: RODIER PATRICIA M.
Published: November 2002

The hypothesis that brain stem injury plays a role in the autism spectrum disorders was suggested by evidence that exposure to thalidomide during the earliest stages of brain development increases the risk of autism spectrum disorders. The implications for the embryological origin of autism first led to studies of neuroanatomy in a human case and an animal model and then to examinations of minor craniofacial features in autism. But the general hypothesis had much broader implications. It has now generated studies of the behavioral and neurological symptoms of human patients, of human molecular genetics and population genetics, and of animal behavioral teratology and molecular pharmacology. The collection of this range of data was made possible by adding experts from many fields to the research team. They worked both independently and collaboratively to try to unravel the etiology of autism.
Developmental language learning impairments
Authors: TALLAL PAULA , BENASICH APRIL A.
Published: November 2002

Developmental language learning impairments (LLI) are one of the most prevalent of all developmental disabilities, can occur in children for a wide variety of reasons, and have been shown to co-occur frequently with other developmental social, emotional and behavioral disorders, as well as with academic achievement problems. Research pertaining to developmental LLI of unknown origin, with an emphasis on the continuum between oral and written language impairment, is the focus of this review. Given the complexity of language learning, research has focused on multiple levels of analysis, including linguistic, neuropsychological, genetic, neurobiological, and remediation studies. To date, the vast majority of data on LLI derive from studies focused on a single level of analysis. Although attempts have been made to integrate data across studies and multiple levels of analysis, this has proven to be problematic, given the heterogeneity of the subject populations used to study LLI, as well as the differences in ages, degree of impairment, and types of impairment included in each study. Given that LLI is a complex developmental disability, it is suggested that future research would benefit from taking a multiple levels of analysis approach with the same individuals, incorporating mathematical models designed to analyze dynamically changing complex systems, and studying individual differences in language learning, prospectively and longitudinally, throughout the most dynamic stages of the process.
Defining the broader phenotype of autism: Genetic, brain, and behavioral perspectives
Authors: DAWSON GERALDINE , WEBB SARA , SCHELLENBERG GERARD D. , DAGER STEPHEN , FRIEDMAN SETH , AYLWARD ELIZABETH , RICHARDS TODD
Published: November 2002

Achieving progress in understanding the cause, nature, and treatment of autism requires an integration of concepts, approaches, and empirical findings from genetic, cognitive neuroscience, animal, and clinical studies. The need for such integration has been a fundamental tenet of the discipline of developmental psychopathology from its inception. It is likely that the discovery of autism susceptibility genes will depend on the development of dimensional measures of broader phenotype autism traits. It is argued that knowledge of the cognitive neuroscience of social and language behavior will provide a useful framework for defining such measures. In this article, the current state of knowledge of the cognitive neuroscience of social and language impairments in autism is reviewed. Following from this, six candidate broader phenotype autism traits are proposed: (a) face processing, including structural encoding of facial features and face movements, such as eye gaze; (b) social affiliation or sensitivity to social reward, pertaining to the social motivational impairments found in autism; (c) motor imitation ability, particularly imitation of body actions; (d) memory, specifically those aspects of memory mediated by the medial temporal lobe–prefrontal circuits; (e) executive function, especially planning and flexibility; and (f) Language ability, particularly those aspects of language that overlap with specific language impairment, namely, phonological processing.
The neurobiological basis of autism from a developmental perspective
Authors: AKSHOOMOFF NATACHA , PIERCE KAREN , COURCHESNE ERIC
Published: November 2002

Autism is a neurobiological disorder that is diagnosed through careful behavioral assessment in early childhood. In this paper, we review recent studies that have attempted to reveal the underlying causes of autism using a variety of techniques. Particular emphasis is placed on techniques that have been used by a number of different laboratories, including structural magnetic resonance imaging and postmortem studies of neuroanatomy. Neurobiological and neuropsychological data from individuals across a wide age range are examined from a neurodevelopmental perspective. We discuss how these recent advances have led us to develop a growth dysregulation hypothesis of autism. Finally, we discuss how this hypothesis may lead to new innovations in autism research.
Psychological complexity: Barriers to its integration into the neurobiology of major psychiatric disorders
Authors: POST ROBERT M. , WEISS SUSAN R. B.
Published: November 2002

In the authors' experience interactions between clinical and laboratory research have been greatly mutually facilitatory in the understanding and development of new treatments for the major mental illnesses. Examples in the literature are also highlighted to show how cross-disciplinary studies are important in understanding the subtle interactions of genetic and environmental mechanisms in psychiatric illness. Yet, the results of some current science policies encouraging project focus and superspecialization can lead to the separation of clinical and basic investigators, which threatens the integration of psychological complexity into the neurobiology of psychiatry at both a molecular and behavioral level. This paper endorses renewed effort toward the multidisciplinary team approach under the leadership of a physician–scientist in order to better integrate many fields of study critical to ameliorating the effects of psychiatric illness.
Response to “Autonomy as Scapegoat in the Organ Shortage
Debate: A Reply to Portmann” by T. L. Zutlevics
Authors: Portmann John
Published: November 2002

T. L. Zutlevics has written a thoughtful response to my
piece on the anxiety borne of cutting bodies. I am grateful
for this opportunity to turn back to the pressing problem of
organ shortages.
Response to “May a Woman Clone Herself?” by Jean
E. Chambers (CQ Vol 10, No 2) and “Entitlement to
Cloning” by Timothy F. Murphy (CQ Vol 8, No 3)
Authors: Strong Carson
Published: November 2002

Jean E. Chambers and Timothy F. Murphy responded to my article
“Cloning and Infertility” and extended the debate over
human cloning in interesting ways. I had argued that none of the
objections to cloning by somatic cell nuclear transfer are successful
in the context of infertile couples who use cloning to have genetically
related children, assuming the issue of safety is overcome by scientific
advances.
Response to “May a Woman Clone Herself” by Jean
Chambers (CQ Vol 10, No 2)
Authors: Murphy Timothy F.
Published: November 2002

For many commentators in bioethics and the law, safety is the
fulcrum for evaluating the ethics of human reproductive cloning.
Carson Strong has argued that if cloning were effective and safe
it should be available to married couples who have tried to have
children through various assisted reproductive technologies (ARTs)
but been unable to do so. On his view, cloning should be available
only as reproductive last resort. I challenged that limited use by
trying to show that the arguments Strong adduces in favor of
reproductive somatic nuclear transfer (SNT) for married couples
extend to same-sex couples as well, who face a different kind of
infertility. I also went on to argue that his justifications
would in fact extend the legitimate use of SNT to any
couples regardless of whether they had fertility difficulties
or not.
Successes and Failures of Hospital Ethics Committees: A National
Survey of Ethics Committee Chairs
Authors: McGEE GLENN , SPANOGLE JOSHUA P. , CAPLAN ARTHUR L. , PENNY DINA , ASCH DAVID A.
Published: November 2002

In 1992, the Joint Commission on the Accreditation of
Healthcare Organizations (JCAHO) passed a mandate that all its
approved hospitals put in place a means for addressing ethical
concerns.Although the particular process the hospital uses to
address such concerns—ethics consultant, ethics forum,
ethics committee—may vary, the hospital or healthcare ethics
committee (HEC) is used most often. In a companion study to
that reported here, we found that in 1998 over 90% of U.S.
hospitals had ethics committees, compared to just 1% in 1983,
and that many have some and a few have sweeping clinical powers
in hospitals.
Response to “Clone Alone” by Carson Strong and
“Are There Limits to the Use of Reproductive Cloning” by
Timothy Murphy (CQ Vol 11, No 1)
Authors: Chambers Jean E.
Published: November 2002

Carson Strong's article “Cloning and Infertility”
has initiated a conversation in this journal about the ethical
and policy issues surrounding the question of who, if anyone,
should be allowed access to human reproductive cloning technology,
should somatic cell nuclear transfer ever become technically
feasible and safe. Strong's position in that article is that
infertile opposite sex couples for whom cloning is the last resort
for having a genetically related child are the only people who should
be granted access to such technology, primarily because this need
to have a genetically related child would give such couples
respectable reasons for cloning themselves. Also, every child
has a basic right to a “decent minimum opportunity for
development.” Thus it would be morally wrong, other things
being equal, to clone a person with cystic fibrosis or spina bifida
but morally permissible to clone a nearsighted person, because
nearsightedness is not sufficiently disabling to violate the child's
birthright. With this caveat, he concludes that protecting reproductive
freedom requires that physicians be allowed to provide cloning services
only to that small subset of infertile opposite sex couples who would
need it as a last resort, should human reproductive cloning
ever become safe and feasible.
Compassionate Utilitarianism: The Unknown Bentham Revealed
Authors: GOLDWORTH AMNON
Published: November 2002

Unlike the compassionate conservatism of George Bush,
Compassionate Utilitarianism is not a confusing concept. Nor
is it a newly minted version of Utilitarianism given that it
is embedded in the writings of Jeremy Bentham, writings that
have come to light only with the Oxford University Press
publication of his Deontology in 1983 as edited by
me. Bentham's An Introduction to the Principles of
Morals and Legislation (IPML) expresses the standard
interpretation of Hedonistic Utilitarianism. What he said in
Deontology serves as the basis of Compassionate
Utilitarianism.
Healthcare without Harm: An Ethical Imperative
Authors:   A Consensus Statement from Biomedical Ethicists in Support of
Environmentally Sound Healthcare Practices
Published: November 2002

(Note: This consensus statement appeared in somewhat differing
format as an editorial in the Western Journal of Medicine
2001;175 [October 2001]. The full text and list of
cosigners is published here for the first time.)

Bioethics is the formal discipline concerned with ethical and
broader issues arising in the practice of medicine and the other
healthcare professions and science as a whole. Bioethicists are
concerned not only with the impacts and quandaries faced by
individual patients and their caregivers, but the impacts of
healthcare on society and the broader natural world. Although
bioethicists approach such issues from many different theoretical
perspectives, most if not all agree that the healthcare professions
and industry should seek to minimize any real or potential health
risks associated with providing healthcare.
Will Social Values Influence the Development of HMOs?
Authors: DAVIS JOHN B.
Published: November 2002

Among industrialized nations the United States is relatively
unique in relying on a mix of public and private financing and
delivery of healthcare: federal and federal-state programs,
such as Medicare and Medicaid; employment-based health insurance
(primarily HMOs); and state-subsidized insurance pools for
high-risk individuals. In recent years, however, there have
been efforts to apply the principles of private employment-based
health insurance to the other forms of healthcare, and there
is speculation that rising healthcare costs can only be addressed
by further extending capitated payment plans. This suggests
that U.S. healthcare may increasingly be organized according
to market principles. For some, this represents a historic
departure from an emphasis on public responsibility for healthcare
and a sacrifice of the value principles embodied in health
relationships between patient and provider. But defenders of
HMOs and a larger role for markets argue that managed care allows
for a more rational allocation of scarce healthcare resources
by minimizing inefficient low-benefit–high-cost care.
More individuals receive essential care if inessential care
is eliminated. HMOs are also said to encourage non-HMOs to provide
lower priced healthcare.
Moral Consensus in Bioethics: Illusive or Just Elusive?
Authors: TROTTER GRIFFIN
Published: November 2002

This issue of CQ was conceived in Salt Lake
City, at the third annual meeting of the American Society of
Bioethics and Humanities (ASBH). There, President-elect Laurie
Zoloth delivered a stirring address, emphasizing the role of
bioethics in responding to social deprivations and suggesting
that ASBH “take a stand” on important issues where
members share consensus. Not all the stirrings were pleasant.
Debate erupted about the propriety of consensus statements,
especially regarding possible deleterious effects on academic
discourse, misappropriation of dues, and the proliferation of
quasi-political factions. The roots of this controversy extend
deeply into the collective psyche of contemporary bioethics.
Consensus Formation: The Creation of an Ideology
Authors: ENGELHARDT H. TRISTRAM
Published: November 2002

Bioethics is not merely a theoretical discipline but
a practice as well. Indeed, bioethics is a sort of moral trade.
Bioethicists serve on ethics committees, give expert testimony
to courts, provide guidance for healthcare policy, and receive
payment for these services. The difficulty is that their role as
experts able to guide clinical choice and public policy formation
is brought into question by the diversity of moral understandings
regarding central moral issues at the heart of the culture wars in
healthcare. The disconfirmation of the expert role of bioethicists
by their apparent actual role as partisans of particular moral
schools and perspectives could be set aside, were there an avenue
to moral consensus, a door to a common moral vision to guide
this new profession of moral experts. This brief article addresses
the hunger for consensus in bioethics, its impossibility with
respect to the controversial issues that mark the field, and
the inclination nevertheless to deny this manifest diversity
by appeals to a consensus that could allow bioethicists to function
as ethics experts able substantively to guide clinical choices
and public policy.
Narrative as Bioethics: The “Fact” of Social
Selves and the Function of Consensus
Authors: HESTER D. MICAH
Published: November 2002

Several months ago, I was walking down the hallway outside
our medical school faculty offices and a colleague stopped me
to ask a question. He phrased his query in the context of a
“hypothetical” case that raised ethical issues for
him, and he asked me to respond. I obligingly offered my opinion
given the details he presented, ending my comments with the
phrase, “at least, that is what I would say.” To
this he kindly shot back, “OK, but what is the consensus
of medical ethicists?” To be honest, this question caught
me off guard. Though his particular dilemma was relatively
well-trod territory for many bioethicists, I had done little
research on the issue and could not immediately render a response
to his latter query.
Two Models of Ethical Consensus, Or What Good Is a Bunch
of Bioethicists?
Authors: KUCZEWSKI MARK
Published: November 2002

Contemporary bioethics is a peculiar creature. What was
once a subdivision of moral theology and philosophy tended mainly
within the confines of schools of arts and sciences or seminaries
has now become a quasi-profession whose practitioners come from
a wide variety of disciplines. Perhaps still more intriguing
is that the “members” of this discipline routinely
engage the public at the hospital bedside, in the institutional
boardroom, and through public policy consultation. Bioethicists
have actively embraced these roles as the natural outgrowth of
their research and study. Contemporary bioethics is thus a
“demi-discipline.” It is study and research but
completes itself in public engagement.
Keeping Company: Ethics and the Talk in the Commons
Authors: ZOLOTH LAURIE
Published: November 2002

The field of bioethics is by definition based on the
presupposition that questioning, arguing, interruption, and
response are the means by which we evaluate the truth claims
of medicine and healthcare policy. The field began with the
premise that another voice, one of at least critique, if not
dissension, was just what was needed in any arena in which
hegemonic expertise held sway. The field of the humanities is
similarly based on the idea that both the literary and cultural
canon—and the disputation and resistance to the
canon—are acknowledged, taught, and honored. In situ in
the clinic, on national boards, or in the literature, when a
philosopher perceives a unanimity, she begins to be uneasy and
begins to do the very thing she is trained for: to raise the
questions of definition, method, data, motive, and goal.
Making Sense of Consensus: Responses to Engelhardt, Hester,
Kuczewski, Trotter, and Zoloth
Authors: MORENO JONATHAN D.
Published: November 2002

It has been a pleasure to read these papers and to contemplate
their importance for what I believe to be a useful and provocative
prism though which to view the field of bioethics: the nature of
moral consensus. In my own most extended contribution to this literature,
Deciding Together, I did not attempt to prescribe so
much as to understand the role of moral consensus in the practice
of bioethics. At the end of the book, I expressed the hope that
it might help trigger an examination of bioethics and moral
consensus. Though a few others shared my interest at that time
(in particular Tris Engelhardt, for whose early encouragement I
remain deeply grateful), with this set of stimulating papers the
conversation has finally begun in earnest.
Abstracts of Note: The Bioethics Literature
Authors: Iserson Kenneth V.
Published: November 2002

This section is meant to be a mutual effort. If you find an
article you think should be abstracted in this section, do not
be bashful—submit it for consideration to Kenneth V. Iserson
care of CQ. If you do not like the editorial comments, this
will igve you an opportunity to respond in the letters section.
Your input is desired and anticipated.
Constructing the Human Dance of Meaning
Authors: BROWN KATHERINE H.
Published: November 2002

The Cambridge Quarterly has a history of presenting
multidisciplinary perspectives in bioethics, welcoming a lively
dialogue between clinicians, philosophers, theologians, social
scientists, lawyers, and others on a range of bioethics concerns.
This special issue of the journal focuses explicitly on
contributions from anthropologists to the field.
Ambiguity and Hope: Disclosure Preferences of Less Acculturated Elderly
Mexican Americans Concerning Terminal Cancer—A Case Story
Authors: FRANK GELYA , BLACKHALL LESLIE J. , MURPHY SHEILA T. , MICHEL VICKI , AZEN STANLEY P. , PRELORAN HAYDEE MABEL , BROWNER CAROLE H.
Published: November 2002

A major shift has taken place since the 1960s concerning
disclosure to patients that they have a diagnosis of cancer
and that their disease is considered terminal. Full disclosure
is now considered the patient's right in the United States.
However, there remain many countries in which nondisclosure is
still the norm. When patients from those countries are diagnosed
with cancer in America, differences in attitudes and expectations
can cause conflict and misunderstanding.
Reading Futility: Reflections on a Bioethical Concept
Authors: JORALEMON DONALD
Published: November 2002

There was a remarkable outpouring of publications related to
the concept of medical futility between 1988 and 1995, and there
has been a substantial drop-off since then (Figure 1). A wide
variety of definitions of the concept were offered from many
corners of the medical profession, from medical social sciences,
as well as from judges in several state and federal courts.
Attention was drawn to the conflicts over when it is appropriate
to declare further treatment futile, who has the authority to
make such determinations, and what evidence is required.
What “Race” Cannot Tell Us about Access to Kidney
Transplantation
Authors: GORDON ELISA J.
Published: November 2002

Despite a growing awareness within American biomedicine and
bioethics that the social category “race” is of
limited use in describing patients, some fields of medicine
continue to use it interchangeably with, or instead of, the term
“ethnicity.” Doing so reflects the assumption that
social categories have a basis in physiology.
Do Genetic Relationships Create Moral Obligations in Organ
Transplantation?
Authors: GLANNON WALTER , ROSS LAINIE FRIEDMAN
Published: November 2002

In 1999, a case was described on national television in which
a woman had enlisted onto an international bone marrow registry
with the altruistic desire to offer her bone marrow to some
unidentified individual in need of a transplant. The potential
donor then was notified that she was a compatible match with
someone dying from leukemia and gladly donated her marrow, which
cured the recipient of the disease. Years later, though, the
recipient developed end-stage renal disease (ESRD), a consequence
of the high-dose chemotherapy she received earlier to destroy her
stem cells and prepare her for the bone marrow transplant. Finding
a suitable donor for a kidney transplant proved extremely difficult.
Desperate, she requested that the donor registry personnel help her
locate the individual who earlier was determined to be a compatible
donor and asked this now-identifiable individual to consider
donating one of her two normally functioning kidneys for a kidney
transplant.
Adults Are Not Big Children: Examining Surrogate Consent
to Research Using Adults with Dementia
Authors: YARBOROUGH MARK
Published: November 2002

Few early debates in bioethics invigorated the field to the
same extent as the one concerning whether or not young children
could be used in nontherapeutic research. Though some of the issues
in the debate were never fully settled, a consensus emerged,
reflected in the Common Rule—that surrogates could consent
to use children in such research, although once the level of risk
rises above minimal, additional stipulations are required.
Nontherapeutic research on cognitively impaired elderly people
raises equally complex ethical issues, but there has been a dearth
of debate in the literature about whether such research is ethically
permissible. Instead, there have been many published recommendations
regarding the circumstances under which such research can occur.
Moral Conundrums in the Courtroom: Reflections on a Decade
in the Culture of Pain
Authors: RICH BEN A.
Published: November 2002

Charles Dickens began one of his many great works of literature
with this seemingly paradoxical, self-contradictory statement.
Reflecting on a jury verdict in Northern California in June
of 2001, in the context of what has transpired during the decade
of the 1990s with regard to the care of dying patients,
observations in the genre of Dickens come readily to mind. In
1991, two of the most compelling books on the subject of pain,
medicine, and society were published: Eric Cassell's The
Nature of Suffering and the Goals of Medicine and David
Morris's The Culture of Pain. Both works
unflinchingly recognized and explored the implications of the
vast clinical literature documenting the failure of modern medicine
to respond compassionately and effectively to what had by then
become an epidemic of undertreated pain.
Mental Competence, Caregivers, and the Process of Consent:
Research Involving Alzheimer's Patients or Others with
Decreasing Mental Capacity
Authors: GUINN DAVID E.
Published: November 2002

Alzheimer's disease and other forms of dementia are among
the fastest growing health problems in America. Dementia incidence
tends to increase with age, and the elderly are the fastest
growing segment of the population. Medical and social sciences
research on dementia involving demented patients is both ongoing
and necessary. However, as noted in a report of the Office for
Human Subjects Research, “while research with intellectually
impaired people generates valuable … data, it also provides
significant ethical challenges.
The Psychological Structure of Patient Autonomy
Authors: WALLER BRUCE N.
Published: November 2002

The patient's right to informed consent is grudgingly
acknowledged by medical professionals, firmly established in
law, and brandished as a shibboleth by most bioethicists. But
questions remain concerning genuine patient autonomy, and the
doctrine of informed consent offers inadequate answers. In addition
to the continuing controversy over what counts as
“informed,” the passive acquiescence implied by
“consent” seems a pale shadow of genuine autonomy.
Can There Be a “Duty to Die” without a Normative
Theory?
Authors: SEAY GARY
Published: November 2002

Unlike many philosophers who write on biomedical ethics, John
Hardwig is not primarily concerned to test our intuitions about
the limits of normative theories by thought experiments or
problematic borderline cases. Rather, he presses us to accept
the conclusions to which our most firmly held principles commit
us. But these conclusions, if Hardwig is right, turn out to
be quite startling claims about moral duty that would undermine
much of contemporary bioethical theory regarding end-of-life
decisions. On his view, we must face squarely the moral
implications of our present arrangement of healthcare funding
in the United States, where more and more of the financial
responsibility of care is being shifted onto the families of
patients, often with disastrous results. Yet, in the context of this
increasingly unstable arrangement, our chief principle of medical
decisionmaking also holds that their interests are
not morally relevant at all in deciding what should be done
for the patient, and only the patient's wishes
count (insofar as we can determine them). Now Hardwig thinks
that this rule is irrational in the present circumstances, and
that it would make more sense to admit the moral relevance of
the interests of family members, but also that if we do give
appropriate weight to their concerns, we shall be led in some
cases to the conclusion that the patient has a duty to die.
The Virtue of Moral Responsibility in Healthcare Decisionmaking
Authors: GAUTHIER CANDACE CUMMINS
Published: November 2002

The principle of respect for autonomy is increasingly under
siege as a valuable component of healthcare ethics. Its critics
charge that it has been elevated to a position out of proportion
to its contribution, so that the individual's wishes and
rights have come to dominate healthcare decisionmaking, while
obligations and responsibilities are ignored or devalued. If
we are to salvage respect for autonomy we must find a way to
reconnect the individual and the community, rights and
responsibilities, in the way we think about, discuss, and make
healthcare decisions.