The principles of medical ethics and their application to Mexican-American elderly patients.

Within the vigor of the American medical ethical dialogue, awareness that the principles of respect for autonomy, beneficence, and justice may reflect some cultural bias that, in effect, may not be applicable to Americans of all ethnicities is growing. This bias raises the question about what happens when these three ethical principles are applied in clinical situations involving elderly Mexican-American patients. Four case studies based on actual patient encounters are presented to show the manner in which ethical principles may apply for Mexican-American patients and to generate discussion by presenting evidence that indicates that the fundamental ethical principle that Mexican-American elders expect will be applied by their physicians is beneficence, and not respect for self-determination.

An instrument to evaluate alcohol-abuse interviewing and intervention skills.

At the University of Texas Health Science Center at San Antonio from 1988 through 1990, the authors developed the Alcoholism Intervention Performance Evaluation (AIPE), a rating instrument for the evaluation of alcohol-abuse interviewing and intervention skills. Factor analysis of 51 rating items identified seven factors that accounted for most of the variability among the items; 35 were retained and assigned to the factor with which they correlated most highly, thus resulting in a seven-factor instrument with 35 items. The AIPE overall score had an interrater reliability of .73 (for four raters each rating approximately 30 videotaped simulated-patient interviews) and a test-retest reliability of .89 (for one rater rescoring 20 interviews after one month). The authors suggest that the individual scores for the seven factors can be used to provide instructional feedback to trainees and that the overall score can be used to certify interviewer proficiency.