Policy vs. Ethics.

Editor's Note: As Catholic ethics increasingly diverge from those of other religious traditions and from secular principles, it is important to explore how-if at all-Catholic physicians and institutions can work with those whose view of life and faith are very different. This article presents not only an historical vision of how the Ethical and Religious Directives came to be, it raises questions about just how Catholics go about moral reasoning when there are competing interests and principles at play. The author of the article, Warren T. Reich, was, at the time it was written, a Senior Research Scholar in Medical Ethics at the Kennedy Center for Bioethics, Georgetown University. He went on to be a founding member of the Kennedy Institute of Ethics. He was also founder and director of the Project for the History of Care, and is Distinguished Research Professor of Religion and Ethics in the Georgetown University Theology Department and Professor Emeritus of Bioethics in the Georgetown University School of Medicine. This article was prepared for delivery at the Annual Meeting of the National Federation of Catholic Physicians' Guilds, New Orleans, November 27. 1971. The issues he raises and the conflicts he perceives are as relevant now as they were 50 years ago. Reich, Warren T. (1972) "Policy vs. Ethics, "The Linacre Quarterly: Vol. 39: No. 1, Article 8. Available at: http://epublications.marquette.edu/lnq/vol39/iss1/8.

Self-Role Integration: A Person-Specific Predictor of Life Satisfaction and Prosocial Behavior.

We investigated whether a novel self-structural variable, self-role integration, incrementally predicts life satisfaction and prosocial behavior beyond dispositional trait predictors that are known from prior research to be linked to these outcomes. At Time 1, 223 participants (171 female) completed measures of life satisfaction, optimism, the Big Five personality traits, reward and punishment sensitivity (BIS/BAS), psychological distress, and prosocial behavior. They then completed an idiographic measure in which they selected from a list of trait terms to describe their actual self and a series of role-specific identities. At Time 2 (60 days later, N = 134), they again reported prosocial behavior. Self-role integration was computed from the linkages between actual self and role-identities derived from a Hierarchical Classes (HICLAS) analysis of each participant's self-descriptive data. Self-role integration concurrently and prospectively predictive of prosocial behavior beyond significant trait-level predictors, and was marginally significantly correlated with life satisfaction beyond a set of trait-level predictors. Results demonstrate that a self-structural variable can add predictive utility to life satisfaction and prosocial behavior beyond dispositional traits.

Medication adherence feedback intervention predicts improved human immunodeficiency virus clinical markers.

Thirty-three participants in a human immunodeficiency virus (HIV) medication adherence feedback (MAF) intervention were compared with 58 HIV-positive non-participants in laboratory-tested CD4 and viral load. The intervention provided adherence feedback and counselling based on a visual display from an electronic pill bottle (MEMS(TM) ). Multiple regression controlling for baseline CD4 and showed that postintervention CD4 was higher for MAF participants than for non-MAF participants. Non-MAF participants' CD4 significantly declined over time. MAF participants were also less likely than non-MAF participants to have a detectable postintervention viral load.

From ancient consolation and negative care to modern empathy and the neurosciences.

A historical understanding of the virtue of consolation, as contrasted to empathy, compassion, or sympathy, is developed. Recent findings from neuroscience are presented which support and affirm this understanding. These findings are related to palliative care and its current practice in bioethics.

Forms of social support and their relationships to mental health in HIV-positive persons.

A baseline assessment for an HIV health services study recruited 626 people living with HIV/AIDS (PLWHA) in New York city who participated in an interview querying social support, health status, substance use, and mental health. Data were modeled using hierarchical classes (HICLAS) analysis. HICLAS discriminated items reflecting general support and assistance vs. support from an important person in one's life who was named in addition to other family members and friends. HICLAS then identified respondents who reported that they had general support and assistance, support from an important person, both types, or neither type of support. Having one or more important persons as part of the respondent's social network was associated with more positive mental (but not physical) health than having only general support and assistance, or no support at all. Results argue for differentiating support obtained through one's relationship with an important person.

Predicting the decision to pursue mediation in civil disputes: a hierarchical classes analysis.

Clients (N = 185) involved in civil court cases completed the CPR Institute's Mediation Screen, which is designed to assist in making a decision about pursuing mediation. The authors modeled data using hierarchical classes analysis (HICLAS), a clustering algorithm that places clients into 1 set of classes and CPRMS items into another set of classes. HICLAS then links the sets of classes so that any class of clients can be identified in terms of the classes of items they endorsed. HICLAS-derived item classes reflected 2 underlying themes: (a) suitability of the dispute for a problem-solving process and (b) potential benefits of mediation. All clients who perceived that mediation would be beneficial also believed that the context of their conflict was favorable to mediation; however, not all clients who saw a favorable context believed they would benefit from mediation. The majority of clients who agreed to pursue mediation endorsed items reflecting both contextual suitability and perceived benefits of mediation.

Prototypical images in condom scripts among AIDS-bereaved adolescents.

Twenty-five HIV-negative late adolescents (13 women and 12 men) who had lost a parent to AIDS generated vignettes in which the characters were deciding whether to use a condom (condom scripts). Two clinically trained judges rated the interpersonal tone of the condom scripts on 17 semantic differential scales. Three other clinically trained raters described script characters' attributes by selecting from a list of 36 terms. Multidimensional scaling (MDS) and individual differences hierarchical classes analyses (INDCLAS) were used to inductively derive a typology of condom scripts. Two dimensions emerged from MDS analysis: incompatibility and inequality. Condom scripts culminating in unprotected sex depicted situations in which partners held unequal influence. INDCLAS results suggested a prototype for equal-influence condom scripts - excited male and assertive, powerful female - and for unequal-influence (unprotected sex) condom scripts - powerful, disengaged male and permissive female. These results inform the development of theoretical models and HIV prevention program materials.

Actual and ideal conflict styles and job distress in a health care organization.

Employees (N = 176) of a large metropolitan health care corporation completed the Thomas-Kilmann Conflict Mode Inventory (TKI; K. W. Thomas & R. H. Kilmann, 1974), and the authors computed scores on each of 5 characteristic conflict styles (competing, collaborating, compromising, accommodating, and avoiding). Respondents again completed the TKI, this time by identifying their ideal conflict styles. Participants also provided ratings of job distress and demographic information. Compromising and avoiding were the most strongly endorsed actual conflict styles, and avoiding was the most strongly endorsed ideal conflict style. Respondents viewed their ideal conflict style as more competitive, less collaborative, and more avoidant than their actual conflict style. Job distress did not correlate with actual or ideal conflict styles. However, participants whose actual conflict style matched their ideal conflict style reported lower distress, especially if they perceived a high level of destructive conflict in their work environment. Distress was also lowest for respondents in high managerial positions and respondents who had been in the organization for a short time.

Domain specific effects of central traits in impression formation.

In a procedure similar to that used in Asch's classic studies in 1946, 125 college students (54 men and 71 women, Mage=20.9 yr., SD=4.8) rated their impression of a hypothetical man or woman who was described by seven stimulus traits. This list included one of four central traits which appeared in the middle of the list: warm, cold, serious, or foolish. The dependent measures were factor scores derived from participants' ratings of 20 traits on social desirability and intellectual desirability. As hypothesized, warm and cold, prototypes of social desirability and undesirability, were associated with judgments of social but not intellectual desirability, and serious and foolish, prototypes of intellectual desirability and undesirability, were associated with judgments of intellectual but not social desirability. In addition, there was evidence of a subtle sex bias: ratings of "foolish" women were higher on social desirability than ratings of "foolish" men.

Self-structure and postpartum dejection in first-time mothers.

Twenty-nine first-time mothers completed the Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) at Time 1 (3rd trimester) and at Time 2 (3-6 months after delivery). At Time 1, women described each of 20 self-aspects by repeatedly selecting from a list of 36 traits; they also reported the size of their social support network in a structured interview. At Time 2, the new mothers completed a short measure of mother role stress and described postpartum difficulties to an interviewer. The authors used HIerarchical CLASses (HICLAS; P. De Boeck & S. Rosenberg, 1988) to idiographically model each woman's self-descriptive data and to identify the class that contained each woman's most superordinate (cardinal) traits, which were then coded either as agentic or social-emotional. Postpartum difficulty predicted Time 2 dejection, but mother role stress and social network size did not. However, the content of the most superordinate trait class moderated the latter two effects. New mothers coded as agentic were more dejected than were new mothers coded as social-emotional when there was high mother role stress and when there was a large social support network.

The "wider view": André Helleger's passionate, integrating intellect and the creation of bioethics.

This article provides an account of how André Hellegers, founder and first Director of the Kennedy Institute of Ethics at Georgetown University, laid medicine open to bioethics. Helleger's approach to bioethics, as to morality generally and also to medicine and biomedical science, involved taking the "wider view" -- a value-filled vision that integrated and gave meaning to what otherwise was disparate, precarious, and conflicting. This article shows how Helleger's wider view of bioethics was shaped by events in his own life, his resultant sense of the precariousness of life and health, his commitment to religious inclusiveness, his research in fetal medicine, his clinical experience in obstetrics, his role in the struggle to change the teaching of the Roman Catholic Church on fertility control, and his developing concepts of health and disease. Hellegers was committed to and worked toward bioethics as a self-consciously interdisciplinary field in which the contributing disciplines adapt to each other -- rather than sustain themselves as autonomous disciplines -- to create a dynamic and complex intellectual, clinical, and social activity.

Revisiting the launching of the Kennedy Institute: re-visioning the origins of bioethics.

Twenty-five years ago, on October 1, 1971, at a press conference held at Georgetown University, the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics, later called the Kennedy Institute of Ethics, was offically inaugurated. To revisit that event -- and the Institute's five founding collaborators who spoke at it -- provides an opportunity to re-vision some of the most significant intellectual, moral, cultural, and political factors that shaped both this Institute and the then-nascent field of bioethics.

The word "bioethics": the struggle over its earliest meanings.

An article by Warren Reich in the December 1994 issue of this journal concludes that the word "bioethics" and the field of study it names experienced a "bilocated birth" in 1970/1971 under Van Rensselaer Potter, at the University of Wisconsin, and André Hellegers, at Georgetown University. Further historical inquiry confirms (1) that there were, from the start, some major differences -- even clashes -- between the Potter and the Hellegers/Georgetown understandings of bioethics; and (2) that the Hellegers/Georgetown approach came to be the more widely accepted meaning of the term, while Potter's idea of bioethics remained largely marginalized. However, this inquiry also results in a third, unanticipated, conclusion: that Hellegers (in contrast to the dominant model offered by the Georgetown scholars) actually proposed a global approach to bioethics, bringing his vision much closer to Potter's evolving view than previously has been acknowledged.