Lack Of Honesty Research Articles

The Main Problems of China's Business Integrity and Its Solutions

In the development of China''s market economy, the problem of business integrity causes wide public concern. The main problems of China''s business integrity are that the high cost of business integrity makes it difficult to form an incentive mechanism for integrity management, the lack of honesty in government affairs has an enormous impact on business integrity and integrity management is made difficult by the social psychology of mutual distrust. To improve the current situation of China''s business integrity, it is necessary to enhance the contract spirits of business operators, intensify the legal punishment of business dishonesty, and establish and improve the social credit system.

ПРОБЛЕМИ ЗАСТОСУВАННЯ ПОЛІГРАФОЛОГІЧНИХ ДОСЛІДЖЕНЬ

The article examines the problem of ambiguity in the use of the polygraph, examples of the introduction of polygraphs are given. The author distinguishes an individual static emotional experience that is the psychological states that personality experiences during polygraph examinations such as lies, deceit, mood, joy, anxiety, fear, excitement, calm. It is emphasized on the presence of the necessary condition - the ability of a polygraph specialist to penetrate the psychological state of the subject. Attention is drawn to the fact that an experienced polygraph examiner is able to compose the psychological image of the subject before the study, because of the contradiction in the views on the evidence base obtained by polygraph examinations, the author recommends using a combined method of obtaining true information. The attention is paid to the training of a polygraph specialist. He must have knowledge of philosophy, psychology, law, anatomy, mathematics and physics. Attention is drawn to the conditions created by polygraph specialists during the study, it is noted that the atmosphere of isolation for the subject is undesirable. The author agrees with separate statements about the fact that the subject should not be distracted by superfluous sounds, to answer the questions that are transmitted by the researcher, but is convinced that too hermetic conditions affect the result of the study, it is recommended to create normal living environment conditions. The further prospect of research in creating a system of psychological views on the problems of predicting lack of honesty through the assumption of future delinquent behavior through the indicators of personal deviance, as a sociopathic personality and psychopathic deviation is seen.

QUALITY OF LIFE IN NURSING HOMES: ELEVATING THE STATUS OF RECORDING TO A RELATIONAL PRACTICE

Internationally, nursing home care provision demands radical change. Lack of honesty about the complexity of so-called ‘basic care’ together with performance cultures have created a more transactional and confused environment, detracting from authentic care work grounded in human relationships. A personal outcomes approach, comprising three inter-related components of engaging, recording and using information, can result in more effective, inclusive, enabling and relational ways of working, but raises particular challenges in collective living settings for older people with complex and often fluctuating needs and priorities. This session presents results from an action research study conducted in collaboration with multi-disciplinary staff from six nursing homes in Scotland to facilitate a focus on personal outcomes. Grounded in the philosophy of relationship-centred care, the study recognised the importance of everyday acts of noticing alongside scheduled care planning processes, including being attentive to, and properly valuing, the life stories and more embodied stories of people with communication or cognitive impairments. Building upon the ways staff already come to understand and negotiate what matters to a person and to family members, and thinking about how such insights might be used by others, the study facilitated a shift from recording as a bureaucratic task with a primarily retrospective orientation demonstrating compliance, to a practice foregrounding information useful for maintaining the identity of the older person, building relationships and shaping future care. It also highlighted the practical and ethical dilemmas encountered daily, and the necessity of successful negotiation amongst everyone involved in individual and collective decision making processes.

Komunikasi Interpersonal Suami dan Istri Dalam Mencegah Perceraian di Ponorogo

This study aims to determine the interpersonal communication of husband and wife in preventing divorce. The location of research in Ponorogo Regency with the subject of research five couples who have been divorced by Ponorogo Religious Court. The method used in this study is descriptive qualitative with data collection techniques through interviews, observation and documentation. The results showed that interpersonal communication husband and wife less well awakened due to disharmony interpersonal relationships in the family. Factors that lead to disharmony interpersonal relationships in the family is the attitude of disbelief between husband and wife caused by lack of honesty and mutual attitude of each partner in the family causing interpersonal conflict and lead to divorce. This study provides recommendations to the community, especially couples to build good interpersonal communication in the family by always putting honest and open attitude so that any problems that arise in the family can be resolved properly.

Causes of financial mismanagement in South African public schools: The views of role players

This paper investigates the underlying causes of financial mismanagement in public schools and focuses on the perceptions of various role players in the Limpopo Province of South Africa. The various Departments of Basic Education in South Africa allocate funds to schools each year, and expect school principals and school governing bodies to manage it appropriately. The problem is that in some schools, the principals, teachers and school governing body members are perpetrators of various financial mismanagement activities related to financial mismanagement. This article reports on qualitative research used to arrive at an in-depth understanding of why financial mismanagement occurs in certain schools. For this purpose, data was collected through semi-structured interviews with principals, finance officers and departmental officials and analysed thematically. The findings revealed a lack of knowledge of legislation and skills, poor monitoring and control of funds, unavailability of financial policies in schools, omission to act against culprits, and lack of honesty, openness and trustworthiness. The article proposes remedies that might bring financial management in public schools in line with the principles of good governance. Keywords: Accountability; Corruption; Financial maladministration; Financial mismanagement; Misappropriation; Principals; Public schools; School governing bodies

Sexual Content in Young Adult Literature: Reading Between the Sheets by Bryan Gillis and Joanna Simpson

Reviewed by: Sexual Content in Young Adult Literature: Reading Between the Sheets by Bryan Gillis and Joanna Simpson Christine N. Stamper (bio) Sexual Content in Young Adult Literature: Reading Between the Sheets. By Bryan Gillis and Joanna Simpson. Lanham, MD: Rowman & Littlefield, 2015. Bryan Gillis and Joanna Simpson’s survey of young adult novels with sexual content serves as a comprehensive overview of how and why sexuality and sex acts are used within books for adolescent readers. The authors state their hope that the book “provide[s] parents, teachers, and librarians with a better understanding of the role that sex in young adult fiction plays in the socioemotional and academic development of adolescents” (ix). In looking at specific novels, genres, and time periods, Gillis and Simpson’s analysis is often punctuated with quotations from authors about how and why they include scenes that contain explicit sex or emotionally charged intimate situations. While this approach certainly gives insight into the scenes that Gillis and Simpson analyze in their study, it also serves to illustrate (perhaps to concerned parent readers) that the sexual content in adolescent literature is not included without intention and character/plot development. Rather, sex is often used in these novels as a space for character growth and maturation, providing fictional models for teens to explore safely. The book opens with two chapters that contextualize why the use of sexual content in novels matters for real-world teenagers, looking at identity formation within adolescents and, briefly, at the history of public school sex education in the United States. These chapters are brief but informative, summarizing how identities (including normative gender roles) are socially constructed, and how the US came to have the abstinence-only sex ed currently provided in many schools. Gillis and Simpson then turn their attention to literature, looking at sexual content within the Western canon that is often taught in high schools. This chapter highlights the sex present in works by authors that many expect high schools to be teaching to teenagers, such as Shakespeare, Chaucer, Hawthorne, and Homer. Looking at pedagogy, the authors argue that teachers are often able to avoid discussing sex when using these works, which are linguistically difficult for their students; however, removing the sexual content from these novels does them a disservice: “If we are requiring students to read adult content, then we should treat them as adults or choose alternative texts” (34). The authors then shift to young adult literature from the 1950s through the 1980s. Here they illustrate how sex was often punished with awful consequences, such as pregnancy, unfulfilling marriages, or being forced to leave school. However, they then look at prolific authors at the time—such as Judy Blume and Norma Klein—who redefined gender roles and included female characters who showed sexual agency and desire, [End Page 465] which had previously been virtually absent in literature for teens. In the next three chapters, Gillis and Simpson examine contemporary young adult literature by genre, dividing the field into dystopian novels, romance novels, and contemporary realistic fiction and giving a brief history of each of them, both within and outside of adolescent literature, along with short analyses of representative novels. Within the dystopia chapter, they investigate several of their own subcategories, including government-controlled sex, disease-induced sexual abstinence, and sex and romance in dystopian series. These categories all serve the same purpose of examining how sex, romance, and love are governed within these repressive societies. The authors posit that “Dystopian YAL is popular because these stories create worlds that challenge the protagonists to question the status quo,” and expressing their sexuality is one way in which characters can rebel against authoritarianism (98). Similarly, the romance chapter is divided into paranormal romance and realistic romance, discussing how in this category sexual content must be emotionally linked to character and plot development. Whether the romance takes place in supernatural worlds or in familiar settings, it is the “honesty [of sexual relationships] that draws readers in and keeps them reading. A lack of honesty, particularly emotional honesty, is what has led to the failure of school sex education programs across the country” (121). It is also this honesty that allows...

Pietro Aretino, Lodovico Dolce y el «Juicio Final» de Miguel Ángel

This paper attemps to evaluate the reception of Michelangelo’s Last Judgment in the literary production of Pietro Aretino and Lodovico Dolce to explore if personal or ideological interests moved them to attack the lack of honesty in the Sistine fresco.

Toward a Unified Framework of Perceived Negative Leader Behaviors Insights from French and British Educational Sectors

In this paper, we challenge the commonly held assumption that actors in the education sector are largely ethical, and that there is therefore little need to scrutinize leader behaviors in this sector. We also overcome past scholars’ tendencies to either focus selectively on positive leader behaviors, or to stay content with categorizing leader behaviors into effective and ineffective (if at all they do focus on negative leader behaviors). Using data (Critical Incidents) from three case studies previously conducted in eight British and French academic establishments, we show that not only do negative leader behaviors abound in the education sector, but they can also be differentiated into three types: (1) behaviors emanating from leaders’ lack of functional skills i.e., ineffective behaviors, (2) behaviors emanating from leaders’ insouciance toward harming the organization and its members i.e., dysfunctional behaviors, and (3) behaviors emanating from leaders’ lack of honesty, integrity, ethicality, and transparency i.e., unauthentic behaviors. We enrich current understanding on ineffective, dysfunctional, and unauthentic leader behaviors, and offer a unified (yet differentiated) framework of negative leader behaviors in the academic sector. Since each type of negative behavior emanates from different motivational drivers, different measures are required to curb them. These are also discussed. A comparison of our findings with those from leadership studies in other sectors reveals that negative leader behaviors in the education sector are quite similar to those in other sectors.

Achieving Public Sector Competitiveness through Vision 2020 Goals Delivery in Nigeria: The Role of Forensic Accounting

There is a paramount need for all government machinery organizations to be globally competitive and largely free of corruption all over the world. Vision 20:2020 in Nigeria seeks to develop the country and bring it into the league of the world’s 20 leading economies by the year 2020. The identified vehicles for realizing this goal are sound economy, good governance and sustainable development. In Nigeria and other global climes, financial irregularity and corruption are severe problems of concern. The conception and attainment of vision 2020 for nations will be futile if issues such as lack of a well-developed and implemented policy of corporate governance, lack of honesty and transparency in financial reporting, and an inefficient and ineffective system of internal controls, persist in the public sector. The role that forensic accounting or investigative accounting plays in achieving public sector global competitiveness through delivering Nigeria’s vision 2020 constitutes the focus point of this research. The adopted research methodology is the survey research design which employs the Kruskal-Wallis statistical test for analysis. The research finds that fraud and corruption are fundamental problems of the Nigerian public sector and that forensic accounting is relevant in making Nigeria globally competitive via a successful vision 2020 agenda that entrenches stable economic growth, crime free society, foreign direct investments and positive image both locally and internationally. The paper recommends, among others, the strengthening of forensic accounting institutions and their increased engagement in public sector services delivery towards vision 2020 agenda actualization.

Role of Gender Equality in the Enhancement of Tea Quality and Quantity in Kenya: A Survey of Farmers Served by Gathuthi Tea Factory of Nyeri County

Studies have shown that gender equality has a crucial part to pray in the improvement of any situation that has faced human being. However its role in the tea sector is not well known. This study sought to identify the role of gender equality in enhancement of tea quality and quantity. The study assessed the most important aspects of gender equality, the extent of its use, the factors limiting its use and the relationship between it and tea quality and quantity. The study was a census of all tea farmers served by Gathuthi tea factory in Nyeri County. Primary data was collected using semi-structured questionnaires with the aid of a questionnaire guide. Analysis was done using descriptive statistics and then presented in tables charts, in percentages and frequencies. The research found that Gender equality is an important component in the improvement of tea quality and also quantity. The respondents clearly stated that what was most important is the issue of involving everybody in the family in decision making concerning money and any other resource that are used in process of tea production. The research identified the factors related to gender that limited the production of better quality and also quantity. These included among others, lack of honesty among family members, one person decision, dictatorship in the family, miss use of financial resources and other resources etc.The findings were that there are a direct positive relationship between gender equality and enhancement of tea quality and quantity. The study also made some recommendations that are geared towards improving on tea quality and quality for future consideration.

An Exploratory Study of Shari’ah Compliance in Islamic Banking : Evidences from Bangladesh

Purpose – The purpose of this paper is to assess the Shari’ah compliance eminence of the Islamic banks in Bangladesh. Design/methodology/approach – The research was grounded on mutually primary and secondary data. Primary data were collected via sample questionnaire survey and individual interview by the researchers; the secondary data were gained from Qur’an, Hadiths, different circular/letters, manuals, research books and journals, annual reports, websites of the sample banks. “Among Shari’ah violation score and bank-specific traits were checked through statistical tools and techniques like weighted average, percentage, SD, variance and correlation by using applying statistical software Statistical package for Social Science ( version17.0).” Findings In Bangladesh Shari’ah compliance status of the Islamic banks is in a susceptiple condition, Shari’ah compliance status extremely diverges amongst the Islamic banks, and due to absence of awareness Shari’ah violation is extreme in financing Activities, lack of honesty in obeying Shari’ah, poor devotion/courtesy in Shari’ah audit and Shari’ah research and privation of strong Shari’ah administrative boarding encompassing twenty-fourhour skilful dexterous associates. Practical implication – The main strategy allegation of this study amongst others are as follows: this study provide strategies to supervisory bodies and Shari’ah boarding associates to govern their future responsibilities and to find their limitations; to acquire the anticipated idea of current state of Shari’ah compliance by senior manager and Workforces and to ascertain their flaws in this respect; this provide strategies to indicate the improved Islamic banks to execute banking transaction for clients and other stakeholders; and the questions upraised in this paper may useably practice by the researchers in Islamic banking for more inclusive studies in Islamic banking and Shari’ah compliance. Originality/value – Status of Shari’ah compliance with a new dataset and comparing Shari’ah violation score with bank-specific attributes can be explanatory a new opportunity by this paper.

Experiences of experts about the instances of plagiarism

Introduction:Plagiarism is defined as intentional deceiving or lack of honesty, which deprives others from both material and spiritual possessions. Ethics is considered as one of the most important aspects of evaluating the quality of higher education. Moreover, scientific ethics should be reflected from university values, as a specialized institution, rather than being a reflection of the others cares. Therefore, the main aim of the present study is explore of expert experiences about plagiarism in Isfahan University of Medical Sciences.Materials and Methods:This study employed qualitative method with using in-deep interview. The research participants consisted of 21, who tend to this work. Semi structure interview were conducted and recorded. The method of analyzing data was ‘thematic analysis’. The data were transcribed and saved on computer after each interview. Themes and sub-themes were extracted. Finally, relevant sub-themes were arranged in a category and suggested were presented.Result:Analyzing data showed 600 primary codes, 40 sub-themes and 6 themes. The main themes included repeated works, non-normative adoption, non-normative adaptation, shares distribution, forging, and profit-seeking, each of which consisted of one or several subgroups.Conclusion:The findings of this study show that since, there are numerous ways of cheating, the universities’ research committees must create institutions in order to educate the individuals how to avoid plagiarism. In addition, providing information about different types of scientific violations, as well as their following punishments might lead to the decrease of such misbehaviors.

The Actual Collapse and the Importance of Moral Values (ethics); Some Reflections Regarding the Roots of the Current Crisis

Economists who talk about free markets seem to ignore that Adam Smith (considered as the father of laissez-faire economics) wrote also “The Theory of Moral Sentiments”; and that Max Weber, the famous sociologist, connected hard work and moral values (ethics) with the advance of capitalism. Public policy has to deal with the social fallout of unlimited greed, lack of honesty, cynicism, selfishness, etc, which the current financial crisis illustrates conspicuously. The actual financial crisis, which has shaken the beliefs of even the most ardent supporters of unfettered markets, cannot be explained only by years of cheap money and growing imbalances in the world economy. Mistakes in macro-economic policy were accompanied by gross abuses of securitisation, abnormally skewed incentives and loss of moral compass, inadequate risk-assessment models and failures to check for systemic risks, a breakdown of due diligence and an almost blind belief in the self-regulating virtues of markets.

Identifying and evaluating E-procurement in supply chain risk by Fuzzy MADM

Article history: Received October 15, 2011 Received in Revised form October, 30, 2011 Accepted 30 January 2012 Available online 9 February 2012 E-procurement risks has emerged as an important issue for researchers and practitioners because mitigating supply chain risk helps improve firms’ as well as supply chains’ performance. E-marketplaces have been steadily growing and there have been significant interest in e-business research. There are different risks and uncertainties involved with Emarketplaces, which jeopardizes the sector but we have had a large amount of hype and the business still continue to grow. The primary aim of this study is to identify E-procurement risks and evaluate them using a fuzzy AHP framework. We contribute E-procurement risk by identifying 13 critical criteria and determine four important ones including the extent of acceptable information, interrelationship risk, lack of honesty in relationships and product quality and safety for evaluating suppliers’ risk. © 2012 Growing Science Ltd. All rights reserved.

Incidentes moralmente incorrectos en la relación docente-alumno en educación médica

Background The relationship teacher-student might determine the link between the student and the patient. Currently, this relationship has been spoilt by causes typical of the institution and of the education in general, but also by the lack of honesty among students and by teachers’ abuse. The students may consider abuse as a morally incorrect incident, but they may take into account other actions. Objective To analyze which incidents are considered morally incorrect by final year medical students. Material and Methods A semi-structured survey was conducted on students of the final year of the School of Medicine, with closed items (variables: student’s gender and age; aspects: teacher’s position and gender, cycle and instance) and an opened item: reporting the incident. Categories were constructed for the latter item. The significance of the relation between variables and aspects Results The survey was responded by 80 students; 6 did not report any incident. Average age was 26.83 years (MSE 0.47); 59.4% were women. The greatest number of incidents occurred during the clinical cycle, in oral examinations and with male professors. We found a significant relation between student’s age and teacher´s gender on the one hand, and cycle (basic and clinical) and instance (teaching-learning and evaluation) on the other. Abuse and unfair evaluation criteria were the categories most frequently mentioned. was analyzed using the chi square test (p ≤0.05).

Ethics and teaching medicine. A principles declaration

Medicine is an old profession, having existed for twenty-four centuries. The ethical principles assumed since the beginning and have been enriched through time, culture and tradition. The stone corner of the moral commitment of physicians with the patient and medical students has deteriorated due to a values crisis. This is due to a lack of personalized and humanized care in "altars of progress," characterized by fragmentation of medical care, excessive use of the technology and merchandizing of medicine, where profits is a priority over human need. The effects are unconsciousness and a lack of professional values, which are expressed as disloyalty, deficient solidarity, diminution of confidence, inequality and lack of honesty, affecting the patients and the whole medical relation. The problem also extends to medical education, when the students follow the same way to practice of physicians. To be a real educating physician in medicine implies an indissoluble educational symbiosis (teacher-student). When there is an ethical deterioration the immediate task is to propose alternative ethical and morals rules in medical education, which feed on values and traditional medicine principles.

Training in hospitals: what do GP specialist trainees think of workplace-based assessments?

Workplace-based assessment (WBPA) was introduced in 2007 as a new approach to monitoring competence of GP specialist trainees (GPSTs). It includes a raft of assessments carried out in the workplace to assess what a trainee actually does in clinical practice. The assessment tools used are adapted from other contexts of doctors' training but little is known about how they function in day-to-day practice within GP training or how valid and useful they are found to be by trainees. To establish how the new system of WPBA is working in day-to-day practice for GPSTs in hospital posts. A mixed methods design including quantitative and qualitative phases of data collection. Two training locations within Severn Deanery. A questionnaire was completed by 52 GPSTs (67% response rate) currently in hospital posts. Twenty-two took part in focus groups and semi-structured interviews to explore key findings from the questionnaire in greater depth. There is value in the face-to-face contact between trainees and senior doctors. However, quality and depth of feedback are not consistent and there is evidence of poor use of the tools, reducing the value of the assessments. The system is further undermined by a clear perception of bias and lack of honesty in judgements which limit the scope for assessment to lead to learning. Overall, these weaknesses may impair the validity and usefulness of the system and its potential to improve the performance of doctors. General practice trainees in this study have a low opinion of how WPBA assessments function in the hospital setting. Changes are needed to optimise the potential of WPBA to improve the performance of doctors in training and to increase its credibility.

Cultural and hierarchical influences: ethical issues faced by Taiwanese nursing students

OBJECTIVES Improving nurses' competence in resolving clinical ethical issues must start with ethics education in training and clinical practice. However, many students complain that they cannot apply classroom learning to actual clinical scenarios. This study explored ethical issues and dilemmas, and their impact experienced by student nurses in clinical practice. METHODS Focus groups were conducted with 44 first-year student nurses from a 2-year college course in northern Taiwan. Interviews were tape-recorded and verbatim transcripts were analysed using content analysis. RESULTS Students expressed and discussed their views in eight focus groups. Analysis of interviews revealed five themes: frustration at inability to help some patients; oppression caused by lower status; lack of honesty and ethical courage; powerlessness, and self-encouragement in adversity. CONCLUSIONS Taiwanese nurse ethics training was only recently introduced and the curriculum has not addressed the clinical reality in Taiwan. This reality includes limitations arising from the medical hierarchy and the socio-cultural role of families in medical decision making, which may inhibit ethical judgements and decision making. In clinical dilemmas, the most common problems faced by Taiwanese nursing students involved not knowing how to handle some situations, inability to abide by principles, and a lack of appropriate role models. Hence, we suggest that nursing ethics education should: (i) integrate scenarios involving ethical dilemmas into daily routines; (ii) give students opportunities to discuss their feelings about their experiences; (iii) allow teachers and students to talk about scenarios with ethical implications, and (iv) provide students with opportunities to reflect on clinical scenarios in order to clarify their values and learn how to respect the value of life.

Social Responsibility and Sustainable Development of China’s Private Enterprises

Social responsibility is of great significance for the sustainable development of the whole society as well as every enterprise. Due to some misunderstandings held by China’s private enterprises, some problems such as the lack of honesty, infringing upon laborers’ rights and environmental pollution have been brought about. Therefore, private entrepreneurs are expected to take up their responsibility to establish the “man-oriented” concept of development, put more importance on the interests of employees, consumers as well as the whole society, hence promoting the sustainable development of our enterprises and the harmonious progress of our society.

Is Collusion Necessary? A Commentary on Necessary Collusion

The argument made by Helft in favor of “necessary collusion” in the discussion of prognosis between patients with cancer and their oncologists is predicated on the presumption that the primary goal of oncologic care is to maintain hope. If this were the case, then it would be difficult to argue against such an approach. However, the primary goal of oncologic service is to care for patients with cancer in a comprehensive manner, with appropriate attention paid to their physical, psychological, and practical needs. Helping patients maintain hope is but one part of this, not the core principle. In order for patients to make rational decisions regarding their treatment, they need to understand the nature of their illness, particularly with regard to how the disease will affect their lives. A clear discussion of the goals of treatment, which inherently must touch on prognosis, is a key factor in this equation. The most important aspect of prognosis that patients must understand to participate in medical decision-making is whether or not the practical goal of treatment is cure. If not, then patients need to be told up front that their disease is not considered curable with currently available therapy. Of course, as noted by Helft, there is the major issue of medical uncertainty, and in light of this reality, a good rule of thumb is to “never say never, never say always.” Along these lines, it is medically dishonest to give someone a quantitative prognosis when they are initially diagnosed with cancer, as it is impossible for us to know how long any one individual will live. Median survival is not meaningful to the individual patient, whereas an honest statement of interval survival (eg, “X percent of people live longer than 1 year and X percent live longer than 2 years”) can provide them with a clear notion of the seriousness of their disease, while also affording them the hope of open-endedness. As pointed out by Groopman, we can all relate stories of our rare outliers who have proven the textbooks wrong. While it may be appropriate to share such optimistic tales with patients, it is necessary to qualify such vignettes with objective measures of probability. It is good to hope for a miracle, but care of the patient with advanced disease can become very difficult when they are led to expect a miracle. It is in the practical application that “necessary collusion” meets its biggest challenges. Patients with a terminal illness need time not only to come to terms with their spiritual being, but also to see to the practical matters in their daily lives. Arrangements may need to be made on the management of the family business or the care of young children or older parents. Lack of honesty regarding prognosis can lead to devastating financial and social consequences when such decisions are put off until it is too late. A related practical concern with collusion is that many patients with advanced cancer suffer precipitous declines in their functional status that preclude the measured use of “forecasting” as proposed by Helft. In such From the Division of Hematology/ Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.