Value-laden Issues Research Articles

To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization

BackgroundThe growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters.MethodsPatients with medical uncertainty or conflict regarding value-laden issues, and requests made by the attending physicians or nurses for HCEC from December 1, 2009 to April 30, 2012 were randomly assigned to the usual care group (UC group) and the intervention group (HCEC group). The patients in the HCEC group received HCEC conducted by an individual ethics consultant. Data analysis was based on the intention-to-treat principle. Mann–Whitney test and Chi-squared test were used depending on the scale of measurement.ResultsThirty-three patients (53.23%) were randomly assigned to the HCEC group and 29 patients were randomly assigned to the UC group. Among the 33 patients in the HCEC group, two (6.06%) of them ultimately did not receive a HCEC service. Among the 29 patients in the UC group, four (13.79%) of them received a HCEC service. The survival rate at hospital discharge did not differ between the two groups. Patients in the HCEC group showed significant reductions in the entire ICU stay and entire hospital stay. HCEC significantly facilitated achieving the goal of medical care (p < .01). Furthermore, patients in the HCEC group had a shorter ICU stay and shorter hospital stay after the occurrence of medical uncertainty or conflict regarding value-laden issues than those in the UC group.ConclusionsOur findings demonstrated that HCEC were associated with reduced consumption of medical resources as indicated by shorter entire ICU stay, entire hospital stay, and shorter ICU and hospital stay after the occurrence of the medical uncertainty or conflict regarding value-laden issues. This study also showed that HCEC facilitated achieving a consensus regarding the goal of medical care, which conforms to the goal of HCEC.

The role of teachers in inculcating moral values: operationalisation of concepts

Dealing with values and moral issues is recognised as an integral part of teachers’ roles. Especially in culturally heterogeneous societies teachers face multiple values that students and their families may hold. The study reported in this article explores different conceptions of teachers’ moral roles aiming to develop an instrument for assessing teacher beliefs about those roles that could be used in teacher development. Paternalist, liberal and social-relativist conceptions of teachers’ moral roles were operationalised using data collected in three focus groups with teachers from Bosnia & Herzegovina and Serbia discussing cases of school practices involving value-laden issues. Initial items for construction of a questionnaire for teachers were generated from teachers’ utterances to ensure ecological validity. Implications for teacher development and future research are discussed.

Realising ecological sustainability in community gardens: a capability approach

In early 2011, there were over 1782 community garden sites officially registered with the Federation of City Farms and Community Gardens. In addition to promoting healthy food and healthy eating, many of these sites contain a number of sustainable design features and associated activities. They also claim to deal with value-laden ethical and social issues relating to human wellbeing. In this way, they aim to be ecologically sustainable. Using a normative framework for evaluating wellbeing – the capability approach – this paper reports on the multiple impacts that the design of such spaces may have on the subjective wellbeing of site users, which go beyond physical health and healthy eating. Qualitative research methods of data collection and analysis in five community garden sites in the UK and Ireland resulted in new explanations of both sustainable design and wellbeing. Two key aspects of design – agency and dynamic balance – were found to enhance both the sustainability of the community garden sites and the wellbeing of site users. As a result, new explanations for realising ecological sustainability at a local level emerge.

Envisioning sustainability: Recent progress in the use of participatory backcasting approaches for sustainability research

This paper describes recent progress in the utilization of participatory scenario-based backcasting approaches to sustainability research that blend quantitative and qualitative analyses in order to explore alternative climate change futures, as undertaken in a range of academic, government, and private sector projects in the Lower Mainland of British Columbia, Canada. These projects reveal that buy-in to policy proposals may be enhanced by participation, but there is a risk of participants being overwhelmed by the complexity of the choices they are being asked to make. Furthermore, tools are grounded in a process, which must itself be the explicit focus of attention in designing successful backcasting projects and combining participatory backcasting techniques with more interactive processes that can enhance our ability to explore highly complex and uncertain, value-laden issues. These approaches can be used to drive action and support decision-making, but for a truly consultative and consensus-oriented process to occur, it is important that a broad sample of the community be engaged in the discussion that are equipped with technical knowledge or understanding of the goals of the process in order to participate in an equitable and effective fashion.

Environmental education under assault: can instructors teach environmental science without fear?

Environmental science has evolved into a politically charged science branded as ‘controversial’ in the media and academic circles. Instructors may be fearful to discuss certain environmental topics in an academic setting for fear of possible retribution (i.e., academic freedom issues) or accusations of instructional bias. Some college instructors may feel compelled to delete topics from the curriculum. Diluting the curriculum shields students from the opportunity to discuss compelling arguments, deal with complex scientific and value-laden issues, and develop critical thinking skills in a safe, academic setting.

A Developmental Biology/Medical Ethics undergraduate learning community: a novel approach to explore value-laden social and ethical issues related to developmental biology

A Developmental Biology/Medical Ethics undergraduate learning community: a novel approach to explore value-laden social and ethical issues related to developmental biology

Political Deliberation and E-Participation in Policy-Making

In her paper, "Political Deliberation and E-Participation in Policy-Making," Rebecca J. Romsdahl proposes that the internet has now become a valuable medium for information dissemination and long distance communication; it is also gaining attention as a potential tool for political deliberation. Public participation has been a long-standing tradition in American democracy but most scholars today believe it needs a revival. Some of these scholars believe that e-participation in policy-making could help revitalize political discussion between citizens and government and promote greater participation by disenfranchised groups. Whether this would lead to greater opportunities for true deliberation on political issues and not just add to the prolific exchange of conversation on the internet, however, is a more difficult question. Romsdahl argues that despite the internet's ability to reduce the transaction costs of participation, true deliberation will be more difficult to develop. The internet poses great challenges for the essential components of deliberation, such as ensuring access for all interested individuals, fair and equal involvement for all participants, development of interpersonal trust, and the ability to produce effective dialogue on complex, value-laden issues.

Where Science Meets Society

T he theme for next week's American Association for the Advancement of Science (AAAS) annual meeting, “The Nexus: Where Science Meets Society,” reminds us of many events of the past few years that suggest that the relationship between science and society is undergoing significant stress. Some members of the public are finding certain lines of scientific research and their outcomes disquieting, while others challenge the kind of science taught in schools. This disaffection and shift in attitudes predict a more difficult and intrusive relationship between science and society than we've enjoyed in the recent past. Examples of these strains in the relationship include sharp public divisions about therapeutic or research cloning and stem cell research. Although many understand the potential benefits of such research, they also are troubled about scientists working so close to what they see as the essence and origins of human life. Last year, ideology came dangerously close to publicly trumping science when the U.S. Congress failed by only two votes to defund a set of grants from the National Institutes of Health on sexual behavior, HIV/AIDS, and drug abuse that made religious conservatives uncomfortable, even though the research was critical to solving major public health problems. And, of course, the scientific community is enmeshed in a continuing battle to keep the nature of science clear in debates about whether schools should be allowed to teach non-science-based “intelligent design theory” alongside evolution in science classrooms. ![Figure][1] CREDIT: ©2004 DESIGNED BY AAAS PUBLICATION SERVICES, ILLUSTRATION BY JEFFREY PELO The common thread linking these examples is that science and its products are intersecting more frequently with certain human beliefs and values. As science encroaches more closely on heavily value-laden issues, members of the public are claiming a stronger role in both the regulation of science and the shaping of the research agenda. To many, this appears to be a new dimension of the science/society relationship (in truth, it may be a recurrent dimension, because the same issues have been prominent at other historical moments). We've been used to having science and technology evaluated primarily on the basis of potential risks and benefits. However, our recent experience suggests that a third, values-related dimension will influence the conduct and support of science in the future. Taizo Nishimuro, chairman of the board at Toshiba Corporation, suggested at the Science and Technology in Society Forum in Kyoto, Japan, in November 2004 that whereas historically science and technology have changed society, society now is likely to want to change science and technology, or at least to help shape their course. For many scientists, any such overlay of values on the conduct of science is anathema to our core principles and our historic success. Within the limits of the ethical conduct of science with human or animal subjects, many believe that no scientifically answerable question should be out of bounds. Bringing the power of scientific inquiry to bear on society's most difficult questions is what we have done best, and that often means telling the world things that it might not initially like. Independence and objectivity in the shaping and conduct of science have been central to our successes and our ability to serve society. Still, our recent experiences suggest that the values dimension is here to stay, certainly for a while, and that we need to learn to work within this new context. Protesting the imposition of value-related constraints on science has been the usual response, but it doesn't work because it doesn't resonate with the public. An alternative is to adopt a much more inclusive approach that engages other communities assertively in discussing the meaning and usefulness of our work. We should try to find common ground through open, rational discourse. We have had some success with programs such as the National Human Genome Research Institute's Ethical, Legal and Social Implications program. Another example is the AAAS's Dialogue on Science, Ethics, and Religion, which brings scientists together with religious leaders and ethicists to discuss scientific advances and how they relate to other belief and value systems. Simply protesting the incursion of value considerations into the conduct and use of science confirms the old adage that insanity is doing the same thing over and over and expecting a different outcome. Let's try some diplomacy and discussion and see how that goes for a change. [1]: pending:yes

The Changing Legal and Conceptual Shape of Health Care Privacy

The contributions of Professor Bernard Dickens to health law and bioethics span the era in which these fields have emerged as distinct domains of teaching, scholarship and professional and public conversation. Neither field exists in a vacuum. The concerns of bioethics, like the content of health law, are a product of social forces. The bureaucratization of medical care, the possibilities and uncertainties created by developments in medical technology, not to mention glaring health inequalities, have been destabilizing forces in medicine. Writing in 1974, American sociologist Renée Fox noted that medicine had reached “a stage of development characterized by diffuse ethical and existential self-consciousness.” This new medical introspection was evidenced by intense engagement with issues of biomedical regulation, and with the growth of professional codes and processes for resolving value-laden issues within clinical settings.While sometimes described as a process or site for discussion and “engagement,” bioethics evolved rapidly into a domain of governance, with direct implications for clinical practice.

The perceived problem solving ability and values of student nurses and midwives

Problem solving is defined as a response given in an important and difficult situation, where critical thinking is required for a solution. Problem solving skills determine a person’s ability to relate productively. This research was to determine the perceived problem solving ability and values of student nurses and midwives. It was planned as a descriptive research project in the University of Kocaeli’s, Higher School of Health (Nursing and Midwifery School) in order to find out how students perceive their own problem solving skills, and to examine the relationship between problem solving skills and personal values. The data were collected from 218 students by using a questionnaire to determine the characteristics of the students and the “Problem Solving Inventory” (developed by Heppner and Petersen [Journal of Counseling Psychology 29 (1) (1982) 66]) whose reliability and validity for our country had been tested by Şahin et al. (1993) The scores of the subjects were evaluated and analyzed. Students who describe themselves in accordance with the values of truth (14.2%) and human dignity (19.3%) were also found to evaluate themselves successful in problem solving. Students who expressed that they act systematically (44.5%) and decisively (74.3%) in problem solving were also found to evaluate themselves as successful (47.8%) in problem solving. The results of our study have shown that education in professional ethics should provide the development of professional values (especially of truth and human dignity). Concerning value-laden issues education should help students to reach the desired levels of problem solving skills by allowing them to acquire abilities such as self awareness and being inquisitive.

Bioethics: A “New” Prudence for an Emergent Paradigm?

Bioethics, as an emergent model of an interdependent ethic, has paid increasing attention to casuistry, or case-based reasoning, to resolve its value-laden issues. A case study supports attention to casuistry, but notes its limitations in contemporary bioethical discourse. Casuistry suffers from its connections to Aristotelian phronesis, whose assumptions regarding experiential wisdom weaken its moral force. A “new” prudence exploits several narratively-informed dialogical virtues as argumentation tools in the service of bioethical deliberation. These virtues strengthen critical thinking and contribute to morally justified decisions through self scrutiny, moral imagination, and prudential listening patterns.

Literature as a Source of Information and Values

Stories create opportunities for readers to consider values that guide human action in both the imaginary context of the story and the real context of their lives, Mr. Estes and Ms. Vasquez-Levy remind us. EVERY TEACHER can recall incidents that turned out to be watershed events. For Thomas Estes (Tom) such a moment occurred a few years ago, when he taught a short story by Molly Picon to a group of Level-4 10th- graders - those labeled as not bound for college. The story is titled I'll Give You Law!1 The plot is simple. A boy and his grandmother find a very expensive lavaliere, which the grandmother turns over to the lost-and-found department at the local police station. The officer at the desk explains to her that, if no one claims the necklace within 90 days, then by law it is hers to keep. Every day, she goes to the station to admire the found treasure, and every day, to her relief, she learns that no one has claimed it. Finally, the day of her dreams arrives, and the pendant belongs to her to wear forever and to cherish as an heirloom for her grandson. And then the inevitable - a woman comes to her door to claim the necklace, despite the police officer's protest that by law she has no right to it. The dilemma arises on the next-to-last page of the story. When the class got to this point, Tom asked the students to predict what the grandmother would do. Would she give the necklace back or keep it? What would the students do if they were in the same situation? We don't know exactly what the students got from the conversation that followed. They had read enough stories to know how this one would end, and Tom knew enough not to tell the students what they should say, but there was no way he could be truly neutral on the question either. At that moment, Tom realized that this story was about values - and that perhaps all stories are. Stories create opportunities for readers to consider values that guide human action in both the imaginary context of the story and the real context of their lives. Stories provide insight but never closure. As we reflect on the students' experience with this story, we realize that the whole curriculum of schooling is, at a bedrock level, about the same thing: how we should conduct ourselves as human beings in relation to one another. In what follows, we elaborate on that insight and explore what it would mean for teaching all that we can to all those we teach. We assert at the outset that the debate over whether we should or should not teach values in the schools is empty, fodder for bad letters to the editor from the extremes of the political and religious spectrums. The argument is full of sound and fury, signifying nothing. We always teach values. The choice lies in which values and in how we teach them. The choice not to teach values explicitly or to maintain a stance of neutrality with respect to value-laden issues teaches volumes to children about values. Furthermore, the values we do teach are conveyed not in what we choose to say about values but in what we choose to do and how we respond to what children say. As to which values we will teach, that too is a red herring. Our culture, like all cultures, is based on values that are the foundation of our way of being. They're in the Declaration of Independence, they're in the Constitution, they're in the code of every state and are the basis of legal arguments and decisions ranging from the Magna Carta to the suits against tobacco companies. We do not mean to imply that values are easy to deal with - only that we must deal with them both in school and out of school. We want to comment about the specifics of a values-centered curriculum. Actually, and this should come as good news, we don't need anything to teach values other than what we already have before us. There are values in the history we teach, in the sciences, in the language arts, in the mathematics, and in every curricular and extracurricular endeavor we nurture and promote. …

Can the Senate Examine the Constitutional Philosophies of Supreme Court Nominees?

In the last 40 years, universal recognition of the Supreme Court's important policy-making role, the prevalence of divided government, and heightened conflict over value-laden issues such as abortion and school prayer have led to ever more elaborate Senate review of Supreme Court nominations (Freund 1988; Ross 1987, 116-23). Senate hearings into nominees' views on constitutional issues comprise the most visible element in the expanded confirmation process. Yet most recent nominees have won Senate approval while revealing little of their legal or political philosophies. As Powe (1976, 893) has concluded, “Senate questioning [of nominees] has proved astonishingly ineffective in eliciting the desired information.” The ability of nominees to hide their beliefs on vital constitutional questions raises serious doubts about the Senate's ability to give informed consent to presidents' Supreme Court nominations.This article examines confirmation hearings on recent, pre-Clinton Supreme Court nominees to answer two questions. First, given the recognized importance of Supreme Court appointments and the correspondingly systematic scrutiny of nominees, how do nominees get away with revealing so little of their views on vital constitutional issues? Second, given the answers to the first question, can the hearings be reformed so that senators may air a nominee's views more thoroughly and give—or withhold—truly informed consent to these nominations?

Economic assessment of maternal serum screening for Down's syndrome using human chorionic gonadotropin.

The effectiveness and costs of prenatal screening programmes for Down's syndrome using maternal serum markers will vary significantly depending on the biological cut-off values chosen in order to select women, at each maternal age, who will be sent for amniocentesis. On the basis of the first French prospective study of human chorionic gonadotropin (hCG) measurement in maternal serum, this paper shows that the screening protocol currently used in France, where hCG cut-off values are defined in order to offer amniocentesis to women of all ages with a 1 per cent fetal risk of Down's syndrome, would detect 64.06 per cent of all cases of trisomy 21 at birth and would be highly profitable for the French social security system. On the basis of a representative sample of 100,000 pregnant women, the total costs of screening would reach $8,302,000 but would generate net potential savings of $32,186,000 in terms of life-long costs of care for trisomic 21 children which would be 'avoided' by termination of pregnancy following a positive diagnosis of Down's syndrome. Economic assessment shows that cost-benefit analysis would justify lower hCG cut-off values and a higher detection rate of fetal Down's syndrome (74.45 per cent) than the current French protocol. This paper concludes that it is ethical and value-laden issues, such as the consequences for women and couples of false positives and false negatives of screening, rather than economic and financial arguments that may set limits to the utilization of screening for Down's syndrome using maternal serum markers like hCG.

Overview and Introduction to the Special Issue

functions, and programs of courts as organizations. Judicial administration casts a wider net to encompass topics bearing on fundamentals of judicial system design that extend well into the realm of forthright value choices. Arguments favoring one scheme for selecting judges over another scheme would typify such obviously value-laden issues. So would questions like the appropriate size and scope of juris dictions, whether the United States should establish a National Court of Appeals, whether trial courts ought to be 'unified,' and whether judges ought to be independent or accountable. Questions like these can be stirring enough that U.S. Senators on one hand, and thoughtful college undergraduates on the other hand, can be energized by them. Taken at face value, contributors to this special issue of the Journal sound themes that arise from the realm of court management. Outsiders are unlikely to find them gripping. Instead, as landscape architects, preschool directors, or university deans might constitute the principal audiences for dissections of their respective occupations, court administrators and the research and education specialists who serve them are the principal audience for this collection. They constitute the class most likely to be interested in both the history and the trajectory of the profession, for their professional lives are framed within it. Yet we think that the issues found in these pages connect to patterns that range well beyond the everyday, and bear meanings that are parts of larger motifs. Simply, questions designed to elicit a particular understanding of court managers must reflect the place of those professionals within our world - and ineluctably, reflect as well something about the nature of world. This is not quite to say, Senators, undergraduates, lend me your ears! It is more to say, to the stewards

The Theory of Public Opinion: The Concept of the Spiral of Silence

This chapter describes the spiral of silence, a theory first introduced in 1972 and published as a book in 1980. It argues that public opinion did not appear first in the eighteenth century, but has existed in all human societies for thousands of years as a force exerted on governments and individuals, creating and maintaining the consensus necessary for society’s functioning. The word public in the concept of “public opinion” is to be interpreted in the sense of “public eye,” “visible to all,” and thus as social control. Opinion refers to publicly visible and audible expressions of opinion as well as public behavior regarding value-laden issues. Its power derives from our social nature, from the willingness of society to threaten isolation in reaction to forbidden opinions and behaviors, and from the individual’s fear of isolation. This fear causes individuals to register continually any changes in society’s approval by means of a “quasi-statistical sense,” and to voice agreement upon increase in approval and to remain silent upon decrease, thus contributing to further decline in the popularity of the originally held opinion. The pressure of public opinion is a source of constant conflict for governments in weighing measures in order to win public support. Individuals also experience ongoing conflict between their individual inclinations and convictions and the social demands to conform. This chapter discusses the consequences of public opinion for the classical theory of democracy and for an understanding of mass media effects. The chapter also provides hypotheses and methods for testing them, and presents the example of public opinion concerning nuclear energy.

From the Editor

From the Editor

Elder maltreatment items, subgroups, and types: policy and practice implications.

An examination of 288 validated instances of elder maltreatment suggests that these phenomena pose questions as diverse as those faced in identifying child and spouse maltreatment. A partial typology is offered to guide further investigations. Implications for policy and practice suggest a cautious approach to value-laden issues while recognizing the need for intervention.

Area-based social indicators: Signed chi-square as an alternative to ratios

This paper examines the statistical requirements of area-based social indicators. It argues that on technical and conceptual grounds conventional ratio-measures fall short as indicators for use in area-based programmes of positive discrimination. Ratios quantify only one of the propositions of area-based policies as identified by Holtermann. The signed chi-square measure expresses all three statistical requirements of social indicators simultaneously, particularly when used with constant areal units. It can also consider subjective value-laden issues in the ranking of geographic areas on a good to bad scale. The concepts will be discussed using the 1971 grid square population census data on unemployment in Humberside.

Operational Definition of Area-Based Social Indicators

On technical and conceptual grounds, ratio measures fall short as social indicators for use in area-based programmes. This paper discusses the requirements of area-based social indicators and examines some value-laden issues which must be operationalised if the signed chi-square representation is to form a viable and effective alternative.