Does Information and Agreement Equal Informed Consent?

The following essay is based on a talk delivered last summer in England and on the chapter Information, Decisions, and the Limits of Informed Consent, in (Michael Freeman and Andrew D. E. Lewis, eds.) Law and Medicine: Current Legal Issues 2000, Volume 3 (Oxford University Press, 2000). This version appears with permission of the publisher. For many years, a principal labor of bioethics has been to find a way of confiding medical decisions to patients and not to doctors. The foremost mechanism for doing so has been the doctrine of informed consent. Anxious as bioethicists and courts have been to promulgate this doctrine, they have been less anxious to discover how well it works. The bioethical tradition has been far more interested in articulating principle than testing practice

Information, Decisions, and the Limits of Informed Consent

For many years, the heart\u27s wish of bioethics has been to confide medical decisions to patients and not to doctors. The favoured key to doing so has been the doctrine of informed consent. The theory of and hopes for that doctrine are well captured in the influential case of Caterbury v. Spence: \u27[t]rue consent to what happens to one\u27s self is the informed exercise of a choice, and that entails an opportunity to evaluate knoledgeably the options available and the risks attendant upon each\u27

Higher-order Refinements of Small Bandwidth Asymptotics for Density-Weighted Average Derivative Estimators

The density weighted average derivative (DWAD) of a regression function is a canonical parameter of interest in economics. Classical first-order large sample distribution theory for kernel-based DWAD estimators relies on tuning parameter restrictions and model assumptions that imply an asymptotic linear representation of the point estimator. These conditions can be restrictive, and the resulting distributional approximation may not be representative of the actual sampling distribution of the statistic of interest. In particular, the approximation is not robust to bandwidth choice. Small bandwidth asymptotics offers an alternative, more general distributional approximation for kernel-based DWAD estimators that allows for, but does not require, asymptotic linearity. The resulting inference procedures based on small bandwidth asymptotics were found to exhibit superior finite sample performance in simulations, but no formal theory justifying that empirical success is available in the literature. Employing Edgeworth expansions, this paper shows that small bandwidth asymptotic approximations lead to inference procedures with higher-order distributional properties that are demonstrably superior to those of procedures based on asymptotic linear approximations

A Method to Assess the Organizing Behaviors Used in Physicians\u27 Counseling of Standardized Parents after Newborn Genetic Screening

Well-organized conversation can improve people’s ability to comprehend and retain information. As part of a long-term effort to adapt Quality Improvement techniques for communication, we developed an explicit criteria method to assess usage of three organizing behaviors (OBs): ‘opening behaviors’ to establish goals; ‘structuring behaviors’ to guide patients through conversation; and ‘emphasizing behaviors’ that signal a need for attention. Pairs of abstractors independently reviewed transcripts in a demonstration sample of conversations between physicians and standardized parents after newborn screening identifies carrier status for sickle cell disease. Criteria for at least one OB were identified in 50/84 transcripts (60%), including 27 with at least one opening behavior (32%), 5 with at least one structuring behavior (6%), and 38 with at least one emphasizing behavior (45%). The limited number of OBs raises concern about communication after newborn screening. Assessment and improvement of OB usage may improve understanding and allow parents to more actively participate in health care

PENGEMBANGAN KEMAMPUAN BERPIKIR KRITIS DENGAN MENGGUNAKAN METODE PROBING PROMPTING DI SMP NEGERI 6 BANDA ACEH KELAS VIII

Routine cancer screening with prostate-specific antigen (PSA) is controversial, and practice guidelines recommend that men be counseled about its risks and benefits. OBJECTIVE. To evaluate the process of decision making as men react to and use information after PSA counseling. DESIGN. Written surveys and semistructured qualitative interviews before and after a neutral PSA counseling intervention. PARTICIPANTS. Men 40 to 65 years of age in southeastern Michigan were recruited until thematic saturation—that is, the point at which no new themes emerged in interviews (n = 40). RESULTS. In a paper survey, 37 of 40 participants (93%) said that they interpreted the counseled information as unfavorable toward PSA. However, 30 participants (75%) said after the intervention that they intended to be tested in the future, including 29 of 30 men (97%) with prior PSA testing. In the interview, many participants cited underlying beliefs as a reason to dismiss the counseled information. Qualitative analysis found the seven most common beliefs cited were fear of cancer, relevance of salient anecdotes and analogies, distrust of statistics, enthusiasm for “prevention,” protection from “bad luck,” faith in science, and valuing PSA as knowledge for its own sake. Although some beliefs could be interpreted as judgment errors, most were credible on a personal level. CONCLUSIONS. Most men who underwent PSA counseling cited underlying beliefs rather than the content of counseled information as the basis for their decisions regarding future PSA screening. If widespread, such beliefs may render clinician counseling and decision support methods less effective. Eliciting patient beliefs prior to counseling may improve the shared decision-making process

Lunar Surface Electric Potential Changes Associated with Traversals through the Earth's Foreshock

We report an analysis of one year of Suprathermal Ion Detector Experiment (SIDE) Total Ion Detector (TID) resonance events observed between January 1972 and January 1973. The study includes only those events during which upstream solar wind conditions were readily available. The analysis shows that these events are associated with lunar traversals through the dawn flank of the terrestrial magnetospheric bow shock. We propose that the events result from an increase in lunar surface electric potential effected by secondary electron emission due to primary electrons in the Earth's foreshock region (although primary ions may play a role as well). This work establishes (1) the lunar surface potential changes as the Moon moves through the terrestrial bow shock, (2) the lunar surface achieves potentials in the upstream foreshock region that differ from those in the downstream magnetosheath region, (3) these differences can be explained by the presence of energetic electron beams in the upstream foreshock region and (4) if this explanation is correct, the location of the Moon with respect to the terrestrial bow shock influences lunar surface potential

Enlarging conference learning : at the crossroads of fat studies and conference pedagogies

This article stages an encounter between the field of fat studies and conference pedagogy scholarship. After laying the foundations for a reading of academic conferences as learning spaces, the authors present two examples—International Fat Studies Conferences held in Aotearoa, New Zealand, in 2012 and 2016—to unpack these ideas. The framing of fat studies conferences as pedagogical spaces sparks questions that travel in multiple directions. It calls us to consider possible modifications to the design of fat studies conferences, as well as how discussions about fat pedagogy may have a wider application to academic gatherings

Elucidation of The Behavioral Program and Neuronal Network Encoded by Dorsal Raphe Serotonergic Neurons

Elucidating how the brain's serotonergic network mediates diverse behavioral actions over both relatively short (minutes–hours) and long period of time (days–weeks) remains a major challenge for neuroscience. Our relative ignorance is largely due to the lack of technologies with robustness, reversibility, and spatio-temporal control. Recently, we have demonstrated that our chemogenetic approach (eg, Designer Receptors Exclusively Activated by Designer Drugs (DREADDs)) provides a reliable and robust tool for controlling genetically defined neural populations. Here we show how short- and long-term activation of dorsal raphe nucleus (DRN) serotonergic neurons induces robust behavioral responses. We found that both short- and long-term activation of DRN serotonergic neurons induce antidepressant-like behavioral responses. However, only short-term activation induces anxiogenic-like behaviors. In parallel, these behavioral phenotypes were associated with a metabolic map of whole brain network activity via a recently developed non-invasive imaging technology DREAMM (DREADD Associated Metabolic Mapping). Our findings reveal a previously unappreciated brain network elicited by selective activation of DRN serotonin neurons and illuminate potential therapeutic and adverse effects of drugs targeting DRN neurons