Predictive genetic test decisions for Huntington's disease: context, appraisal and new moral imperatives

Predictive testing is one of the new genetic technologies which, in conjunction with developing fields such as pharmacogenomics, promises many benefits for preventive and population health. Understanding how individuals appraise and make genetic test decisions is increasingly relevant as the technology expands. Lay understandings of genetic risk and test decision-making, located within holistic life frameworks including family or kin relationships, may vary considerably from clinical representations of these phenomena. The predictive test for Huntington's disease (HD), whilst specific to a single-gene, serious, mature-onset but currently untreatable disorder, is regarded as a model in this context. This paper reports upon a qualitative Australian study which investigated predictive test decision-making by individuals at risk for HD, the contexts of their decisions and the appraisals which underpinned them. In-depth interviews were conducted in Australia with 16 individuals at 50% risk for HD, with variation across testing decisions, gender, age and selected characteristics. Findings suggested predictive testing was regarded as a significant life decision with important implications for self and others, while the right not to know genetic status was staunchly and unanimously defended. Multiple contexts of reference were identified within which test decisions were located, including intra- and inter-personal frameworks, family history and experience of HID, and temporality. Participants used two main criteria in appraising test options: perceived value of, or need for the test information, for self and/or significant others, and degree to which such information could be tolerated and managed, short and long-term, by self and/or others. Selected moral and ethical considerations involved in decision-making are examined, as well as the clinical and socio-political contexts in which predictive testing is located. The paper argues that psychosocial vulnerabilities generated by the availability of testing technologies and exacerbated by policy imperatives towards individual responsibility and self-governance should be addressed at broader societal levels. (C) 2003 Elsevier Science Ltd. All rights reserved.

Surgical Theatre, Gifted Performances: The Changing Moral Economy of Surgical Training

Fred Hollows and his work to reduce blindness in Indigenous communities is an obvious example of benevolence of doctors and nurses towards patients while the role of the staff of burns units around Australia in treating the victims of the Bali bombing is another. Some different stories about benevolence in medicine, concerning the benevolence of patients towards trainee clinical staff are suggested.

Bad apples in bad barrels revisited: Cognitive moral development, just world beliefs, rewards, and ethical decision-making

In this study, we test the interactive effect on ethical decision-making of (1) personal characteristics, and (2) personal expectancies based on perceptions of organizational rewards and punishments. Personal characteristics studied were cognitive moral development and belief in a just world. Using an in-basket simulation, we found that exposure to reward system information influenced managers' outcome expectancies. Further, outcome expectancies and belief in a just world interacted with managers' cognitive moral development to influence managers' ethical decision-making. In particular, low-cognitive moral development managers who expected that their organization condoned unethical behavior made less ethical decisions while high cognitive moral development managers became more ethical in this environment. Low cognitive moral development managers also behaved less ethically when their belief in a just world was high.

Capital market equilibrium with moral hazard and flexible technology

(Magill, M., Quinzii, M., 2002. Capital market equilibrium with moral hazard. Journal of Mathematical Economics 38, 149-190) showed that, in a stockmarket economy with private information, the moral hazard problem may be resolved provided that a spanning overlap condition is satisfed. This result depends on the assumption that the technology is given by a stochastic production function with a single scalar input. The object of the present paper is to extend the analysis of Magill and Quinzii to the case of multiple inputs. We show that their main result extends to this general case if and only if, for each firm, the number of linearly independent combinations of securities having payoffs correlated with, but not dependent on, the firms output is equal to the number of degrees of freedom in the firm's production technology.

Paraíso Terrestre ou terra sem mal? uma reconstrução do universo mental, simbólico e religioso dos povos que viveram no Brasil durante o século XVI

O impacto cultural e religioso causado pelo encontro dos indígenas e europeus no Novo Mundo me levou à busca de uma reconstrução do universo mental, simbólico e religioso dos povos que viveram no Brasil, nesse período.Para entender as origens, as matrizes fundantes, da religiosidade brasileira busquei, através da análise dos relatos dos cronistas quinhentistas, uma via para essa compreensão. Sabe-se que durante muito tempo a historiografia brasileira desconheceu o fenômeno das Santidades Ameríndias , ou seja, a dimensão dessa religiosidade envolta em magia, mas que pode ser observada e relatada pelos cronistas. Podemos verificar que o sagrado perpassa o campo social e o político dos indígenas brasileiros. Além da crença religiosa, existe a crença em outras forças que regem esse mundo: a crença nas profecias, nas benzeções para afastar os males e na cura ou nos feitiços que podem fazer o mal para seus desafetos. Todavia, nosso propósito não é um estudo da magia ou da religião, mas uma tentativa de abordar as crenças, a religiosidade indígena, nesse Paraíso Terrestre, que por um bom tempo foi o Brasil do Século XVI. O principal personagem: o profeta-caraíba é, ao mesmo tempo, sacerdote e fiel seguidor dos princípios tradicionais, fundamentais de sua tribo. Esse guia espiritual, com a missão de derrotar as forças do mal e libertar sua tribo das garras do inimigo, é quem deverá os conduzir até a Terra sem Mal.(AU)