From both sides now: informed consent, organ transplantation, and family-based disclosure

Drawing on the legal and social development of the right of individual patients to give informed consent to medical treatment, this article explores some implications of heroic life-saving measures in medicine that are made possibly by unprecedented advances in medical technology. Talcing cardiac transplantation as its primary example, the article examines the broader effects, both short-term and long-term, on family members as well as on the patient of this and similar types of heroic treatment. The author then offers a novel legal theory: where the heroic measure holds the risk of serious or life threatening changes, not just for the patients themselves but for their intimately connected family members as well, those members ought to have a legal right to participate in the informed consent process. The author sketches the contours of such a right and defends it in the face of various objections that may be made to it. I've looked at life from both sides now from win and lose, and still somehow it's life's illusions I recall. I really don't know life at all. (“Both Sides Now,” on Colors of the Day: The Best of Judy Collins, Electra Records 1972)     

Testing the limits of freedom of contract: the commercialization of reproductive materials and services

This article examines the cases for and against commercializing, or "commodifying," reproductive materials and services. Using a supply/demand third-party framework, three basic scenarios in which commercial-exchange relationships may be possible--exchange of gametes and zygotes, exchange of gestational services, and exchange of fetal material--and the major parties of interest, or stakeholders, are identified. The study sketches the liberal, essentialist, and radical contingency theories that shape the debate over the commercialization of reproductive materials and services. The article then attempts to derive some basic governing principles that reflect as much common ground as possible amongst these various normative perspectives, while recognizing that complete reconciliation is impossible. Taken together, these principles are designed to reflect a strategy of "constrained commodification," where commercialization or commodification, that is, financial remuneration, plays a relatively neutral role in the utilization of reproductive materials and services. In light of these principles, the article concludes by sketching legal and regulatory regimes with respect to the exchange of gametes and zygotes, gestational services, and fetal tissue.     

Cultural Equivalence and Cultural Variance in Longitudinal Associations of Young Adolescent Self-Definition and Interpersonal Relatedness to Psychological and School Adjustment

Ethnic group differences in the contributions of self-definition (self-worth and efficacy) and interpersonal relatedness with parents and peers to changes in psychological and school adjustment were examined among 448 White, Black, and Latino girls and boys (11–14 years of age). Self-report questionnaires and school records were evaluated for socioeconomic and ethnic group differences in patterns of change over 1 year. Overall similarity in changes over time across ethnic groups was found for relatedness, self-definition, and psychological adjustment, although Black and Latino youth reported more overall adjustment difficulties, Black youth reported less positive relationships with parents, and lower SES youth reported less positive peer relationships than others. Ethnic group differences in changes to school adjustment, even after controlling SES, suggested a cultural variation in which often cited declines in school adjustment during middle school characterize White adolescents to a greater degree than Black or Latino adolescents. Ethnicity moderated associations of relatedness and self-definition with psychological and school adjustment such that Black and Latino youth appeared particularly vulnerable to experiences that threaten closeness and trust in relationships. Results pointed to potentially important situational and cultural differences in maladaptive and adaptive developmental processes across ethnicity.     

Coping with Concerns: An Exploratory Comparison of Australian,Colombian, German,and Palestinian Adolescents

Consistent with an emphasis on positive psychology, and on ability rather than deficit, this study of adolescents in 4 communities sought to examine how young people cope with their concerns. Samples of Australian, Colombian, German, and Palestinian students completed the general form of the Adolescent Coping Scale, an 80-item instrument used to measure coping. A comparison of young people's usage of 3 coping styles and 18 coping strategies within these communities indicated that Palestinian youth report greater usage of all but three strategies (namely, physical recreation, relaxation, and tension reduction), and German youth report the least usage of 2/3 of the strategies assessed. Both Palestinian and Colombian youth were noted to utilize more seek to belong, focus on the positive, social action, solving the problem, seeking spiritual support, and worry than were German or Australian adolescents. When the relative usage of coping strategies within national settings was considered, some noticeable differences were apparent. For example it was found that regardless of the national setting young people reported most frequent use of working hard and use of problem solving strategies. When it comes to more culturally determined activities such as physical recreation, the Australian and German students ranked this strategy more highly in their coping repertoires than do the Colombians, and more noticeably, the Palestinian students. For example, although physical recreation is ranked as the second most commonly used strategy for the German sample, it is ranked 16th by the Palestinians. The study demonstrates the importance of identifying coping strategies that are reflective of each community under investigation. Similarity in coping cannot be assumed across different student populations. Consequently caution needs to be exercised when importing coping programs from one community to another.     

Bureaucracy,Network, or Enterprise? Comparing Models of Governance in Australia,Britain, the Netherlands,and New Zealand

Theories of democratic government traditionally have relied on a model of organization in which officials act impartially, accept clear lines of accountability and supervision, and define their day–to–day activities through rules, procedures, and confined discretion. In the past 10 years, however, a serious challenge to this ideal has been mounted by critics and reformers who favor market, network, or "mixed–economy" models. We assess the extent to which these new models have influenced the work orientations of frontline staff using three alternative service types—corporate, market, and network—to that proposed by the traditional, procedural model of public bureaucracy. Using surveys of frontline officials in four countries where the revolution in ideas has been accompanied by a revolution in methods for organizing government services, we measure the degree to which the new models are operating as service–delivery norms. A new corporate–market hybrid (called "enterprise governance") and a new network type have become significant models for the organization of frontline work in public programs.     

Adolescent Depressed Mood in a Multiethnic Sample

This research assessed whether there is an impact of race-ethnicity on depressed mood among adolescents, independent of socioeconomic status, whether gender differences in depressed mood are apparent within all race-ethnicity subgroups, and whether pubertal development influences depressed mood in a similar manner within gender and race-ethnicity subgroups. A three-stage, area probability sampling frame was utilized to select adolescents, ages 12–17 years, for an in-person interview. Depressed mood was assessed by the Children's Depression Inventory. Compared to Whites, African Americans, or Asian Americans, Latinos reported more symptoms of depressed mood, a finding that was independent of socioeconomic status. Advancing puberty was associated with depressed mood only among females, but the timing of pubertal changes, relative to ones peers, was related to depressed mood among both males and females, and among Latinos.     

A Question of Morality: Artists' Values and Public Funding for the Arts

In 1989, the combination of art, religion, homosexuality, ana¹ public dollars set off an explosive two-year battle and a decade of skirmishes over funding for the National Endowment for the Arts. To promote artistic freedom and to avoid political controversy, federal arts policy delegates specific funding decisions to private donors and arts professionals. In an era of morality politics—hot-button issues driven by deeply held beliefs rather than by expertise—that strategy no longer works. Artists, donors, and arts audiences diverge widely from the rest of the American public in their attitudes toward religion, sexual morality, and civil liberties, as General Social Survey data show. Delegating funding decisions to them has naturally led to some subsidies of art offensive to important segments of the population.