The Ethical Health Lawyer: An Empirical Assessment of Moral Decision Making

Writing in 1999, legal ethics scholar Brad Wendel noted that "[v]ery little empirical work has been done on the moral decision making of lawyers." Indeed, since the mid-1990s, few empirical studies have attempted to explore how attorneys deliberate about ethical dilemmas they encounter in their practice. Moreover, while past research has explored some of the ethical issues confronting lawyers practicing in certain specific areas of practice, no published data exists probing the moral mind of health care lawyers. As signaled by the creation of a regular column "devoted to ethical issues arising in the practice of health law" in the Journal of Law, Medicine & Ethics , the time to address the empirical gap in the professional ethics literature is now. Accordingly, this article presents data collected from 120 health care lawyers. Presenting this population with a number of hypothetical scenarios relating to how they would respond when confronting an ethical dilemma without an obvious solution or when facing a situation in which their personal values were in tension with their professional obligations, this article represents a first step toward better understanding how lawyers who practice in health care settings understand and resolve the moral discomfort they encounter in their professional lives.     

Correlativity

In a celebrated article, published nearly a century ago, Wesley Newcomb Hohfeld endeavored to elucidate the various types of jural relations. Hohfeld’s scheme has been justly regarded as a seminal contribution to analytical jurisprudence, and has stimulated lively debate since. This Essay aims to refute one of Hohfeld’s fundamental and most influential theses: the axiom of right–duty correlativity. To do so, it employs the simplest refutation strategy in first-order logic, namely providing a valid counterexample. Part I discusses earlier attempts to do likewise, and explains why they failed. For the most part, previous illustrations of ostensibly standalone rights or standalone duties neglected relevant parties who could owe the correlative duties or hold the correlative rights, respectively. Part II puts forward a simple argument: There are abstract duties in private law that ban certain types of conduct without reference to specific victims. Those duties are not necessarily correlative with rights, although their breach may generate secondary duties with corresponding rights. In particular, tort law allows plaintiffs to recover for harm caused by breach of duty that occurred before they acquired legal personality. This is tantamount to recognizing duties that are not correlative with rights, and therefore invalidates the correlativity axiom.     

A new psychometric instrument assessing vulnerability to risk of suicide and self-harm behaviour in offenders: Suicide Concerns for Offenders in Prison Environment (SCOPE)

This study aimed to develop a new psychometric instrument to assess vulnerability to risk of suicide and nonfatal self-harm behaviour in young adult male and female offenders. In total three studies were conducted to assess the psychometric properties of the new instrument using both exploratory and confirmatory factor analysis in different samples. Participants in all three studies included a total of 1,166 young adult offenders across six Her Majesty's Prisons. The new instrument, Suicide Concerns for Offenders in Prison Environment (SCOPE), contained 28 items scoring on two subscales. The factorial structure of the new instrument initially obtained with exploratory factor analysis was subsequently confirmed in a new sample. The internal consistency of the two subscales were acceptable but the test-retest reliability coefficients were moderate. Concurrent validation with the Beck Hopelessness Scale was acceptable and SCOPE showed the ability to discriminate between those at risk and those with no known history of attempted suicide and nonfatal self-harm behaviour ( p < 0.01).     

Experiences of Racism,Racial/Ethnic Attitudes,Motivated Fairness and Mental Health Outcomes Among Primary and Secondary School Students

While studies investigating the health effects of racial discrimination for children and youth have examined a range of effect modifiers, to date, relationships between experiences of racial discrimination, student attitudes, and health outcomes remain unexplored. This study uniquely demonstrates the moderating effects of vicarious racism and motivated fairness on the association between direct experiences of racism and mental health outcomes, specifically depressive symptoms and loneliness, among primary and secondary school students. Across seven schools, 263 students (54.4 % female), ranging from 8 to 17 years old (M = 11.2, SD = 2.2) reported attitudes about other racial/ethnic groups and experiences of racism. Students from minority ethnic groups (determined by country of birth) reported higher levels of loneliness and more racist experiences relative to the majority group students. Students from the majority racial/ethnic group reported higher levels of loneliness and depressive symptoms if they had more friends from different racial/ethnic groups, whereas the number of friends from different groups had no effect on minority students’ loneliness or depressive symptoms. Direct experiences of racism were robustly related to higher loneliness and depressive symptoms in multivariate regression models. However, the association with depressive symptoms was reduced to marginal significance when students reported low motivated fairness. Elaborating on the negative health effects of racism in primary and secondary school students provides an impetus for future research and the development of appropriate interventions.     

Book reviews

Chen Kuide, ed., Zhongguo dalu dangdai wenhua bianqian (197801989) (Cultural change in Contemporary Mainland China, 1978–1989) Taibei: Guiguan, 1991. 278 + iv pp.

Yizi Chen. China: the Ten Years Reform and Democratic Movement in 1989. Pp. ix, 209, Taipei, Taiwan, Lianjing Press, 1990.

Wu Xiaomei et al., Zhongguo xiandai zuojia yu dongxifang wenhua [Modern Chinese Writers and Eastern and Western Cultures]. Lanzhou: Lanzhou daxue chubanshe, 1990. 272 pp. 2.12 Yuan.

Zhao Xueyong, Shen Congwen yu dongxifang wenhua [Shen Congwen and Eastern and Western Cultures]. Lanzhou daxue chubanshe, 1990. 226 pp. 1.75 yuan.

Zhongguo Waijiaoguan Huiylilu: Xin Zhongguo Waijiao Fengyun (Memoirs by China's Diplomats: Diplomatic Winds of New China). Edited by Waijiaobu Waijiaoshi Bianjishi (Editorial Office of Diplomatic History of the Ministry of Foreign Affairs). Beijing: Shijie Zhishi chubanshe, 1990. 196 pp. 3.20 yuan

Zhao Wei, Zhao Ziyang zhuan (Biography of Zhao Ziyang)

Ruan Ming: Lishi Zhuanzedian Shangde Hu Yaobang (Hu Yaobang At the Turning Point of History), New Jersey: Global Cultural Publishing House, 1991     

Three to Four Year Prospective Evaluation of Personality and Behavioral Risk Factors for Later Disordered Eating in Adolescent Girls and Boys

Findings of a 3- to 4-year prospective investigation of personality, temperament, and behavioral factors predictive of the later development of disordered eating in an adolescent population are presented. The sample consisted of 726 girls and 698 boys who entered the study in grades 7–10 in year 1 or in grade 7 in year 2. Predictors of eating disorder risk score were determined separately by gender. For both girls and boys, the latent variable of negative affect/attitudes determined at study entrance was the only significant predictor of final-year risk score. Semistructured diagnostic interviews confirmed an eating disorder diagnosis in 52.8% of 36 female subjects in the high eating disorder symptom group. A substantial history of lifetime and current comorbidity also was noted in this group. The function of negative affect/attitudes as a generalized psychopathology vulnerability factor and as a specific factor increasing risk for disordered eating is discussed.     

Not guilty by reason of insanity: a research note

The question of the insanity defense centers around the moralist-determinist debate. Insanity defense laws are premised on the assumption that individuals choose between right and wrong, and are responsible for that choice. Mental disease, however, can overpower, and thus, not of their own volition, insane persons become out-of-control. Hence, they cannot be held responsible for their behavior or subject to criminal punishment. It is the purpose of the insanity defense, of course, to distinguish between offenders in need of punitive disposition and ones where a medical-custodial disposition is best. The research presented here indicates that defendants who successfully raise the plea of NGRI do not beat the rap. In other words, they do not spend fewer days in confinement via an NGRI plea than had they been convicted and sentenced. Thus, for the reasons of justice, equity, and fairness the insanity defense should be kept intact. The wave of public fear and reaction to the decision in a few highly publicized cases is insufficient grounds for eliminating the plea. Not only is the use of the insanity defense infrequent, but defendants who select it give up important safeguards. Namely, they are unable to plea bargain, are stigmatized as "mad and bad," have no access to probation or parole, and are confined for an indeterminate amount of time. That some would call this leniency we find surprising. And, of course, we should not forget the findings reported here. NGRI acquittees spend more time being locked up. Defendants who successfully raise the NGRI plea are confined until professionals say they are no longer dangerous.(ABSTRACT TRUNCATED AT 250 WORDS)