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PubMed2005

Acceptance, avoidance, and ambiguity: conflicting social values about childhood disability.

Advances in medical technology now permit children who need ventilator assistance to live at home rather than in hospitals or institutions. What does this ventilator-dependent life mean to children and their families? The impetus for this essay comes from a study of the moral experience of 12 Canadian families--parents, ventilator-dependent child, and well siblings. These families express great love for their children, take on enormous responsibilities for care, live with uncertainty, and attempt to create "normal" home environments. Nevertheless, they experience social isolation, sometimes even from their extended families and health care providers. Their lives are constrained in many ways. The challenges faced by parents of technology-dependent children raise questions of justice within society and within families.

Adolescent↗
PubMed1995

Who cares about cost? Does economic analysis impose or reflect social values?

In a two-stage survey, a cross-section of Australians were questioned about the importance of costs in setting priorities in health care. Generally, respondents felt that it is unfair to discriminate against patients who happen to have a high cost illness and that costs should therefore not be a major factor in prioritising. The majority maintained this view even when confronted with its implications in terms of the total number of people who could be treated and their own chance of receiving treatment if they fall ill. Their position cannot be discarded as irrational, as it is consistent with a defensible view of utility. However, the results suggest that the concern with allocative efficiency, as usually envisaged by the economists, is not shared by the general public and that the cost-effectiveness approach to assigning priorities in health care may be imposing an excessively simple value system upon resource allocation decision-making.

Attitude to Health↗
PubMed1992

[Comparative psychosocial study of social values].

A culturally readapted scale of the classical Rokeach scale was applied to a 200-subject sample. Subjects were male and female workers on the one hand, and university men and women, on the other hand. The results of the different subsamples were compared by means of statistical techniques. Later, the same comparison was carried out with data from a similar study performed in Venezuela.

Female↗
PubMed2005

Equity in health care prioritisation: an empirical inquiry into social value.

The value of QALY gains for different patients may be recalculated using equity weights, but it is unclear which interpretation of equity should be used: severity of illness, fair innings or proportional shortfall. We set up an experiment to analyze which of these equity concepts best reflects people's distributional preferences. Sixty respondents assigned a priority rank to the treatment of 10 conditions using the paired comparison technique. We described these real-life conditions by their actual QALY profiles, i.e. in terms of age, disease free period, duration of disease, quality of life, and life years lost. Next we determined the priority rank order of the 10 conditions by the three equity concepts, using the weights that each equity concept attributes to the different units of the QALY profile describing the 10 conditions. To explore the social interpretation of equity, we compared the observed and theoretical rank orderings using Spearman correlations. All correlations were significant at a 0.05 level. Fair innings best predicted the observed rank order of the 10 conditions (r=0.95). Weaker correlations were found for proportional shortfall (r=0.82) and severity of illness (r=-0.65). This result calls attention to health policy, because actual health care decisions often reflect concerns of severity of illness. This raises the question if health care decision makers evaluate the claims of different patients for health care by appropriate criteria.

Aged↗
PubMed2005

The impact of social values on the psychology of gender among Arab couples: a view from psychotherapy.

Three major psychosocial conditions have an effect upon the establishment of psychological problems within individuals and in the relationship of couples in the Arab family: (a) gender-dependent assessment of emotions, i.e., holding two different unequal yardsticks for two highly-genderized value systems; (b) imposing conflicting value demands on women; (c) glorifying and giving much respect to the notion of women's suffering in silence, a state described here as the "Mastoura" (tight lipped) woman, equivalent to the "learned helplessness" state. This article will also focus on the common forms of the manifestation of psychological or marital problems: sexual dysfunctions, somatic behavior and the usage of metaphoric language of psychosomatics. The article presents frequent complaints of couples who seek marriage therapy and the characteristics of each group.

Arabs↗
PubMed1985

Psychiatry and social values: the American Psychiatric Association and immigration restriction, 1880-1930.

From time to time during the late 19th and early 20th centuries, the issue of immigration came before the American Psychiatric Association (APA). Members of the APA who publicly discussed the problem of immigration often addressed it in ways that emphasized the importance of hereditary and racial factors in determining mental health. There was considerable feeling among psychiatrists that the immigrant population harbored a large number of "mental defectives" who would taint future generations of Americans if not restricted. Though psychiatrists were not as extreme in their advocacy of immigration restriction as some segments of American society (Grob 1983), many were nonetheless eager to see limits imposed upon the entry of defective and potentially defective immigrants, particularly those from Southern and Eastern Europe. Some practitioners were also deeply concerned about what might happen to the state of American mental health if the racial mixture of the nation's population were substantially altered. On the other hand, some psychiatrists, particularly in the period after 1910, were uncomfortable with views that emphasized hereditary determinism and therefore emphasized the role of environmental factors in the development of mental disease. The purpose of this paper is to examine how social and cultural forces interacted with contemporary scientific ideas to shape the way psychiatrists dealt with the problem of immigration at the turn of the century.

Emigration and Immigration↗
PubMed1976

Personal and social value concerns of Scandinavian elderly: a multivariate study.

This study is a descriptive account of the results obtained by a set of three attitudes scales, as part of a larger study on the value concerns of two samples of Scandinavian elderly, one Danish and the other Norwegian. The measuring instruments were the Cantril Self Anchoring Scale, the Life Satisfaction Index-A and Rosencranz-McNevin's Semantic Differential. The results indicate that both samples are equally preoccupied with personal security rather than economic concerns. The Danish sample perceives greater congruence between life goals and achievements than the Norwegians. The Norwegians see their young as deviant from the modal ideology of the adult world, while the Danes perceive the young as drifters, but functionally efficient. No correlation was found between personal life satisfaction and acceptance of youth, a finding at variance with results obtained by the authors among previous U.S. Samples of aged.

Aged↗
PubMed1980

Value socialization of black medical students at the Howard University College of Medicine: a case report.

The major objective of this research is to examine whether or not medical students acquire values other than those related to traditional orientations to medical service. These values are approached in the context of the medical training of the student physician at a predominantly black medical college. The research setting is the Howard University College of Medicine in Washington, DC, one of the two black four-year medical colleges in the United States.Specifically, the study examines whether or not socialization in medical school initiates the acquisition of a communal value system among students. A communal value system in this analysis consists of (1) community involvement and (2) an ideology emphasizing liberalism toward social change.Methodologically, interviews (unstructured and focused), direct observation, and survey research are used in the data collection process. The research design also includes the use of a cross sectional method of analysis with longitudinal focus involving first, second, third, and fourth year students.The findings suggest that this particular medical school reinforces, clarifies, or alters communal value orientations acquired prior to coming to medical school. Among students who do not change their communal value commitments after entering graduate training, the feeling is that the medical school reinforces prior dispositions. Among students who change as medical trainees, two tendencies are evident. Regarding community involvement, the majority of students develop a stronger interest as the result of their medical school experience. Concerning social change, students, in general, move from a liberal perspective to a more conservative position. The initial development of a communal value orientation is related to family socializing influences and racial identification factors.It is concluded that the experiences at Howard University Medical College interact with previous student dispositions concerning a communal value orientation.

Black or African American↗
PubMed2004

Investigating the social value of health changes.

This survey has demonstrated that the Danish public is concerned with distributional aspects of health gains. They have a strong inclination to give priority to those in a more severe health state provided their expected benefits are large enough to bring them to the health level where their rival patients are without treatment. Results also indicated that the equity argument may not apply with equal force on all health dimensions. Respondents did to some extent trade-off equity for greater health gains. A nouvelle finding is that the valuations of health increments per se seem to be affected by whether questions are framed as individual or social choices. If social decision making is the issue, health gains which involve relieving patients of extreme problems are valued more highly than relief of minor ailments. These discrepancies between individual and social valuations suggest that the use of QALY values elicited from an individual's perspective may not be valid in social decision making.

Adult↗
PubMed2005

Can we estimate the 'social' value of a QALY? Four core issues to resolve.

There is growing interest in estimating the 'societal' willingness to pay (WTP) for a quality adjusted life year (QALY) to help public health system decision-makers determine whether a health care programme should/not be undertaken. However, there is a lack of clarity in this debate concerning four core issues: (i) is 'social' WTP simply the sum of 'individual' WTP; (ii) will 'individual' WTP map directly into 'social' WTP; (iii) is 'personal' income the appropriate budget constraint; (iv) should WTP be adjusted for ability to pay? This paper outlines the relevance and importance of each of these issues in the hope of encouraging a wider debate on the core issues that empirical studies will have to explore to discover whether such a value may be obtained.

Australia↗