Reinout de Vries

In this issue of The Journal of Clinical Ethics, we offer a variety of perspectives on the moral and medical responsibilities of professionals with regard to a woman’s choice of where she will birth her baby. The articles in this special issue focus on place of birth, but they have larger resonance for clinicians whose decisions about providing the best possible care require them to sort through evidence, consider their own possible biases and the limitations of their training, and balance the wishes of their patients with the demands of colleagues, hospitals, and insurers. The articles published in this special issue of The Journal of Clinical Ethics will help those who wrestle with such dilemmas in everyday clinical decision making.

Ethical arguments about caregiver responsibility and the limits of client autonomy rely on best evidence about the risks and benefits of medical interventions. But when the evidence is unclear, or when the peer-reviewed literature presents conflicting accounts of the evidence, how are clinicians and their clients to recommend or decide the best course of action? Conflicting evidence about the outcomes of home and hospital birth in the peerreviewed literature offers an opportunity to explore this question. We present the contrary evidence and describe the social and cultural elements that influence the production of the science of birth, including professional, publication, and critical bias. We then consider how the science of birth has been used an misused in making ethical arguments about preferred place of birth. We conclude with a number of recommendations about the responsible use of the evidence, arguing for an “ethics of information” that can be drawn on to guide caregivers and clients in the use of evidence for clinical decision making.

This review offers an integration of dark leadership styles with dark personality traits. The core of dark leadership consists of Three Nightmare Traits (TNT)—leader dishonesty, leader disagreeableness, and leader carelessness—that are conceptualized as contextualized personality traits aligned with respectively (low) honesty-humility, (low) agreeableness, and (low) conscientiousness. It is argued that the TNT, when combined with high extraversion and low emotionality, can have serious (‘explosive’) negative consequences for employees and their organizations. A Situation-Trait-Outcome Activation (STOA) model is presented in which a description is offered of situations that are attractive to TNT leaders (situation activation), situations that activate TNT traits (trait activation), and the kinds of outcomes that may result from TNT behaviors (outcome activation). Subsequently, the TNT and STOA models are combined to offer a description of the organizational actions that may strengthen or weaken the TNT during six career stages: attraction, selection, socialization, production, promotion, and attrition. Except for mainly negative consequences of the TNT, possible positive consequences of TNT leadership are also explored, and an outline of a research program is offered that may provide answers to the most pressing questions in dark leadership research.

To uncover the main dimensions of sport personality traits, a lexical study was conducted. In the first two phases, 321 adjectives denoting the way somebody practices sports were selected. In the third phase, 555 respondents self-rated the adjectives. Congruence analyses provided evidence of six factors, five of which are sport personality trait factors plus one physical individual difference factor. Marker scales from the sport personality trait factors show convergent correlations with the generic HEXACO personality obtained years earlier. Furthermore, meaningful relations with the six most frequently practiced sport and leisure activities were observed. Contextualized sport personality trait factors can be useful in research on sport preferences, sport behaviors, and sport outcomes.

Objective The study evaluated patient informed consent for the Quad screen and examined differences in IC between test acceptors and test refusers. A multidimensional model of IC was used. Methods Women seeking prenatal care at nine obstetrics clinics in a large Midwestern city completed surveys between February and December 2006. Surveys contained measures for three dimensions of IC: intention, understanding and controlling influence. Results 56.2% of women did not meet criteria for all three of our dimensions of IC and therefore failed to give it. The failure rate was higher among women who choose to screen than women who choose not screen. Women who met all criteria for IC were over three times less likley to choose to screen ) than women who did not meet criteria for IC. Conclusion The decision to screen for fetal anomalies is less of a deliberated action than the decision not to screen. Women who lack a fundamental understanding of the purpose and nature of the screen may be operating on the belief that the screen is part of standard care and presents no need to deliberate.

The present study investigated relations between personality and values on the one hand and compensation preferences on the other. We hypothesized that HEXACO Honesty-Humility and self-transcendence versus self-enhancement values predict preference for higher relative compensation level and that HEXACO Openness to Experience and openness to change versus conservation values predict preference for compensation variability. Furthermore, we expected perceived utility of money and risk aversion to mediate the respective relations. The hypotheses were tested using a sample of 2,210 employees from a large international organization. The results provided support for the direct and mediated relations between personality and values on the one hand and preferences for compensation variability and level on the other.