<p>Lay People’s Ethical Attitudes To Placebo Treatment: A Q-Methodology Study</p>

Abstract

BackgroundPlacebo-treatment acceptability is debated among ethicists, mostly due to conflict between respect-to-autonomy and beneficence principles. It is not clear how lay people balance these and other ethical principles.MethodsOne hundred and eighty-seven respondents rank-ordered 42 opinion statements covering various ethical aspects of placebo-treatment, according to a 9-category symmetrical distribution. We analyzed statements’ scores using averaging-analysis and by-person factor analysis (Q-methodology).ResultsRespondents’ mean (SD) age was 34.6 (10.6) years, 54% were women, 40% healthcare-related, 68% Muslims (31% Christians), and 39% received general education in Saudi Arabia (24% in the Philippines). On averaging-analysis, the most-agreeable statements were “Acceptable if benefit to patient large” and “Acceptable with physician intent to benefit patient”. The most-disagreeable statements were “Acceptable with physician self-benefit intent” and “Acceptable with large harm to other patients”. Muslims gave a higher rank to “Giving no description is acceptable”, “Acceptable with small benefit to patient”, and “Acceptable with physician intent to benefit patient” and a lower rank to “Acceptable to describe as inactive drug”, “Acceptable with physician intent to please patient caring relative”, and “Acceptable with moderate harm to other patients” (p<0.01). Q-methodology detected several ethical attitude models that were mostly multi-principled and consequentialism-dominated. The majority of Christian and Philippines-educated women loaded on a “relatively family and deception-concerned” model, whereas the majority of Muslim and Saudi Arabia-educated women loaded on a “relatively common-good-concerned” model. The majority of Christian and healthcare men loaded on a “relatively deception-concerned” model, whereas the majority of Muslim and non-healthcare men loaded on a “relatively motives-concerned” model. Of nine intent-related statements, ≥2 received extreme rank on averaging-analysis and in 100% of women and men models.Conclusion1) On averaging-analysis, patient’s beneficence (consequentialism) followed by physician’s intent (virtue ethics) were more important than deception (respect-to-autonomy). 2) Q-methodology identified several ethical attitude models that were mostly multi-principled and associated with respondents’ demographics.

<p>Modeling Lay People’s Ethical Attitudes to Organ Donation: A Q-Methodology Study</p>

“…Finally, one advantage of Q-methodology is its tendency to avoid the depersonalization of averaging-analysis. [50][51][52][53] This was obvious in this study. Out of the 23 statements that received neutral ranks on averaging-analysis, 48-65% received extreme ranks in one or more of the women and men models, and out of the 14 statements with extreme ranks in a women or men model, 14-64% received neutral ranks on averaging-analysis.…”

“…Factors (or ethical attitude models) were construed according to their seven most agreeable and seven most disagreeable statements, post-sorting comments by respondents, and variation of statement scores among and within factors. 53 We considered statements to have "neutral" score on averaging-analysis, if the average score was ≥4 and ≤6. We considered statements to be strongly agreed with or strongly disagreed with if they were assigned a Q-methodology score of 8 to 9 or 1 to 2, respectively.…”

“…As part of a series of studies, 53 this exploratory cross sectional study was designed to model the ethical decisionmaking of common people in regard to controversial issues in contemporary medicine. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Research Ethics Committee (REC) of the King Faisal Specialist Hospital and Research Center (KFSH&RC).…”

“…The instrument (Q-set) was author-developed and underwent three rounds of pilot-testing, validation, and revision as previously described. 53 The final Q-set (Supplementary material Additional File 1, Q-set statements) consisted of 42 opinion statements divided into four major domains: 1) Consequentialism: a) recipient (3 statements covering graded health benefit to recipient), b) donor (3 statements covering graded social benefit and 3 statements covering graded risk of harm to donor), c) common good (3 statements covering graded benefit to community), and d) ethics of care (3 statements covering graded benefit to donor family, 3 statements covering graded harm to donor family, and 5 statements covering organ allocation choices). 2) Justice (2 statements covering cost-bearing and 2 statements covering State involvement).…”

“…Q-methodology has been used to overcome such limitations. [50][51][52][53] A type of by-person factor analysis, Q-methodology uses forced-ranking of opinion statements to produce grouping of respondents based on their thinking patterns. 54 The aim of this study was to explore how lay people invoke and balance the four ethical principles of principlism and whether they use other principles to achieve ethical resolution in relation to organ donation.…”