Our purpose in this article is to identify and suggest resolution for two core problematics of grounded theory. First, while grounded theory provides transparency to one part of the conceptualization process, where codes emerge directly from the data, it provides no such systematic or transparent way for gaining insight into the conceptual relationships between discovered codes. Producing a grounded theory depends not only on the definition of conceptual pieces, but the delineation of a relationship between at least two of those pieces. Second, the conceptualization process of grounded theory is done in hierarchical fashion, where individual codes emerge from the data but then are used to generate insight into more general concepts and thematic statements. But various works on grounded theory have failed to provide any systematic way of using data specific levels of scale (the codes) to gain insight into more macro levels of scale (concepts and themes). We offer fractal concept analysis as a means of resolving both of these issues. By using a logic structure generator, fractal concept analysis delineates self-similar conceptual frameworks at various levels of abstraction, yielding a method for linking concepts together within and between levels of scale encountered in the grounded theory coding and categorization process. We conclude that this fractal analytic technique can bolster the aims of grounded theory as a formalized and systematic process for generating theory from empirical data.

African American distrust of medicine has consequences for treatment seeking and healthcare behaviour. Much work has been done to examine acute events (eg, Tuskegee Syphilis Study) that have contributed to this phenomenon and a sophisticated bioethics discipline keeps watch on current practices by medicine. But physicians and clinicians are not the only actors in the medical arena, particularly when it comes to health beliefs and distrust of medicine. The purpose of this paper is to call attention not just to ethical shortcomings of the past, but to the structural contexts of those events and the contributions and responsibilities of popular media and academic disciplines in the production of (often mythic) knowledge. We argue that ignoring context and producing inaccurate work has real impacts on health and healthcare, particularly for African Americans, and thus engenders ethical obligations incumbent on disciplines traditionally recognised as purely academic.

In this article, the authors examine the political and economic community dynamics of the street homeless as well as other groups involved in conflicts regarding the process of urban renewal. Since postwar suburban flight, homeless people have lived largely in the shadows of vacated city centers. But “not-in-my-backyard” (NIMBY) battles over the homeless have become increasingly common, especially as the influx of comfortably housed residents bring suburban expectations to urban centers, generating conflicts that affect homeless urban camp communities. Drawing on four years of ethnographic data, the authors describe social conflicts revolving around homelessness and urban renewal. Moreover, through examining the patterns of economy and polity among sectors with different economic positions in the city, the authors illustrate how “problematic” groups of people, such as the homeless, are not antithetical to community. Instead, they are key stakeholders in urban communities with goals, concerns, and desired boundaries similar to those who “legitimately” live downtown.

The topic of euthanasia has been a matter of public debate for several decades. Although empirical research should inform policy, scale measurement is lacking. After analyzing shortcomings of previous work, we offer a systematically designed scale to measure attitudes toward euthanasia. We attempt to encompass previously unspecified dimensions of the phenomenon that are central to the euthanasia debate. The results of our pretest show that our attitude towards euthanasia (ATE) scale is both reliable and valid. We delineate active and passive euthanasia, no chance for recovery and severe pain, and patient's autonomy and doctor's authority. We argue that isolating these factors provides a more robust scale capable of better analyzing sample variance. Internal consistency is established with Cronbach's alpha=.871. Construct external consistency is established by correlating the scale with other predictors such as race and spirituality.

This article reports on the relationship of personality and euthanasia attitudes. Results from a survey of 165 Iranian students showed that religiosity, honesty-humility, agreeableness, and extraversion were related to negative attitudes toward euthanasia, whereas openness was related to acceptance of euthanasia, with the unconventionality facet driving this relationship. Moreover, openness explained additional variance when added to a multivariate model containing religiosity and HEXACO factors. This study illustrates the possibility of accounting for variation beyond the traditional group level predictors of attitudes toward euthanasia and promoting future cross-cultural studies into personality and end-of-life issues and informing end-of-life conversations at the bedside.

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In the past thirty to forty years, clinicians and bioethicists have expanded the scope for children’s participation in decision‐making about their medical care, often under the banner of “pediatric assent.” The success of this movement was signaled perhaps most strongly by the creation of American Academy of Pediatrics guidance on pediatric assent in 1995. We agree with the AAP that both the best interests of the child patient and the need to respect the child patient are reasons to take seriously children’s treatment preferences. However, we argue that the AAP could provide a stronger and more stable ethical foundation for pediatric assent. Current policy documents invoke a conception of respect that is grounded in autonomy and cannot apply in most cases of pediatric assent. We argue that the mere fact that children have treatment preferences is a reason to support pediatric assent. We defend this claim by focusing on the importance of what we have called “capacity for preferences.” The notion of capacity for preferences underscores that the moral value of a patient’s preferences is not reducible to considerations of either autonomy or best interests.

Nocebo effects occur when an adverse effect on the patient arises from the patient's own negative expectations. In accordance with informed consent, providers often disclose information that results in unintended adverse outcomes for the patient. While this may adhere to the principle of autonomy, it violates the doctrine of "primum non nocere," given that side-effect disclosure may cause those side effects. In this article we build off previous work, particularly by Wells and Kaptchuk ( 2012 ) and by Cohen ( 2013 ), to suggest ethical guidelines that permit nondisclosure in the case when a nocebo effect is likely to occur on of the basis of nonmaleficence. We accept that that autonomy vis-à-vis informed consent must be forestalled, but salvage much of its role by elaborating a practical clinical approach to postencounter follow-up. In doing so, we reconcile a clinically practicable process of determining conditions of disclosure with long-standing ethical commitments to patients.