Casuistry as methodology in clinical ethics

This essay focuses on how casuistry can become a useful technique of practical reasoning for the clinical ethicist or ethics consultant. Casuistry is defined, its relationship to rhetorical reasoning and its interpretation of cases, by employing three terms that, while they are not employed by the classical rhetoricians and casuists, conform, in a general way, to the features of their work. Those terms are (1) morphology, (2) taxonomy, (3) kinetics. The morphology of a case reveals the invariant structure of the particular case whatever its contingent features, and also the invariant forms of argument relevant to any case of the same sort: these invariant features can be called topics. Taxonomy situates the instant case in a series of similar cases, allowing the similarities and differences between an instant case and a paradigm case to dictate the moral judgment about the instant case. This judgment is based, not merely on application of an ethical theory or principle, but upon the way in which circumstances and maxims appear in the morphology of the case itself and in comparison with other cases. Kinetics is an understanding of the way in which one case imparts a kind of moral movement to other cases, that is, different and sometimes unprecedented circumstances may move certain marginal or exceptional cases to the level of paradigm cases. In conclusion, casuistry is the exercise of prudential or practical reasoning in recognition of the relationship between maxims, circumstances and topics, as well as the relationship of paradigms to analogous cases.     

Toward a Synthetic Approach to the Rorschach: The Case of a Psychotic Child

Much Rorschach research on case material focuses on the utility of a single scoring system, set of variables, or scale in isolation from other systems, scales, or perspectives. This approach fails to acknowledge the complexity of the Rorschach and to reflect the manner in which sophisticated clinicians select and synthesize various perspectives during the clinical inference and decision-making process. A case of a psychotic child is presented to illustrate the utility of a synthetic approach to the Rorschach. The strengths and weaknesses of various Rorschach perspectives in addressing specific diagnostic issues is explored through the case material.     

Toward a synthetic approach to the Rorschach: the case of a psychotic child.

Much Rorschach research on case material focuses on the utility of a single scoring system, set of variables, or scale in isolation from other systems, scales, or perspectives. This approach fails to acknowledge the complexity of the Rorschach and to reflect the manner in which sophisticated clinicians select and synthesize various perspectives during the clinical inference and decision-making process. A case of a psychotic child is presented to illustrate the utility of a synthetic approach to the Rorschach. The strengths and weaknesses of various Rorschach perspectives in addressing specific diagnostic issues is explored through the case material.     

Linguistic Assimilation of First-Generation Jewish South African Immigrants in Israel

We contribute to scholarship on the linguistic assimilation of migrants by focusing on the special case of Jewish South African migrants in Israel. English as an international language is widely used in the Israeli society, so immigrants whose mother tongue is English are a very interesting case because they might experience much less social pressure to improve their Hebrew skills than other immigrant groups who speak other languages. The study reveals that, although most first-generation immigrants participated in state-sponsored Hebrew classes and reported relatively moderate levels of language proficiency, it has not become their primary language. Hebrew proficiency proved conditional on age at arrival and rise sharply with tenure in the country and exposure to Hebrew (at origin or at destination). Hebrew proficiency is higher for migrants with more extensive contacts with Israelis and with higher education. Positive synergism emerged between language acquisition and reasons for migrating and attachment to the country.     

Correlated symptoms and simulated medical classification

Category learning theories can be separated into those that expect judgments to be sensitive to configural information and those that expect judgments to be based on a weighted, additive summation of information. Predictions of these two classes of models were investigated in a simulated medical diagnosis task. Subjects learned about a fictitious disease or about two diseases from hypothetical case studies in which some symptoms were correlated with each other and others were independent. Following this initial training, subjects were presented either with pairs of new cases and asked to judge which was more likely to have the disease or with a single case and asked which disease was present. Across four experiments, subjects proved to be sensitive to configural information. When choosing between pairs of new cases, subjects tended to choose the case that preserved the correlation over the case that broke the correlation, even when the case with correlated symptoms contained fewer typical symptoms. When judging which disease was present in a single case, subjects' diagnoses were determined primarily by the correlated symptoms. Implications of these findings to process models of categorization are discussed.     

Reaction time to letter name or letter case

Subjects were shown two letters from the set BDGbdg. In one condition, subjects were required to decide whether or not the letters had the same name. In the other condition, subjects decided whether or not the two letters were presented in the same case. Reaction times were always faster when the two letters on a given trial were physically identical. However, there was no difference in the speed of a name match or a case match when the two letters were not physically identical. Since subjects could have based a case match on the presence or absence of a single feature — a protruding vertical line — it was concluded that subjects are not able to selectively attend to a single visual feature in order to identify a letter. Rather, a subject analyzes several features in parallel in order to arrive at a simultaneous decision about a letter's name or case.     

Visual problem solving in the absence of lexical semantics: Evidence from dementia

A case of dissociation between visual and praxic skills and linguistic, referential, and semantic skills is described in a case of dementia. Testing revealed that her visual processing was intact and that she was capable of a wide range of visually based tasks. These included copying geometric figures and block designs; matching items on the basis of number, color, or relative size, matching upper and lower case letters, sequencing numerals, orienting pictures, coins, and letters appropriately, and solving problems based on the identification of geometric patterns or on the identification of logical sequences based on pattern alternation, number, and size increases. In contrast, she was completely incapable of matching pictures on the basis of their semantic or referential meaning; similarly she had lost all comprehension of language. It was argued that this case demonstrates the capacities of a visual system cut off from all symbolic and semantic processes. When examined with other case studies this case provides information about the nature of and interaction between modality-specific perceptual processing and semantic processing, and information about the various cognitive factors involved in visual gnosis. The CT scan indicated frontal atrophy and marked anterior temporal atrophy, a pattern that is consistent with Pick's disease. The case was discussed in terms of the correlation between the pattern of observed strengths and deficits and the neurological pattern of atrophy.     

Deservingness and emotions: Applying the structural model of deservingness to the analysis of affective reactions to outcomes

This chapter describes how a structural model of deservingness governed by a principle of balance may be applied to the analysis of emotions relating to deserved or undeserved outcomes of other or of self. In each case perceived deservingness/undeservingness is assumed to mediate both general emotional reactions such as pleasure and dissatisfaction and discrete emotions such as sympathy, resentment, disappointment, and guilt, depending on outcome (positive, negative), the evaluative structure of action/outcome relations, and whether outcomes relate to other or to self. Evidence from studies of reactions to success or failure, and reactions to penalties for offences, supports the analysis, as does earlier research on tall poppies or high achievers. The theoretical analysis is then related to the wider psychological literature on justice and emotions, especially to appraisal theory as exemplified in Weiner's approach. Also discussed are issues concerned with reciprocal relations between affect and deservingness, thoughtful versus automatic processing, new extensions of balance theory, and variables such as like/dislike relations, ingroup/outgroup relations, and perceived responsibility that would moderate perceived deservingness/undeservingness, thereby influencing the emotions that are assumed to be activated in each case.     

Against simulation: the argument from error

According to Simulation Theory, to understand what is going on in another person's mind, the observer uses his or her own mind as a model of the other mind. Recently, philosophers and cognitive neuroscientists have proposed that mirror neurones (which fire in response to both executing and observing a goal directed action) provide a plausible neural substrate for simulation, a mechanism for directly perceiving, or 'resonating' with, the contents of other minds. This article makes the case against Simulation Theory, using evidence from cognitive neuroscience, developmental psychology, and social psychology. In particular, the errors that adults and children make when reasoning about other minds are not consistent with the 'resonance' versions of Simulation Theory.     

On separability of and interference between tracking dimensions in dual-axis tracking

Time-shared tasks may conceivably be separable or integral. A case in which the question of separability seems quite relevant is dual-axis tracking. To test the interaction between tracking dimensions, we first studied whether they interfere with each other. Practiced subjects performed tracking on one or two axes, with or without feedback indicators and with or without a requirement to allocate resources unevenly between axes. They also performed with or without a concurrent binary classification of visually presented digits which were presented within a moving square that served as the target for tracking. Small deficits were found in the performance of both tracking and digit classification when performed together. However, the conditions of tracking did not have a discernible effect on either tracking or digit classification. Hence, the introduction of a second tracking axis probably does not have harmful consequences either on tracking itself or on any other task time-shared with tracking. Further studies were conducted to examine whether the absence of an effect of number of tracking axes is dues to their integrality. Ordinary position tracking was paired either with another similar task on the other axis or with a novel sort of tracking in which subjects had to continually match sizes of moving rectangles. Tasks were paired under both divided-attention and focused-attention instructions. No interference on position tracking was observed even when the types of task on the two axes differed, and no other evidence for integrality of the homogeneous task pairs was found.     

On Separability of and Interference Between Tracking Dimensions in Dual-Axis Tracking

Time-shared tasks may conceivably be separable or integral. A case in which the question of separability seems quite relevant is dual-axis tracking. To test the interaction between tracking dimensions, we first studied whether they interfere with each other. Practiced subjects performed tracking on one or two axes, with or without feedback indicators and with or without a requirement to allocate resources unevenly between axes. They also performed with or without a concurrent binary classification of visually presented digits which were presented within a moving square that served as the target for tracking. Small deficits were found in the performance of both tracking and digit classification when performed together. However, the conditions of tracking did not have a discernible effect on either tracking or digit classification. Hence, the introduction of a second tracking axis probably does not have harmful consequences either on tracking itself or on any other task time-shared with tracking.

Further studies were conducted to examine whether the absence of an effect of number of tracking axes is due to their integrality. Ordinary position tracking was paired either with another similar task on the other axis or with a novel sort of tracking in which subjects had to continually match sizes of moving rectangles. Tasks were paired under both divided-attention and focused-attention instructions. No interference on position tracking was observed even when the types of task on the two axes differed, and no other evidence for integrality of the homogeneous task pairs was found.     

A classmate in distress: schoolchildren as bystanders and their reasons for how they act

Research has shown that bystanders more often fail to or are slower to help a victim in emergency when there are other bystanders than when there are not. The study presented in this paper is a qualitative case study with a focus on students’ own reasons why they do not help a classmate in emergency when there are other children witnessing the emergency situation in the real-life classroom case studied. Grounded theory methods were used to analyse the data. The individual conversations with the students indicated a variety of definitions of the specific distress situation when they recalled and talked about the classroom incident. During the process of the analysis seven concepts of definitions associated with passive or non-intervention bystander behaviour were constructed and grounded in the empirical material: trivialisation, dissociation, embarrassment association, busy working priority, compliance with a competitive norm, audience modelling, and responsibility transfer. Relations between these concepts of definitions were also analysed. However, this study is a first step and a first report from an ongoing study about school children as helper and bystander.     

Case method and casuistry: The problem of bias

Case methods of reasoning are persuasive, but we need to address problems of bias in order to use them to reach morally justifiable conclusions. A bias is an unwarranted inclination or a special perspective that disposes us to mistaken or one-sided judgments. The potential for bias arises at each stage of a case method of reasoning including in describing, framing, selecting and comparing of cases and paradigms. A problem of bias occurs because to identify the relevant features for such purposes, we must use general views about what is relevant; but some of our general views are biased, both in the sense of being unwarranted inclinations and in the sense that they are one of many viable perspectives. This reliance upon general views to determine relevancy creates additional difficulties for defenders who maintain that case methods of moral reasoning are not only useful, but more basic, reliable or prior to other forms of moral reasoning. If we cannot identify the case's relevant features and issues independently of our general views or biases, we need further explanation about why a case method or casuistry should be viewed as prior to or more basic or reliable than other forms of moral reasoning. Problems of bias also arise for other methods of reasoning. In medical science, case reviews are regarded as an unreliable way to form generalizations, and methods such as clinical trials are used to address bias.     

Remorse in psychotic violent offenders: An overvalued idea?

Expressing remorse – or not – appears to influence criminal justice outcomes, but preliminary exploration of both judicial and psychological concepts suggests they lack clarity. We asked the following questions: does psychosis impair capacity for, or expression of, remorse for a homicide or other serious harm to others? Is failure to express remorse for an offence associated with recidivism? We conducted systematic reviews of empirical literature on remorse for serious violence while psychotic, and on relationships between remorse and reoffending regardless of mental state. No articles on remorse for homicide or other serious violence while psychotic were identified. There is weak evidence that lack of remorse is associated with reoffending generally, but nothing specific to psychosis. The literature is strong enough to support a case for research into valid measurement of remorse for offending, associations of such measures with recidivism, and whether a change in remorse can be effected – or matters. It is not strong enough to support reliance on perceptions of the presence or absence of remorse as a basis for judicial decisions.     

Direct-to-Consumer Personal Genomic Testing: A Case Study and Practical Recommendations for “Genomic Counseling”

Technological advances and information-seeking consumers have pushed forward the movement of direct-to-consumer (DTC) genetic testing. Just like with other types of testing, there are potential risks, benefits and limitations. A major limitation of DTC testing is the incomplete view it provides regarding lifetime risk for common, complex diseases, since most tests only analyze 1–2 single nucleotide polymorphisms (SNPs) and do not include evaluation of medical or family histories, which is necessary to risk assessment. Further, it is not currently well-established whether personal genomic testing results will lead toward improved health behaviors, adverse psychological effects or potential overuse of the health care system. To display these and other issues, we present an in-depth case study of an individual who ordered DTC genetic testing and subsequently sought genetic counseling. This case presents a unique learning experience for the field of genomic counseling, as the patient did not fit the typical assumptions regarding ‘early adopters’ of DTC testing. It also allowed the genetics health care providers involved in the case to identify gaps in current genetic counseling practice that need to be filled and approaches to employ for successful delivery of genomic counseling. Based on our experience, we developed practical recommendations for genomic counseling, which include novel approaches to case preparation, use of electronic tools during the counseling session, and focusing on education as the major component of the genomic counseling session, in order to provide patients with the knowledge necessary to independently interpret and understand large amounts of genomic testing information provided to them.     

Quantum Cooperation

In a theoretical simulation the cooperation of two insects is investigated who share a large number of maximally entangled EPR-pairs to correlate their probabilistic actions. Specifically, two distant butterflies must find each other. Each butterfly moves in a chaotic form of short flights, guided only by the weak scent emanating from the other butterfly. The flight directions result from classical random choices. Each such decision of an individual is followed by a read-out of an internal quantum measurement on a spin, the result of which decides whether the individual shall do a short flight or wait. These assumptions reflect the scarce environmental information and the small brains’ limited computational capacity. The quantum model is contrasted to two other cases: In the classical case the coherence between the spin pairs gets lost and the two butterflies act independently. In the super classical case the two butterflies read off their decisions of whether to fly or to wait from the same internal list so that they always take the same decision as if they were super correlated. The numerical simulation reveals that the quantum entangled butterflies find each other with a much shorter total flight path than in both classical models.     

What can a perception-memory expert tell a jury?

Witnesses to crimes and other forensically relevant events sometimes describe memories in which they express confidence that, on the basis of research in perception and memory, may be inappropriately high, given the circumstances of the case. The most effective way of conveying this observation and the reasons for it to a jury is via an expert in perception and memory. In any given case, a mosaic of factors having to do with perception and memory are relevant. I briefly sketch the most common of these factors and categorize them as to the degree to which they may be unambiguously and/or quantitatively applied to a specific case. I discuss one such factor, witness-object distance, in some detail, showing how an expert might describe distance effects on perception and providing examples from actual cases.     

Use of base rates and case cue information in making likelihood estimates

In five experiments, we investigated college students' use of base rate and case cue information in estimating likelihood. The participants reported that case cues were more important than base rates, except when the case cues were totally uninformative, and made more use of base rate information when the base rates were varied within subjects, rather than between subjects. Estimates were more Bayesian when base rate and case cue information was congruent, rather than contradictory. The nature of the "witness" in case cue information (animate or inanimate) did not affect the use of base rate and case cue information. Multiple trials with feedback led to more accurate estimates; however, this effect was not lasting. The results suggest that when base rate information is made salient by experience (multiple trials and within-subjects variation) or by other manipulations, base rate neglect is minimized.