Pellegrino,MacIntyre, and the internal morality of clinical medicine

Theoretical Medicine and Bioethics - There has been significant debate about whether the moral norms of medical practice arise from some feature or set of features internal to the discipline of...     

A constructivist approach to supervision: Some preliminary thoughts

Supervision from a constructivist point of view is explored. Supervision processes with three different therapists are presented to exemplify this constructivist stance. In this approach the relation between supervisor and therapist is seen as similar to that between therapist and client. Thus, a “therapist-centered” approach for supervision is outlined, the main points of which are as follows: The main focus of a constructivist supervision is the therapist, supervision should be centered on the therapist's complaint, supervision should generate a learning context, the therapist and supervisor have different types of expertise, the supervising context should generate alternative views about the problem, and the supervision context should be reflexive.     

The relationship between medicine's internal morality and religion.

In the face of managed care and market economies infringing on the practice of medicine, reducing its autonomy and determining the moral guidelines for medical practice, many physicians are calling out for a return to what is perceived as a traditional medical ethic. Many religiously motivated critics of certain modern developments in medicine have made similar appeals. These calls are best understood as an attempt to define medicine as a practice that is necessarily ethical in nature, a practice the moral basis of which is internal to that practice. This article examines and assesses this definition of medicine in reference to Aristotle's division of human undertakings into three distinct categories: theory, poieisis (i.e., production), and praxis. It is concluded that medicine can be understood as a praxis (as opposed to a theory or production, both of which are morally neutral), because the practice of medicine, and all of its constitutive acts, can only be explained and assessed in reference to health, which is itself a final good and hence of moral value. Such an understanding would immunize medicine against usurpation by the free market. However, by the same token it would also dissociate medicine from all other moralities external to it, including those grounded in faith and religion.     

The neural basis of cognitive development: a constructivist manifesto

How do minds emerge from developing brains? According to "neural constructivism," the representational features of cortex are built from the dynamic interaction between neural growth mechanisms and environmentally derived neural activity. Contrary to popular selectionist models that emphasize regressive mechanisms, the neurobiological evidence suggests that this growth is a progressive increase in the representational properties of cortex. The interaction between the environment and neural growth results in a flexible type of learning: "constructive learning" minimizes the need for prespecification in accordance with recent neurobiological evidence that the developing cerebral cortex is largely free of domain-specific structure. Instead, the representational properties of cortex are built by the nature of the problem domain confronting it. This uniquely powerful and general learning strategy undermines the central assumption of classical learnability theory, that the learning properties of a system can be deduced from a fixed computational architecture. Neural constructivism suggests that the evolutionary emergence of neocortex in mammals is a progression toward more flexible representational structures, in contrast to the popular view of cortical evolution as an increase in innate, specialized circuits. Human cortical postnatal development is also more extensive and protracted than generally supposed, suggesting that cortex has evolved so as to maximize the capacity of environmental structure to shape its structure and function through constructive learning.     

Toward a more pragmatic approach to morality: a critical evaluation of Kohlberg's model

In this article, the authors evaluate L. Kohlberg's (1984) cognitive- developmental approach to morality, find it wanting, and introduce a more pragmatic approach. They review research designed to evaluate Kohlberg's model, describe how they revised the model to accommodate discrepant findings, and explain why they concluded that it is poorly equipped to account for the ways in which people make moral decisions in their everyday lives. The authors outline in 11 propositions a framework for a new approach that is more attentive to the purposes that people use morality to achieve. People make moral judgments and engage in moral behaviors to induce themselves and others to uphold systems of cooperative exchange that help them achieve their goals and advance their interests.     

The constructivist brain

How do the representations underlying cognitive skills emerge? It is becoming increasingly apparent that answering this question requires integration of neural, cognitive and computational perspectives. Results from this integrative approach resonate with Piaget's central constructivist themes, thus converging on a 'neural constructivist' approach to development, which itself rests on two major research developments. First, accumulating neural evidence for developmental plasticity makes nativist proposals increasingly untenable. Instead, the evidence suggests that cortical development involves the progressive elaboration of neural circuits in which experience-dependent neural growth mechanisms act alongside intrinsic developmental processes to construct the representations underlying mature skills. Second, new research involving constructivist neural networks is elucidating the dynamic interaction between environmentally derived neural activity and developmental mechanisms. Recent neurodevelopmental studies further accord with Piaget's themes, supporting the view of human cortical development as a protracted period of hierarchical-representation construction. Combining constructive growth algorithms with the hierarchical construction of cortical regions suggests that cortical development involves a cascade of increasingly complex representations. Thus, protracted cortical development, while occurring at the expense of increased vulnerability and parental investment, appears to be a powerful and flexible strategy for constructing the representations underlying cognition.     

A dynamic constructivist approach to culture: Lessons learned from personality psychology

The comparison of differences between cultural groups has been a dominant approach in cross-cultural psychology. This approach assumes behavioral influence of a relatively static, monolithic culture on members in a cultural group. This paper, however, calls for a dynamic constructivist approach to the study of culture. We begin by drawing a parallel between past research in cultural and personality psychology. We then highlight recent findings that attest to the value of a social-cognitive model of culture. Specifically, we discuss studies that have demonstrated how well established cross-cultural differences may appear or disappear depending on the availability, accessibility, and applicability of cultural theories. We present evidence that situational characteristics may render cultural theories more or less accessible and applicable, and propose a culture × situation interaction model for understanding inter- and intra-cultural variations.     

Limits of morality: A sociological approach to higher moral stages

Grounded in the wider framework of Kohlberg's (1984) stage theory of moral development and Habermas' (1981; Habermas &; Luhmann, 1971) theory of discourse, this article addresses the question: Is a moral stage 6 society possible? Toward answering this question, a sociological approach to moral stage 6 is employed that complements the usual psychological approach to moral development. The article posits that a moral stage 6 society is impossible. Therefore, lower-stage institutions cannot be abolished; they have to be controlled and supervised. This calls for a new and structurally different type of discourse, the metadiscourse. The article postulates that such metadiscourse has the property of moral stage 7 according to the general stage model (Commons &; Richards, 1984a, 1984b). Finally, several strategies for controlling lower-stage institutions are considered, with bureaucracy serving as example of a lower-stage institution.     

Walden two: The morality of anarchy

The utopian label is often pinned on calls for comprehensive change as a means of dismissing them from serious consideration.... [S]ocial orders come and go, and those who indulge in utopian thinking may be more prepared for... the inevitability of widespread societal transformation.... Keeping utopia in mind can prevent our settling for minor reforms when more significant change might be possible. (Fox, 1985, p. 55)When... I called myself a benign anarchist... someone said that that was not like the dictatorship of Walden Two. But Walden Two was anarchistic.... The functions delegated to [authority figures] in the world at large were performed by the people themselves through face-to-face commendation and censure. (Skinner, 1983, p. 426, emphasis his)The issue for anarchists is not whether there should be structure or order, but what kind there should be and what its sources ought to be. The individual or group which has sufficient liberty to be self-regulating will have the highest degree of order; the imposition of order from above and outside induces resentment and rebellion where it does not encourage childlike dependence and impotence, and so becomes a force for disorder. (Barclay, 1982, p. 17).     

The possibility of morality

Despite much discussion over the existence of moral facts, metaethicists have largely ignored the related question of their possibility. This paper addresses the issue from the moral error theorist’s perspective, and shows how the arguments that error theorists have produced against the existence of moral facts at this world, if sound, also show that moral facts are impossible, at least at worlds non-morally identical to our own and, on some versions of the error theory, at any world. So error theorists’ arguments warrant a stronger conclusion than has previously been noticed. This may appear to make them vulnerable to counterarguments that take the possibility of moral facts as a premise. However, I show that any such arguments would be question-begging.     

Multicultural minds. A dynamic constructivist approach to culture and cognition

The authors present a new approach to culture and cognition, which focuses on the dynamics through which specific pieces of cultural knowledge (implicit theories) become operative in guiding the construction of meaning from a stimulus. Whether a construct comes to the fore in a perceiver's mind depends on the extent to which the construct is highly accessible (because of recent exposure). In a series of cognitive priming experiments, the authors simulated the experience of bicultural individuals (people who have internalized two cultures) of switching between different cultural frames in response to culturally laden symbols. The authors discuss how this dynamic, constructivist approach illuminates (a) when cultural constructs are potent drivers of behavior and (b) how bicultural individuals may control the cognitive effects of culture.     

The morality of harm

In this article, we discuss the range of concerns people weigh when evaluating the acceptability of harmful actions and propose a new perspective on the relationship between harm and morality. With this aim, we examine Kelly, Stich, Haley, Eng and Fessler’s [Kelly, D., Stich, S., Haley, K., Eng, S., & Fessler, D. (2007). Harm, affect, and the moral/conventional distinction. Mind and Language, 22, 117-131] recent claim that, contrary to Turiel and associates, people do not judge harm to be authority independent and general in scope in the context of complex harmful scenarios (e.g., prisoner interrogation, military training). In a modified replication of their study, we examined participants’ judgments of harmful actions in these contexts by taking into account their explanations for their judgments. We claim that both in terms of participants’ judgments and rationales, the results largely confirm our hypothesis that actions involving harm andinjustice or rights violation are judged to be authority independent and general in scope, which is a modification of Turiel’s traditional hypothesis.