Toward a Pellegrino-inspired theory of value in health care

Contemporary medical practice and health policy are increasingly animated by the concept of providing high value care. Nevertheless, there can be disagreements about how value is defined and from whose perspective. Individual patients suffering from terminal cancer, for example, may have a different perception of the value of an expensive chemotherapy when compared to health policymakers, insurers, or others responsible for the financial solvency of health care organizations. Thus it seems reasonable to ask what is meant by “value” in high value care. In light of Edmund Pellegrino’s significant contributions to the philosophy of medicine, medical humanities, and bioethics, it seems equally reasonable to examine how he might answer it. This paper describes a Pellegrino-inspired theory of (health care) value that is instrumental, agent relative, and pluralistic. It then compares and contrasts this to the contemporary view and argues that only when individual patients incorporate concern for societal-level value into their conceptions of the highest good can the Pellegrino-inspired and contemporary views of value be reconciled.

     

Toward a theory of verbal behavior

This paper is a reply to an accompanying set of six commentaries by Sidman; Hayes and Barnes; Schusterman, Kastak, and Reichmuth; Tonneau and Sokolowski; Lowenkron; and Moerk. Those commentaries were prompted by our article “On the Origins of Naming and Other Symbolic Behavior” (1996), which was, in turn, followed by 26 commentaries and a reply. In the course of the present reply, we further develop the naming account to embrace more complex verbal relations such as same, different, more, and less. We also examine what we see as the lack of conceptual coherence in equivalence theories, including relational frame theory, and the disparities between these accounts and the findings from empirical research.     

Toward a quantitative theory of punishment

In two experiments, pigeons' key pecking for food on concurrent variable-interval schedules was punished with electric shock according to concurrent variable-interval punishment schedules. With unequal frequencies of food but equal rates of punishment associated with the two keys and at several intensities of shock, the response and time allocation of all six pigeons overmatched the obtained relative frequency of food. The overmatching was predicted by a subtractive model of the interaction between punishment and positive reinforcement but not by two alternative models. Increases in the k and r_e parameters of the generalized matching law could not account for the observed shifts in preference.     

Toward a perceptual theory of transparency

Theories of perceptual transparency have typically been developed within the context of a physical model that generates the percept of transparency (F. Metelli's episcotister model, 1974b). Here 2 fundamental questions are investigated: (a) When does the visual system initiate the percept of one surface seen through another? (b) How does it assign surface properties to a transparent layer? Results reveal systematic deviations from the predictions of Metelli's model, both for initiating image decomposition into multiple surfaces and for assigning surface attributes. Specifically, results demonstrate that the visual system uses Michelson contrast as a critical image variable to initiate percepts of transparency and to assign transmittance to transparent surfaces. Findings are discussed in relation to previous theories of transparency, lightness, brightness, and contrast-contrast.     

Toward a dialectic theory of concepts

The article spells out some guidelines for a dialectic theory of concepts. Concept formation is treated in terms of polemic and polar reference. The main thesis is that opposite references structure concepts by way of advocacy. On polar dimensions of comparison, (e. g., light versus dark), people select and advocate objects of comparison in agreement with the context of comparison (i.e., what is light depends on what is dark, and vice versa). In principle, any concept is subject to polemics because polarity enables opposite comparisons, (e.g., an object as dark and light with reference to lighter and darker objects, respectively). When opposite comparisons apply to the same object, reference becomes anomalous which will motivate conceptual change, (e.g., twilight accounts for a reference in between). Consequently, meaning is not secured by general rules but concepts presuppose advocated references; concepts are intentional constructs. The dialectic theory is illustrated by a case study of the environmental discourse on forest management. Conflicting references fuelled by industrial and environmental values demonstrate how opposite comparisons motivate revisions.Dialectic is a convenient technical name for the kind of thinking which takes place when human beings enter into dispute, or when they carry on in reflection the polemical consideration of some theory or idea. Adler, 1927, p. V     

Toward a feminist theory of disability

We need a feminist theory of disability, both because 16 percent of women are disabled, and because the oppression of disabled people is closely linked to the cultural oppression of the body. Disability is not a biological given; like gender, it is socially constructed from biological reality. Our culture idealizes the body and demands that we control it. Thus, although most people will be disabled at some time in their lives, the disabled are made "the other," who symbolize failure of control and the threat of pain, limitation, dependency, and death. If disabled people and their knowledge were fully integrated into society, everyone's relation to her/his real body would be liberated.