A Legacy of Silence: Bioethics and the Culture of Pain

For over 20 years the medical literature has carefully documented the undertreatment of all types of pain by physicians. During this same period, as the field of bioethics came of age, the phenomenon of undertreated pain received almost no attention from the bioethics literature. This article takes bioethicists to task for failing to recognize the undertreatment of pain as a major ethical, and not merely a clinical, failing of the medical profession. The nature and extent of the problem of undertreated pain is examined, as well as possible reasons for its disregard by bioethicists. The factors contributing to undertreated pain in the clinical setting are considered, as well as the hazards posed by recent failures to address ethically questionable clinical practices. Finally, suggestions are offered for refocusing the attention of bioethicists to this significant problem.     

Deterrence, Opportunity, and Choice

Traditional studies of deterrence have focused on punishment with less regard for the rewards of both crime and noncrime. Influenced by work in economics and behavioral psychology, more recent studies have departed from tradition by incorporating rewards for crime. To this extent, they should be regarded as advances over the more traditional approaches. Notwithstanding these advances, variations in both the probability and magnitude of reward for noncrime have not been systematically included in these more recent theories of choice. In an attempt to determine whether opportunities for noncrime are either central or trivial to the criminal decision-making process, the present study fitted two alternative models to experimental data involving risk-taking: (a) the economic utility model employed by Piliavin, Gartner, Thornton, and Matsueda (1986) in their study of criminal choice; and (b) the satisfaction balance model developed by Gray and Tallman (1984). Results showed that while both models explained significant amounts of variation in the dependent variable, the Gray-Tallman model provided a substantially better fit of the data. Despite limitations inherent in experimental studies as, for example, limitations surrounding the issue of external validity, the findings strongly suggest that opportunities for noncrime are as important as rewards and costs for crime in the process by which criminal decisions are made.     

A study of neuropsychological impairment among school-indentified learning-disabled students

This investigation examined the proportion of school-identified learning-disabled (LD) students who scored in the impaired range on the Halstead Reitan Neuropsychological Battery for Children (HNBC) over a 20-year period. A difference was noted in findings for periods before and after the passage of federal legislation (Public Law 94-142); specifically, the proportion of LD students who scored in the impaired range on neuropsychological tests was significantly higher prior to than after this law. A similar pattern of impaired performance across the different tests was noted before and after the legislation. The implications of these results for theorists and practitioners are discussed.     

Evidence that blocking is due to associative deficit: Blocking history affects the degree of subsequent associative competition

Rats were trained on an appetitive discriminated operant procedure according to a blocking design, in which training with a compound stimulus (A + B) was given with or without prior training with A alone. Stimulus B was then presented in compound with a new stimulus (B + C compound). The ability of Stimulus B to block acquisition of control by Stimulus C was decreased by B having itself been blocked by A during the prior training. The results imply that the mechanism of blocking during the initial blocking procedure was a reduced association between Stimulus B and the reinforcer, and not a performance deficit such as that postulated by comparator models of learning.     

The changing pattern of perceptual analytic strategies and response selection with practice in a two-choice reaction time task

In the experiment reported here the primary hypothesis proposed, which was supported by the data, was that subjects performing a two-choice self-paced serial RT task would learn to change their strategy of perceptual analysis of signals presented to them as they became progressively more practised. Early in practice each signal is identified as a particular state of the display and an appropriate response is then made. Well practised subjects, however, select their responses by reference to the change or constancy between successive displays. This strategy implies that the assumptions made by the generally accepted simple S-R connectionist model of two-choice serial RT may be quite misleading, since the choice of any particular response must be determined not only by the display state but also by what the previous response had been.     

Alphanumeric category effects: Evidence against the sufficiency of a localization explanation

The Hatfield Polytechnic, Hatfield, Herts ALIO 9AB, England The experiment utilized a serial choice reaction time (RT) paradigm in which only one alphanumeric stimulus was presented per trial, and the target set consisted of a single identified item. The categorical relationship between the target and nontarget items was varied as a property of blocks of trials. Target and nontarget RTs were smaller when the specified target item (e.g., the number 6) was categorically distinct from the nontargets (e.g., letters) than when it was from the same category (e.g., digits). The processing of catch-trial stimuli (items from the alternate category to the nontargets) and homographie category-ambiguous items was inhibited only in the former, between-category, condition. The results are contrasted with those obtained in visual search tasks. They suggest that a “locational-cue” explanation of alphanumeric category effects is inadequate.     

An instrumented method for assessment and remediation of stuttering: A single-subject case study

A single-subject experimental design was used to investigate the feasibility of applying non-invasive laboratory instrumentation for examining speech physiology to assessment and biofeedback-based remediation of stuttering. Physiologic assessment facilitated the development of behavioral goals directed at changing respiratory and phonatory behaviors for this subject. Visual biofeedback therapy produced reduction in respiratory discontinuities and increased phonatory continuity, concomitant with reduced perceivable molar dysfluency. Methods used in this case illustrate a variety of options and problems related to clinical use of instrumentation. Results suggest that signals which represent respiratory, phonatory, and articulatory physiologic events may be clinically practical for evaluating and altering perceivable dysfluency.     

Short-term retention of response outcome as a determinant of serial reversal learning

The correlation between short-term retention of the outcome of the preceding response and overall learning proficiency was investigated for serial reversal learning. Pigeons were trained to asymptote on a serial reversal problem and then were presented a percentage reinforcement schedule where only some correct trials were rewarded. Nonrewarded correct trials were treated exactly as incorrect trials. The difference in error probability following the two types of correct trials was then used as a measure of short-term retention. When intertrial intervals (ITI) were short (6 sec), substantial differences occurred. When the ITI's were increased, the difference in accuracy declined regularly to no difference at an ITI of 60 sec. This demonstration of a short-term retention gradient, coupled with the finding that overall reversal learning was much better with the shorter ITI's, suggests that a primary mechanism of improvement in serial reversal learning is the acquisition of a conditional discrimination based on the outcome of the preceding response.     

忘我问卷的编制及其信效度检验

通过文献分析和访谈,阐明忘我的概念与结构,并编制了忘我问卷。采用现场发放和网络问卷的方式对607名被试进行忘我问卷的初测。接着,对357名被试施测正式问卷,进行信度、效度检验。探索性因素分析显示,忘我问卷由3个因子构成; 验证性因素分析表明该量表拟合良好(RMSEA=0.07,NFI=0.95,CFI=0.95,GFI=0.92,AGFI=0.89)。问卷总体一致性系数为0.89,3个因子的内部一致性系数在0.84-0.88之间。问卷总体得分与效标问卷特质焦虑得分呈负相关(-0.51),与安适幸福感、正念觉知的得分呈正相关(分别为0.36、0.31)。忘我问卷具有良好的信度和效度,可在后续的相关研究和实践中作为测量问卷或评估工具使用。