Thinking critically in medicine and its ethics: relating applied science and applied ethics

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision-making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision-making.     

The relationship of sex-role orientation to heterosexuals' attitudes toward homosexuals

It has been proposed that heterosexuals' negative attitudes toward homosexuals derives in part from perceptions that homosexuality threatens society's traditional sex role structure. This explanation suggests that persons who are more traditional in their sex role characteristics will hold more negative attitudes toward homosexuals. This hypothesis was tested using three aspects of sex role — sex role beliefs, sex role self-concept, and sex role behavior pattern — and four measures of attitudes toward homosexuals — attitudes toward male homosexuals, attitudes toward female homosexuals, personal responses to homosexual advances and feelings, and attitudes toward the social role of homosexuals. In general, for both female and male respondents, less negative attitudes were related to being older, being less conservative, and holding less traditional sex role beliefs. In addition, for women, less negativie attitudes were also associated with a more stereotypically masculine behavior pattern. The conceptual and methodological implications of these findings are discussed.I would like to thank Michael R. Stevenson for his helpful comments on an earlier version of this article.     

Social support: Its structure and impact on marital disruption

Availability of social support has been hypothesized to play a role in influencing adjustment to marital disruption either directly or by moderating the debilitating effects of stress. Yet previous research has not adequately conceptualized or measured the nature and availability of social support. In an effort to learn more about the structure and impact of social support as it relates to marital disruption, 50 newly separated men and women were interviewed at 2 months and again at 8 months after their separations. The structure of social support was found to include (a) several important sources of support, including family, friends, and the larger community; (b) an index of social activity; and (c) a sense of satisfaction with present marital status. Although the stress associated with separation was positively related to poorer adjustment, certain aspects of social support were found to moderate this relationship. This report is based, in part, on work supported by National Institute of Mental Health grant No. MH 26373 (Preventive Intervention for Newly Separated Persons), Bernard L. Bloom and William F. Hodges, co-principal investigators. We are pleased to acknowledge this support.     

Pastoral counseling with alcoholics and their families

The pastor is often in contact with the alcoholic and his or her family. Providing help to alcoholics and their families is a spiritual, humanistic, and therapeutic challenge. Recent developments have favored a family systems orientation to working with alcoholic families. This orientation acknowledges the family as contributor to maintaining alcoholic behavior and includes the family in treatment. Specific family systems concepts are discussed and how they relate to the dysfunctional unit which houses an alcoholic. Implications for pastors and specific role definitions are explored. Krebs' therapeutic model is expanded to: 1) evaluate, 2) support, 3) refer, and 4) support, as appropriate for the pastor working with alcoholics and their families.     

A case of cortical deafness: Clinical and electrophysiological data

A patient suffering from a primary myocardiopathy is suddenly no longer able to recognize speech and environmental sounds, in spite of good peripheral hearing; he remains able to speak, read, and write. The C.T. scan shows lesions involving both supratemporal planes. The cortical sensory deficit documented by the absence of late acoustic evoked potentials leads to a diagnosis of cortical deafness rather than of auditory agnosia.     

Book reviews

BODEN, MARGARET A. Artificial Intelligence and Natural Man. Hassocks : Harvester Press Limited, and New York: Basic Books Inc., 1977. Pp. ix+537. £613.50 hardback; £64.95 paperback. ISBN 0 85527 435 2.

ESTES, W. K. (Ed.). Handbook of Learning and Cognitive Processes. Vol. 6. Linguistics. Functions in Cognitive Theory. Hillsdale, N.J. : Erlbaum Associates. 1979. Pp. 331. £12.70. ISBN o 470 26311 3.

O'KEEFE, J. and NADEL, L. The Hippocampus as a Cognitive Map. London: Oxford University Press. 1978. Pp. 543. £25.00. ISBN 0 12 524150 X.

FITZSIMONS, J. T. The Physiology of Thirst and Sodium Appetite. Cambridge: Cambridge University Press. 1979. Pp. 572. £32.50. ISBN 0 521 22292 3.

MURRAY, F. B. and PIKULSKI, J. J. (Eds). The Acquisition of Reading. Baltimore: University Park Press. 1978. Pp. 178. £8.95. ISBN 0 8391 1281 5.

NEWTON, M. J., THOMAS, M. E. and RICHARDS, I. L. Readings in Dyslexia. Wisbech: Benrose Ltd. 1979. Pp. 203. £4.50. ISBN 09 0511 4124.

SENDERS, J. W., FISHER, D. F. and MONTY, R. A. (Eds). Eye Movements and Higher Psychological Processes. Hillsdale, N. J. : Erlbaum. 1978. Pp. 394. £19.95. ISBN 0 470 26489 6.

GRUBER, H. E. and VONECHE, J. J. (Eds). The Essential Piaget. London: Routledge & Kegan Paul. 1977. Pp. 880. £12.95. ISBN 07100 87780.

SIEGEL, L. S. and BRAINERD, C. J. (Eds). Alternatives to Piaget. New York: Academic Press. 1978. Pp. 262. £11.70. ISBN 12 641950 7.

BRANSFORD, J. D. Human Cognition: Learning, Understanding and Remembering. Belmont, California: Wadsworth. 1979. Pp. xii+300. £11.85. ISBN 0 534 00699 X.

VON FIEANDT, K. and MOUSTGAARD, I. K. The Perceptual World. London: Academic Press. 1977. Pp. 680. £32.00. ISBN 0 12 725050 6.

BURTON, A. and RADFORD, J. (Ed.). Thinking in Perspective: Critical Essays in the Study of Thought Processes. London: Methuen. 1978. Pp. xxii+232. £3.95. ISBN 0 416 85840 6.

MAYER, R. E. Thinking and Problem Solving: An Introduction to Human Cognition and Leavning. Glenview, Illinois: Scott, Foresman and Company. 1977. Pp. viii+214. £4.95. ISBN 0 673 15055 0.

BATES, E. Language and Context: The Acquisition of Pragmatics. New York: Academic Press. 1976. Pp. 375. £14.50. ISBN 0 12 081550 8.

MILGHAM, N. W., KRAMES, L. and ALLOWAY, T. M. Food Aversion Learning. New York: Plenum Press. 1977. Pp. 263. £27. ISBN 0 306 31040 6.

O'CONNOR, N. and HERMELIN, B. Seeing and Hearing and Space and Time. London: Academic. 1978. Pp. 157+viii. £6.80. ISBN 0 12 524150 X.