Can applied ethics be effective in health care and should it strive to be?

Drawing upon his work in medical centers, Caplan explores the question of how well ethicists function in hospitals. He asks if their use of the "engineering model" of applied ethics, which emphasizes conceptual clarification, mastery of ethical theory, and impartiality, has made any difference in the way medicine is practiced. Noting that ethicists have been more effective in influencing heatlh policy at the national than at the institutional level, Caplan concludes that they have been less successful in teaching medical ethics, working with health personnel, and helping to formulate hospital policies. He attributes their difficulties primarily to the inadequacies of the engineering model of applied ethics for solving problems in a clinical setting. Caplan cautions ethicists to be aware both of the limitations of the engineering model and of the motives of health personnel in asking for help which may have little to do with resolving moral dilemmas.     

Dissociations and associations of performance in syntactic comprehension in aphasia and their implications for the nature of aphasic deficits

Sixty-one pwa were tested on syntactic comprehension in three tasks: sentence-picture matching, sentence-picture matching with auditory moving window presentation, and object manipulation. There were significant correlations of performances on sentences across tasks. First factors on which all sentence types loaded in unrotated factor analyses accounted for most of the variance in each task. Dissociations in performance between sentence types that differed minimally in their syntactic structures were not consistent across tasks. These results replicate previous results with smaller samples and provide important validation of basic aspects of aphasic performance in this area of language processing. They point to the role of a reduction in processing resources and of the interaction of task demands and parsing and interpretive abilities in the genesis of patient performance.     

The use of prisoners as sources of organs--an ethically dubious practice

The movement to try to close the ever-widening gap between demand and supply of organs has recently arrived at the prison gate. While there is enthusiasm for using executed prisoners as sources of organs, there are both practical barriers and moral concerns that make it unlikely that proposals to use prisoners will or should gain traction. Prisoners are generally not healthy enough to be a safe source of organs, execution makes the procurement of viable organs difficult, and organ donation post-execution ties the medical profession too closely to the act of execution.     

Effects of concurrent arithmetical and syntactic complexity on self-paced reaction times and eye fixations

Two dual-task experiments (replications of Experiments 1 and 2 in Fedorenko, Gibson, & Rohde, Journal of Memory and Language, 56, 246–269 2007) were conducted to determine whether syntactic and arithmetical operations share working memory resources. Subjects read object- or subject-extracted relative clause sentences phrase by phrase in a self-paced task while simultaneously adding or subtracting numbers. Experiment 2 measured eye fixations as well as self-paced reaction times. In both experiments, there were main effects of syntax and of mathematical operation on self-paced reading times, but no interaction of the two. In the Experiment 2 eye-tracking results, there were main effects of syntax on first-pass reading time and total reading time and an interaction between syntax and math in total reading time on the noun phrase within the relative clause. The findings point to differences in the ways individuals process sentences under these dual-task conditions, as compared with viewing sentences during “normal” reading conditions, and do not support the view that arithmetical and syntactic integration operations share a working memory system.     

Generality of a congruity effect in judgements of relative order

The judgement of relative order (JOR) procedure is used to investigate serial-order memory. Measuring response times, the wording of the instructions (whether the earlier or the later item was designated as the target) reversed the direction of search in subspan lists (Chan, Ross, Earle, & Caplan Psychonomic Bulletin & Review, 16(5), 945–951, 2009). If a similar congruity effect applied to above-span lists and, furthermore, with error rate as the measure, this could suggest how to model order memory across scales. Participants performed JORs on lists of nouns (Experiment 1: list lengths = 4, 6, 8, 10) or consonants (Experiment 2: list lengths = 4, 8). In addition to the usual distance, primacy, and recency effects, instructions interacted with serial position of the later probe in both experiments, not only in response time, but also in error rate, suggesting that availability, not just accessibility, is affected by instructions. The congruity effect challenges current memory models. We fitted Hacker’s (Journal of Experimental Psychology: Human Learning and Memory, 6(6), 651–675, 1980) self-terminating search model to our data and found that a switch in search direction could explain the congruity effect for short lists, but not longer lists. This suggests that JORs may need to be understood via direct-access models, adapted to produce a congruity effect, or a mix of mechanisms.     

Facing Ourselves

At the time of this writing, a widely publicized, waived-consent trial is underway. Sponsored by Northfield Laboratories, Inc. (Evanston, IL) the trial is intended to evaluate the emergency use of PolyHeme^®, an oxygen-carrying resuscitative fluid that might prevent deaths from uncontrolled bleeding. The protocol allows patients in hemorrhagic shock to be randomized between PolyHeme^® and saline in the field and, still without consent, randomized between PolyHeme^® and blood after arrival at an emergency department. The Federal regulations that govern the waiver of consent restrict its applicability to circumstances where proven, satisfactory treatments are unavailable. Blood—the standard treatment for hemorrhagic shock—is not available in ambulances but is available in hospitals. The authors argue that the in-hospital stage of the study fails to meet ethical and regulatory standards.     

Comprehension of sentences with stylistic inversion by French aphasic patients

Three French-speaking agrammatic aphasics and three French-speaking Conduction aphasics were tested for comprehension of Active, Passive, Cleft-Subject, Cleft-Object, and Cleft-Object sentences with Stylistic Inversion using an object manipulation test. The agrammatic patients consistently reversed thematic roles in the latter sentence type, and the Conduction aphasics performed at chance. The results are discussed in relationship to existing models of aphasic impairments in assigning syntactic structures and using them to determine thematic roles in sentences. We conclude that the results for the agrammatic patients demonstrate the importance of compensatory mechanisms underlying aphasic comprehension and the results in the Conduction aphasics indicate the importance of working memory deficits in determining such deficits. The results are also relevant to models of normal syntactic structure.     

How long does it take to find a cause? An online investigation of implicit causality in sentence production

Some interpersonal verbs show an implicit causality bias in favour of their subject or their object. Such a bias is generally seen in offline continuation tasks where participants are required to finish a fragment containing the verb (e.g., Peter annoyed Jane because ...). The implicit causality bias has been ascribed to the subject's focusing on the initiator of the event denoted by the verb. According to this "focusing theory" the implicit cause has a higher level of activation, at least after the connective "because" has been read. Recently, the focusing theory has been criticized by researchers who used a probe recognition or reading-time methodology. However no clear alternative has been proposed to explain the offline continuation data. In this paper, we report three experiments using an online continuation task, which showed that subjects took more time to imagine an ending when the fragment to be completed contained an anaphor that was incongruent with the verbal bias (e.g., Peter annoyed Jane because she ...). This result suggests that the offline continuation data could reflect the cognitive effort associated with finding a predicate with an agent incongruent with the implicit causality bias of a verb. In the discussion, we suggest that this effort could be related to the number of constraints that an incongruent clause must satisfy to be consistent with the causal structure of the discourse.