The value of emotionally expressive visual art in medical education

This paper approaches the topic of visual art in medical education from a philosophical perspective, drawing on arguments from epistemology, philosophy of science, aesthetics, and contemporary ethical theory. Several medical ethicists have noted that the traditional clinical paradigm may increase the epistemic and emotional distance between patient and physician in part by focusing on the physical body and medical technology. Some of these same writers recommend a new approach to patients based on empathy and increased attention to suffering. After reviewing these arguments, supporting examples, and recommendations, I explain how visual art that expresses or symbolizes the emotional response to illness could be used to introduce an additional paradigm into medical education. This would be a paradigm based on empathetic attention to patients' emotional experiences in illness. My own argument is that this additional way of perceiving and relating to patients may reduce the distance between patient and physician and may allow physicians to better meet the ideal of treating the patient as a person.     

Evidence of deontic reasoning in 3- and 4-year-old children

Deontic reasoning is reasoning about what one may, ought, or ought not do in a given set of circumstances. Virtually all of our social institutions and child-rearing practices presume the capacity to reason about deontic concepts, such as what is permitted, obligated, or prohibited. Despite this, very little is known about the development of deontic reasoning. Two experiments were conducted that contrasted children’s reasoning performance on deontic and indicative reasoning tasks (i.e., the reduced array selection version of the Wason card selection task). Like adults, children as young as 3 years of age were found to adopt a violation-detecting strategy more often when reasoning about the deontic case than when reasoning about the indicative case. These results indicate that violation detection emerges as an effective deontic reasoning very early in human development.     

The cognitive basis of the Uznadze illusion

The present study examines the role of Luria's dimensions of simultaneous and successive synthesis in fixation and extinction of the Uznadze haptic illusion. The subjects were 53 grade 10 high school students. Extinction of the illusion correlated significantly with three measures which, according to Luria's criteria, are indicative of simultaneous synthesis. Correlations between extinction and measures of successive synthesis failed to reach significance. Fixation of the illusion was unrelated to measures of either simultaneous or successive synthesis. An exploratory factor analysis of the data suggested the hypothesis that extinction of the illusion is greatly facilitated when the successive presentations of the spheres are integrated into a simultaneous or contemporaneous pattern.     

Biological preparedness and evolutionary explanation

It is commonly supposed that evolutionary explanations of cognitive phenomena involve the assumption that the capacities to be explained are both innate and modular. This is understandable: independent selection of a trait requires that it be both heritable and largely decoupled from other 'nearby' traits. Cognitive capacities realized as innate modules would certainly satisfy these contraints. A viable evolutionary cognitive psychology, however, requires neither extreme nativism nor modularity, though it is consistent with both. In this paper, we seek to show that rather weak assumptions about innateness and modularity are consistent with evolutionary explanations of cognitive capacities. Evolutionary pressures can affect the degree to which the development of a capacity is canalized by biasing acquisition/learning in ways that favor development of concepts and capacities that proved adaptive to an organism's ancestors.     

The Validity of Subjective Wellbeing Measurement for Children: Evidence Using the Personal Wellbeing Index—School Children

Research is scarce concerning the validity of subjective wellbeing measures for children aged 12 years and less. There are even fewer subjective wellbeing data for children with complex backgrounds and personal circumstances and those experiencing socio-demographic disadvantage. This study compares the psychometric properties of the child and adult versions of the Personal Wellbeing Index. Participants were 1761 ‘at-risk’ children aged 10–12 years, and 2000 geographically representative Australian adults. While there was sufficient fit with a one-factor structure, the reliability estimates were lower in the child sample and the incidence of response bias was significantly higher. Collectively, these findings suggest caution in the use of subjective wellbeing measures with children.     

Are perceptions of fairness relationship-specific? The case of noblesse oblige

Research in experimental economics suggests that decision making in strategic interactions is often guided by a concern for fairness. However, experimental economics studies routinely place participants of equal social status and no prior social history in anonymous interactions, a context that would tend to foster the adoption of an egalitarian fairness norm. Extensive research in anthropology (Fiske, 1991) and psychology (Bugental, 2000) suggests that social norms, including fairness norms, are relationship-specific, raising doubts about whether the concern for egalitarian fairness observed in the experimental economics literature would generalize to a wider range of social relations. In this paper we focus on an alternative social norm characteristic of hierarchical relationships: noblesse oblige—the obligation of high-ranking individuals to act honorably and beneficently towards subordinates. In a series of five experiments, we show that the norm of noblesse oblige predicts tolerance of free riding better than individual self-interest does.     

Preventing substance abuse in American Indian and Alaska native youth: promising strategies for healthier communities

Substance abuse has had profoundly devastating effects on the health and well-being of American Indians and Alaska Natives. A wide variety of intervention methods has been used to prevent or stem the development of alcohol and drug problems in Indian youth, but there is little empirical research evaluating these efforts. This article is an overview of the published literature on substance use prevention among Indian adolescents, providing background epidemiological information, a review of programs developed specifically for Indian adolescents, and recommendations for the most promising prevention strategies currently in practice.     

Improving Fairness in Coverage Decisions: Performance Expectations for Quality Improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.