Toward a reconstruction of medical morality

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive--together with the physician--at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.     

Assessing the relationship between cold pressor pain responses and dimensions of the anxiety sensitivity profile in healthy men and women

Anxiety sensitivity (AS) has been shown previously to be an important factor in the perception and experience of experimentally induced pain within healthy adults. The aim of the current study was to extend this research by: (i) using the Anxiety Sensitivity Profile (ASP) as an alternative measure of AS; (ii) examining whether different coping instructions affect pain reports; and (iii) investigating potential differences between men and women. Participants were 50 healthy adults (23 males, 27 females) who were required to complete 2 versions of the cold pressor pain task; one version required the use of control instructions, whereas the other made use of acceptance-based instructions. Although the coping instructions were found to affect pain thresholds (acceptance resulted in lower thresholds), a similar pattern of correlations were found between the pain indexes and AS under both conditions. Of the ASP subscales, the gastrointestinal and cognitive concerns components were found to be the most strongly related to pain experiences. When the analysis was conducted separately for each sex, the ASP scales were related to the self-report measures of pain in women, whereas they were related to the behavioural measures of pain in men. These results not only confirm that AS is associated with experimental pain, but that there may be sex differences in this relationship.     

Investigating invariance in the factorial structure of the anxiety sensitivity index across adult men and women

The Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992) is one of the most widely used measures of the fear of anxiety-related sensations. Important gender differences also seem to exist in that women report higher levels of anxiety sensitivity than men. The primary objective of this study was to determine whether an equivalent factorial structure exists for the ASI among nonclinical adult men and women. In Study 1 (568 women; 251 men), the 2-factor (Fear of Cardiopulmonary Sensations and Fear of Mental Catastrophe), 10-item version of the ASI reported by Schmidt and Joiner (2002) provided the best fit to the data for both men and women. Using this model, Study 2 (503 women, 255 men) examined whether the factorial structure of the 10-item ASI was invariant for men and women. Noninvariance was found for one item on the Fear of Mental Catastrophe subscale (Item 15="When I am nervous, I worry that I might be mentally ill"). The implications of this are that this item should be dropped if an equivalent factor structure is to be assumed between men and women.     

The functions of the orbitofrontal cortex

The orbitofrontal cortex contains the secondary taste cortex, in which the reward value of taste is represented. It also contains the secondary and tertiary olfactory cortical areas, in which information about the identity and also about the reward value of odours is represented. The orbitofrontal cortex also receives information about the sight of objects from the temporal lobe cortical visual areas, and neurons in it learn and reverse the visual stimulus to which they respond when the association of the visual stimulus with a primary reinforcing stimulus (such as taste) is reversed. This is an example of stimulus-reinforcement association learning, and is a type of stimulus-stimulus association learning. More generally, the stimulus might be a visual or olfactory stimulus, and the primary (unlearned) positive or negative reinforcer a taste or touch. A somatosensory input is revealed by neurons that respond to the texture of food in the mouth, including a population that responds to the mouth feel of fat. In complementary neuroimaging studies in humans, it is being found that areas of the orbitofrontal cortex are activated by pleasant touch, by painful touch, by taste, by smell, and by more abstract reinforcers such as winning or losing money. Damage to the orbitofrontal cortex can impair the learning and reversal of stimulus-reinforcement associations, and thus the correction of behavioural responses when there are no longer appropriate because previous reinforcement contingencies change. The information which reaches the orbitofrontal cortex for these functions includes information about faces, and damage to the orbitofrontal cortex can impair face (and voice) expression identification. This evidence thus shows that the orbitofrontal cortex is involved in decoding and representing some primary reinforcers such as taste and touch; in learning and reversing associations of visual and other stimuli to these primary reinforcers; and in controlling and correcting reward-related and punishment-related behavior, and thus in emotion. The approach described here is aimed at providing a fundamental understanding of how the orbitofrontal cortex actually functions, and thus in how it is involved in motivational behavior such as feeding and drinking, in emotional behavior, and in social behavior.     

Sortal continuity of material things

Spatiotemporal and qualitative continuity are not sufficient to trace the career or path of one and the same object through its history. One needs sortal continuity, guaranteed by the form-token of the object. In this paper I concentrate on the question of sortal continuity linked to the problem of the cohabitation of objects. I intend to test whether it is possible to stick to the belief in continuants or endurers as well as the sortal dependence of identity and at the same time avoid an undesirable multiplication of spatially coinciding objects, i.e., avoid the thesis of cohabitation. I abandon the philosophical view – this is the price to be paid – that the set of the material constituents making up an object is an object proper. The basic units of reality are the objects falling under sortals and not the ultimate components thereof. That a determinate piece of copper is not identical with the statue made from it, therefore, does not imply that we have a cohabitation of two numerically different objects. This revised version was published online in August 2006 with corrections to the Cover Date.