How careproviders can acquire and apply greater wisdom

In this issue of JCE, Baum-Baicker and Sisti present senior psychoanalysts' views of wisdom. Although views on wisdom differ widely, there is agreement that when ethical conflicts arise, wisdom may be critical in bringing about an optimal result. Here I will present recent empirical findings on wisdom and the ways careproviders may acquire and apply it, especially in ethical conflicts.The findings are not well-known and may seem counterintuitive; I selected them, in large part, for those reasons. A core challenge may be to decide when to give patients standard care and when to make exceptions. In this issue of JCE, Baum-Baicker and Sisti discuss exceptions and Bursztajn and colleagues consider how these exceptions may be further validated as evidence-based treatments.     

How should careproviders respond to patients' requests that may be refused?

Some requests made to careproviders by patients may be of great personal importance to patients. Careproviders may assign proportionally greater weight to these exceptional requests, and may choose to take exceptional measures to assist. A strong trust relationship may be formed with patients as a result.     

Personality,Luck Beliefs,and (Non-?) Problem Lottery Gambling

This study offers both the first systematic investigation of the relationship between the five-factor personality model and general (ostensibly non-problem) lottery gambling, and the first application of Thompson and Prendergast’s (2013) bidimensional model of luck beliefs to gambling behavior. Cross-sectional analyses (N = 844) indicate the bidimensional model of luck beliefs significantly accounts for variance in lottery gambling that is discrete from and greater than that of the five-factor personality model. Moreover, the broad pattern of relationships we find between presumably harmless state-sponsored lottery gambling and both personality and luck beliefs tend to parallel those found in studies of problem gambling, suggesting implications for quality of life and public policy in relation to lottery gambling.

     

What the Philosophy Of Medicine Is

Theoretical Medicine and Bioethics -     

An account of human “impulsivity” on self-control tasks

Three experiments examined the effects of economic constraint (time restriction—trials restriction) on adult humans' performance on concurrent chained schedules of reinforcement in which terminal links differed both in reward size and pre-reward delay levels. In the first, terminal links offered a long delay (20, 30, 40, 50 sec) followed by 2 points, or a short delay (10 sec) followed by 1 point. Initial links consisted of the same variable interval schedules for each alternative. Subjects showed a conditional sensitivity to increases in delay. Under a time constraint, there was an increasing preference for the smaller reward as the delay to the larger reward was increased, whereas under a trials constraint subjects were totally insensitive to such changes. In the second experiment, this finding was replicated using long and short periods of video game playing as large and small rewards. In the third experiment terminal link parameters remained constant (2 points after 15 sec, or 1 point immediately), but initial link parameters were manipulated (either VI 1-sec, 8-sec, or 20-sec) so that the higher relative rate of reward shifted from being associated with the small reward to being associated with the large reward. Again subjects chose differently under the two constraints. Subjects under the time constraint exhibited a preference for the small reward at all levels of initial link, but under the trials constraint subjects preferred the large reward. Subjects in the time constraint condition thus exhibited a maladaptive insensitivity to changes in the initial link duration. These findings are interpreted as supporting a miscalculation rather than a discounting interpretation of human performance on “self-control” tasks.