Causal Responsibility and Rationing in Medicine

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age.     

Win-shift and win-stay learning in the short-beaked echidna (<Emphasis Type="Italic">Tachyglossus aculeatus</Emphasis>)

Numerous previous investigators have explained species differences in spatial memory performance in terms of differences in foraging ecology. In three experiments we attempted to extend these findings by examining the extent to which the spatial memory performance of echidnas (or "spiny anteaters") can be understood in terms of the spatio-temporal distribution of their prey (ants and termites). This is a species and a foraging situation that have not been examined in this way before. Echidnas were better able to learn to avoid a previously rewarding location (to "win-shift") than to learn to return to a previously rewarding location (to "win-stay"), at short retention intervals, but were unable to learn either of these strategies at retention intervals of 90 min. The short retention interval results support the ecological hypothesis, but the long retention interval results do not. Electronic Publication     

The Factor Structure of the Beavers Interactional Scales

Confirmatory factor analysis and regression analyses of the Beavers Interactional Scales did not appear to support the model offered by its developers, namely, several specified family attributes contributing respectively to two global factors of Family Competence and Family Style. Moreover, regression analysis indicated that only three of 12 items predicted raters' assessments of Global Family Health, and one of seven items predicted Global Family Style. Individuals interested in the family dynamic centripetal/centrifugal might best think of that as a unitary entity and rate it accordingly.     

Plantinga’s Reformed Epistemology: What’s the Question?

Alvin Plantingas Warranted Christian Belief is without questionone of the central texts of the Reformed epistemology movement. Critiques of Plantingas defence have been both multiple and varied. As varied as these responses are, however, it is my contention that many of them amount to the same thing. It is the purpose of this paper to offer an overview of the main lines of attack that have been directed as Plantingas project, and thereafter to show how many, if not most, of these objections can be understood as versions or aspects of the same criticism, what I call the Inadequacy Thesis.     

Bioethics and Christian Theology

The authors of this essay suggest that the field of bioethics and Christian theology have a great deal to offer to each other. The authors first argue that representatives from both fields must first make sure that they fully and correctly represent their respective position. In other words, scientists, ethicists, and theologians alike must make sure that they present their fields and not use their knowledge merely for personal gain at the stake of misguiding people. Once this is established, the authors then proceed to show the intimate relationship between Christianity and medicine that has existed throughout the ages. It is a call for a continuation of such a relationship that the authors suggest between bioethics and theology. Through an integration of bioethics and Christian theology, both scientists/physicians and theologians are able to gain greater insight into the human person—a focus in both fields.     

Concordant Spiritual Orientations as a Factor in Physician--Patient Spiritual Discussions: A Qualitative Study

Objectives: To understand the impact of physicians and patients religious/spiritual orientation on discussions of spiritual issues. Methods: We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes. Results: Respondents expressed that similar belief systems facilitate patient–physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers. Conclusions: Our respondents view spirituality similarly to other aspects of the physician–patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions.     

Characteristics of true versus false allegations of sexual offences

The goal of the study was to establish whether false allegations of sexual offences with an unknown perpetrator can be distinguished from accurate allegations. Case files of 27 true allegations of sexual offences with an unknown perpetrator were compared to those of 14 false allegations. The comparison was guided by a list of 43 criteria that are hypothesized to differentiate between true and false allegations of sexual assault. Analyses indicated the employed criteria differentiated true from false allegations to a certain extent. However, the discriminative strength of some criteria appeared to be stronger than that of others. Research is required to assess further the discriminative power of these criteria.     

The Impact of the Big Five Personality Traits on Reports of Child Behavior Problems by Different Informants

The present study compared ratings of a standardized sample of child behavior problems across informants and examined the effects of informant personality traits on child behavior ratings by mothers, teachers, and group-care workers. Participants were 55 clinic-referred children, aged 6–12 years. All informants watched and rated the same 17-min videotaped behavior sample of a familiar target child. Independent trained observers rated the same videotapes to provide criterion ratings. Informants personality traits were assessed using the NEO Five Factor Personality Inventory. Results showed that mothers reported fewer behavior problems than did the professionals, that the informants who were familiar with the child reported more behavior problems than did the independent observers, and that higher levels of informant neuroticism were related to higher ratings of child behavior problems in the case of the professionals, but not in the case of the mothers. In addition, group-care workers who were less extraverted and open were likely to report more child behavior problems than group-care workers with normal levels of extraversion and openness. Finally, no relations were found between agreeableness or conscientiousness and ratings of child behavior. Findings suggest that professionals who work with children are not immune to distortions based on their own personality.     

Paralinguistic processing in children with callosal agenesis: emergence of neurolinguistic deficits

Recent research revealed impaired processing of both nonliteral meaning and affective prosody in adults with agenesis of the corpus callosum (ACC) and normal intelligence. Since normal children have incomplete myelination of the corpus callosum, it was hypothesized that paralanguage deficits in children with ACC would be less apparent relative to their peers. The Familiar and Novel Language Comprehension Test (FANL-C) and Prosody Test were given to 18 children with ACC and normal intelligence and 17 controls matched for age (7-13 years), education, and IQ (83-122). When controlling for age, children with ACC were significantly poorer in comprehension of the precise meaning of both literal and nonliteral items on the FANL-C. Adults with ACC had previously been shown to have difficulty only on nonliteral items. The effect size for nonliteral comprehension in children with ACC was smaller than that seen in adults. There was only a trend for the child ACC group to perform worse on the recognition of affective prosody. Thus, while deficits in paralinguistic processing were apparent, children with ACC were not as clearly different from age peers as adults, and were equally deficient at comprehending literal and nonliteral expressions. The differences in results between adults and children with ACC are thought to reflect incomplete callosal development in normal children, and the importance of the corpus callosum in the early stages of the development of the ability to process literal language.