Just health care (II): Is equality too much?

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence [1]. Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a ‘non-ideal’ mode, a framework in which philosophers have done little.     

A program for constructing SVT tests: An alternative way of assessing text comprehension

The sentence verification technique (SVT), developed by Royer, Hastings, and Hook (1979), provides developmental and educational researchers with an alternative way of assessing text comprehension based on all of the information contained in a passage. Students must decide if test sentences have the same meaning as sentences that appeared in an original passage. The program described here automates the more laborious aspects of constructing SVT tests. The user must create a passage using a word processor. The program will prompt the user for information as needed. Finally, printable text files (SVT test and answer key) are generated. The program is written in BASIC for IBM and IBM-compatible computers.     

Abuse of persons with mental retardation: A literature review

The literature reports a number of reasons why abuse of people with mental retardation occurs. These causes of abusive behavior can be divided into three categories: organizational variables, staff characteristics, and client characteristics. The author examines each of the variables and presents recommendations for reducing their contributions to abusive behavior.     

Teaching dancercise to persons who are mentally handicapped: Programming transfer of stimulus control to a community setting

This study demonstrated procedures to promote the acquisition and transfer of stimulus control of an age-appropriate exercise skill. Three young adults diagnosed as mentally handicapped in a residential setting were taught a commercial dancercise routine during individual training sessions using a package of instructional procedures. A combination of a multiple baseline across subjects and a multiple baseline across response groups design showed that skill acquisition occurred only after each subject received training, and that performance did not generalize across exercise response groups. Training progressively incorporated more participants, new teachers, and new settings. Ultimately, subjects performed in a community dancercise class attended by 100 nonhandicapped persons.     

A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia

A sample of physician-referred chronic insomniacs was randomly allocated to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment conditions. Treatment process and outcome were investigated in terms of mean and standard deviation (night to night variability) measures of sleep pattern and sleep quality. Only active treatments were associated with significant improvement, but the nature of treatment gains varied. In particular, stimulus control improved sleep pattern, whereas relaxation affected perception of sleep quality. All improvements were maintained at 17 month follow-up. Results are discussed with reference to previous research and guidelines are given for clinical practice.     

Adolescent suicide attempters presenting to a pediatric facility

This study profiles the characteristics of adolescent suicide attempters and the treatment they received in a pediatric emergency room (ER). A retrospective chart review of 4,072 adolescents seen in the ER at a children's hospital (CH) from July 1984 to June 1985 was undertaken. Twenty-seven adolescents who had deliberately injured themselves were identified. The average age was 14 years 7 months (range 11-19 years). Fifty-two percent of the patients were white and 78% were female. Ingestion was the most common method (78%), followed by attempted hanging (11%), and wrist laceration (7%). After evaluation by a pediatrician in the ER, 30% of the patients were treated and released, 11% were transferred directly to a psychiatric hospital, and 59% were admitted to the CH, with an average hospital stay of 1.88 days. Once hospitalized, consultations from psychiatry (81%), social service (50%), psychology (19%), and neurology (6%) were obtained. At the time of discharge from either the ER or CH, the patients had a variety of plans for ongoing care, with 52% being referred to outpatient counseling, 37% being transferred to a psychiatric hospital, and 11% having no documented plan for ongoing care. These results demonstrate that the evaluation of suicidal adolescents cared for in a pediatric facility may be episodic and suggest the need for a comprehensive program to approach the problem.     

Students' preferences for male or female counselors for social and educational problems

Fifty-eight male and 66 female junior high school students were examined to determine their preferences for sex of counselor under personal/social and educational hypothetical counseling situations. Girls demonstrated a definite same-sex preference for both counseling situations, while boys preferred male counselors for personal/social counseling and had opposite-sex preferences for educational counseling. Implications of the findings are discussed in light of earlier contradictory results from research on college students.     

Affective quality of family relations and adolescent identity exploration

The purpose of this study was to examine the relationship between adolescent pubertal status, the affective quality of family relations, and the early adolescent's exploration of a sense of ego identity. Fifty-one intact families with adolescents in the seventh grade agreed to participate. Each family member completed a battery of questionnaires designed to assess familial adaptation to pubertal growth and identity exploration. The results reveal that the affective quality of parent-adolescent relationships and the pubertal status of the adolescent appear to influence the adolescent's exploration of ego identity. The need to establish the functional significance of familial adaptation to adolescent pubertal growth for identity development is discussed.