Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

An ethical excursion through labeling the mentally retarded

Review of a representative body of research data concerning the effects of the “mentally retarded” (MR) label on parents, teachers, college students, nonretarded children, communities, and persons labeled fails to support the extravagant claim of some investigators that the labeling process has psychologically damaging effects upon the individuals labeled as well as society. Negative reactions to labels could be minimized by extensive public education and counseling. Labels should be retained as formal instruments essential to establishing the eligibility of the retarded for special assistance, and for maintenance of communication within and between disciplines, without which contemporary society could not operate. An argument for the judicious use of labels is fashioned, recommending replacement of the MR label by “AD” (adaptively deficient), in keeping with the modern view of mental retardation as a psychosocial challenge deemphasizing IQ and requiring adjustment of the whole personality to demands of a complex environment (e.g., coping skill, motivation). Parents, teachers, friends, employers, and public officials could support the AD's struggle to effectively participate in community life by promoting the perennial values of respect for human dignity, fairness, equality, autonomy, and compassion. As a result of monitoring the success of such programs in all settings, public policy administrators could formulate rational approaches to improvement of service programs in the national interest.     

Rosser orderings and free variables

It is shown that for arithmetical interpretations that may include free variables it is not the Guaspari-Solovay system R that is arithmetically complete, but their system R ^–. This result is then applied to obtain the nonvalidity of some rules under arithmetical interpretations including free variables, and to show that some principles concerning Rosser orderings with free variables cannot be decided, even if one restricts oneself to usual proof predicates.     

Three Complexity Problems in Quantified Fuzzy Logic

We prove that the sets of standard tautologies of predicate Product Logic and of predicate Basic Logic, as well as the set of standard-satisfiable formulas of predicate Basic Logic are not arithmetical, thus finding a rather satisfactory solution to three problems proposed by Hájek in [H01].     

Cultural Differences in Physical Contact Between Hispanic and Anglo Mother–Infant Dyads Living in the United States

This is a study of differences in physical contact and tactile interpersonal behaviours between Hispanic and Anglo mothers and infants living in the United States. Infants were 9 months old and 52 mother–infant dyads, 26 Hispanic and 26 Anglo, were videotaped during free play without toys in a university laboratory playroom. Coders judged the interpersonal distance, physical contact and affectionate touch from the videotapes and mothers responded to a questionnaire about the importance of physical contact and affectionate touch in their relationship with their infant. From questionnaire data we found that Hispanic and Anglo mothers both touch their infants on a daily basis, although Hispanic mothers report touching more frequently, being more affectionate with their infants and having more skin-to-skin contact. From videotaped observations we found that there were no overall differences in mother–infant touch between the two cultures; however, the Hispanic mothers showed more close touch and more close and affectionate touch compared to Anglo mothers, who showed more distal touch. The results are discussed in terms of the role of touch in infant development and cultural differences in the evaluation of close physical contact and touch.