An apology for Socratic bioethics

Bioethics is a hybrid discipline. As a theoretical enterprise it stands for untrammeled inquiry and argument. Yet it aims to influence medical practice and policy. In this article we explore tensions between these two dimensions of bioethics and examine the merits and perils of a "Socratic" approach to bioethics that challenges "the conventional wisdom."     

3-Year-Olds’ Perseveration on the DCCS Explained: A Meta-Analysis

The Dimensional Change Card Sort (DCCS) task is a widely used measure of preschoolers’ executive function. We combined data for 3,290 3-year-olds from 37 unique studies reporting 130 experimental conditions. Using raw pass/fail counts, we computed the pass rates and chi-squared value for each against chance (50/50) performance. We grouped data according to DCCS variants and computed the standard pass rate and chi-squared and phi for each variant relative to standard. For all standard versions, the mean pass rate was 36%. We compared all other variants to the standard and found robust improvements in performance for manipulations that involved spatial separation of the conflicting dimensions, use of distraction between pre and post-switch, elimination of all conflict, and extra practice. We also found that negative priming offers a better explanation for 3-year-olds’ perseveration than attentional inertia. The results support a theoretical model of 3-year-olds’ performance based on inhibitory control.     

The fair transaction model of informed consent: an alternative to autonomous authorization

The doctrine of informed consent in bioethics has relied on the view that consent is valid when it represents a patient or research subject's autonomous authorization. In this article we challenge this reigning conception of the validity of informed consent in clinical research, focusing in particular on the problem of the therapeutic misconception. We argue that the autonomous authorization model of informed consent suffers from four defects: (1) it fails to do justice to the relevance of risk-benefit considerations in shaping the criteria for the validity of consent, (2) it compromises the interests of subjects by preventing them from consenting to research participation with less than substantial understanding when doing so would likely be consistent with their preferences and beneficial to them or at least be unlikely to cause them harm, (3) it jeopardizes the interests of investigators by denying them fair notice regarding when the consent of research subjects can be considered valid and thus make it permissible for them to be enrolled in research, and (4) it threatens the reasonable limits on the responsibility of investigators to assure the adequacy of subjects' understanding of what research participation involves. In place of the autonomous authorization model, we present and defend a fair transaction model of informed consent, which better reflects the values served by consent.     

Catching the mind in flight: using behavioral indices to detect mindless reading in real time

Although mind wandering during reading is extremely common, researchers have only recently begun to study how it relates to reading behavior. In the present study, we used a word-by-word reading paradigm to investigate whether it could be possible to predict in real time whether a participant would report mind wandering when probed. By taking advantage of the finding that reaction times to individual words vary based on reports of mind wandering (with participants being less affected by length, number of syllables, and familiarity, and also showing an overall speed-up, during mindless reading), we were able to develop an algorithm that could successfully predict in real time whether a participant would report being on versus off task. In addition, for participants run without thought probes, there was a significant negative correlation between the number of predicted mind-wandering episodes and reading comprehension. Together, these findings offer a key advance toward the development of pedagogical tools for minimizing the negative impact of mindless reading, and they provide a new covert measure that could be used to study mind wandering without requiring participants to report on their mental states.     

Plausibility,Manipulation, and Fischer and Ravizza

The manipulation argument poses a significant challenge for any adequate compatibilist theory of agency. The argument maintains that there is no relevant difference between actions or pro‐attitudes that are induced by nefarious neurosurgeons, God, or (and this is the important point) natural causes. Therefore, if manipulation is thought to undermine moral responsibility, then so also ought causal determinism. In this paper, I will attempt to bolster the plausibility of John Martin Fischer and Mark Ravizza's semicompatibilist theory of moral responsibility by demonstrating how their account provides a distinctive line of response to three important types of manipulation.     

Screening for trauma histories,posttraumatic stress disorder (PTSD), and subthreshold PTSD in psychiatric outpatients

The ability of the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question to identify individuals with PTSD or subthreshold PTSD was examined. First, the screen's sensitivity for detecting a trauma history was determined. Second, the incremental validity of a more thorough trauma assessment was examined by determining how many individuals responded negatively to the screen but then were diagnosed with PTSD or subthreshold PTSD. Last, the optimal SCID termination point for assessing subthreshold PTSD was determined. Using a trauma list increased the number of participants reporting a trauma; however, the SCID screen captured almost all individuals who had PTSD or subthreshold PTSD. When one screens for subthreshold PTSD, the SCID can be terminated on failure to meet Criterion B.     

Differentiating overreporting and extreme distress: MMPI-2 use with compensation-seeking veterans with PTSD

This purpose of this study was to examine overreporting on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in compensation-seeking veterans with posttraumatic stress disorder (PTSD). A sample of veterans tested during a V.A. hospital compensation and pension exam were given the MMPI-2 and measures of PTSD, depression, and combat exposure. Veteran's MMPI-2s were only included in the analyses if their profile was extremely exaggerated, as measured by an F scale T score above 80, did not elevate the MMPI-2 VRIN and TRIN scales, and had a primary diagnosis of PTSD (n = 127). Using the Infrequency-Psychopathology, F(p), scale to distinguish overreporting from distress, it was found that 98 veterans elevated profiles due to distress, whereas 29 elevated due to overreporting, F(p) below and above 7, respectively. Differences between groups on MMPI-2 clinical scales and the other measures were assessed. Implications of these findings for assessing veteran response style and using the MMPI-2 with a PTSD population are discussed.     

What makes placebo-controlled trials unethical?

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm.     

Why is a verb like an inanimate object? Grammatical category and semantic category deficits

Semantic category effects, such as difficulties in naming animate things relative to inanimate objects, have been explained in terms of the relative weightings of perceptual and functional features within the semantic representations of these concepts. We argue that grammatical category deficits, such as difficulties in naming nouns relative to verbs, can be explained within the same framework. We hypothesize that verb concepts are richer in functional than sensory features and present a model of the semantic representations of animate nouns, inanimate nouns, and verbs. The model demonstrates that sensory feature damage results in a deficit for naming living things but spares verb naming, and functional feature damage results in a deficit for naming inanimate objects and verbs. We then report the assessment results of two patient groups. In accordance with the model's predictions, the "verb spared" patients were consistently worse at naming living things than inanimate objects, and their definitions of both living and nonliving items were lacking in sensory information. We conclude that damage to sensory features in semantic representations causes difficulties in naming concrete nouns relative to action verbs, and within the grammatical category of nouns, animate items will be more severely affected. Imageability was shown to be a strong predictor of naming performance in the "verb deficit" patients, and when this variable was controlled no class effect remained. Production of definitions revealed no differential damage to sensory or functional features, and no consistent effect of animacy in naming was shown. While the model suggests that verb deficits might occur in patients for whom functional features are damaged relative to sensory features, we conclude that the "verb deficit" shown in our patients (and potentially in many previously reported cases) was an artifact of the lower imageability of verbs in confrontation naming tasks.