Clinical pragmatism: a method of moral problem solving

This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in moral problem solving are discussed.     

Ethical issues in cochlear implant surgery: an exploration into disease, disability, and the best interests of the child

This paper examines ethical issues related to medical practices with children and adults who are members of a linguistic and cultural minority known as the DEAF-WORLD. Members of that culture characteristically have hearing parents and are treated by hearing professionals whose values, particularly concerning language, speech, and hearing, are typically quite different from their own. That disparity has long fueled a debate on several ethical issues, most recently the merits of cochlear implant surgery for DEAF children. We explore whether that surgery would be ethical if implants could deliver close to normal hearing for most implanted children, thereby diminishing the ranks of the DEAF-WORLD. The ethical implications of eugenic practices with the DEAF are explored, as are ethical quandaries in parental surrogacy for DEAF children, and their parallels in transracial adoption.     

Hippocampal synaptic plasticity during instrumental learning

present research examined the role of hippocampal NMDA-dependent synaptic potentiation on appetitive instrumental conditioning under a continuous reinforcement schedule. In the first experiment, low (.025 mg.kg) or moderate (.05 mg/kg) dosages of the NMDA receptor antagonist, MK801, failed to increase the number of training days required to reach acquisition criterion; number of training days required to reach criterion for extinction were also unaffected. In the second experiment, a higher dosage (.10 mg/kg) of MK801 or induction of long-term potentiation failed to alter the number of responses occurring during acquisition. These data suggest that hippocampal synaptic potentiation does not play a prominent role in instrumental learning with simple contingency conditions. It is suggested that hippocampal LTP reflects a perceptual process that contributes differentially to spatial cognition, classical and instrumental conditioning.     

Developing local lifelong guidance strategies

The background, rationale, methodology and outcomes of a project on developing local lifelong guidance strategies in four areas are outlined. The main components of the strategies developed in the four areas are analysed, and a number of issues relating to the process of strategy development are addressed. Much of the lack of coherence at local level stems from lack of coherence at national policy level: implications for national policy are examined. Finally, implications for parallel work in other localities are explored.     

The specific action of different personality risk factors on cancer of the breast, cervix, corpus uteri and other types of cancer: A prospective investigation

We report the results of a prospective study of a random sample of 1353 elderly but healthy men and women who were followed up for a period of 10 yr, when mortality and cause of death were ascertained. Overall results have been reported elsewhere for mortality from cancer, coronary heart disease and other causes; here we are concerned with the personality factors predicting breast cancer, cervical cancer, cancer of the corpus uteri specifically, as well as other types of cancer in women. Ten specific hypotheses were tested, using specially constructed questionnaires for the purpose, and for most of these statistically significant support was obtained. The results justify belief that specific types of cancer may be related to specific stress/personality factors.     

Is it emotion or is it stress? Gender stereotypes and the perception of subjective experience

Two studies of college undergraduates (ns = 95 and 92, primarily non-Hispanic whites and Asian Americans) investigated gender stereotypes of stress and emotion, as well as variables that influence the perception of gender-related differences. Study 1 assessed how gender stereotypes differ from the self-reports of men and women. When asked to choose a label for the subjective experience of the average man and the average woman in a series of problematic hypothetical situations, participants generally tended to believe that the average female would feel ‘emotional,” but that the average male would feel “stressed.” By contrast, the label participants chose to describe their own subjective experience was not significantly affected by their gender. In addition, participants believed the average woman and man differed more in the intensity of their emotions than in the intensity of their stress, a belief contradicted by their own self-reports. Results of Study 2 indicated that gender-related differences in estimations of stress and emotion for the self were reduced or eliminated when specific information about experience-eliciting situations was provided. We would like to thank Matthew Dank for his help in preparing the stimulus materials.     

Power and Personality: An Analysis of Gay Male Intimate Abuse

A study was conducted to investigate the issue of gay male intimate abuse in a sample of 52 couples. The objective of the study was to explore the association between relationship power dynamics and the perpetration of psychological abuse, and to investigate the correspondence between intimate abuse and factors associated with the Abusive Personality [D. G. Dutton and A. J. Starzomski (1993) Borderline Personality in Perpetrators of Psychological and Physical Abuse, Violence and Victims, Vol. 8, pp. 327–337; D. G. Dutton (1994a) Behavioral and Affective Correlates of Borderline Personality Organization in Wife Assaulters, International Journal of Law and Psychiatry, Vol. 17, pp. 265–279.] The majority of participants were middle to upper class and their ethnic/racial breakdown is as follows: White (86%), Native American (7%), Asian (4%), and Other (3%). In terms of power, results indicated that the more frequent form of psychological abuse was significantly higher in relationships characterized by divided power (i.e., partners sharing decision-making authority by the partners each making decisions in different domains). This finding supports the supposition that abuse can occur in relatively egalitarian relationships. An association between intimate abuse and the Abusive Personality was also clearly observed and this personality profile seemed to characterize both members of abusive dyads. Conclusions are drawn regarding the generalizability of intimate abuse across lines of sexual orientation.     

A History of the Extraterrestrial Life Debate

From antiquity to the present, humans have debated whether intelligent life exists elsewhere in the universe. This presentation will survey this debate, examining the roles played in it by science, religion, philosophy, and other areas of human learning. One thesis that will be developed is that whether or not extraterrestrials exist, ideas about them have strongly influenced Western thought.     

Sexuality education and young people's sexual behavior: a review of studies

Sexuality education for children and young adults is one of the most heavily debated issues facing policy-makers, national AIDS program planners, and educators, provoking arguments over how explicit education materials should be, how much of it there should be, how often it should be given, and at what age instruction should commence. In this context, the World Health Organization's Global Program on AIDS' Office of Intervention Development and Support commissioned a comprehensive literature review to assess the effects of HIV/AIDS and sexuality education upon young people's sexual behavior. 52 reports culled from a search of 12 literature databases were reviewed. The main purpose of the review is to inform policy-makers, program planners, and educators about the impact of HIV and/or sexuality education upon the sexual behavior of youth as described in the published literature. Of 47 studies which evaluated interventions, 25 reported that HIV/AIDS and sexuality education neither increased nor decreased sexual activity and attendant rates of pregnancy and sexually transmitted diseases (STDs). 17 reported that HIV and/or sexuality education delayed the onset of sexual activity, reduced the number of sex partners, or reduced unplanned pregnancy and STD rates Only 3 studies found increases in sexual behavior associated with sexuality education. Inadequacies in study design, analytic techniques, outcome indicators, and the reporting of statistics are discussed.