Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.     

Positive affect as implicit motivator: on the nonconscious operation of behavioral goals

Recent research has revealed that nonconscious activation of desired behavioral states--or behavioral goals--promotes motivational activity to accomplish these states. Six studies demonstrate that this nonconscious operation of behavioral goals emerges if mental representations of specific behavioral states are associated with positive affect. In an evaluative-conditioning paradigm, unobtrusive linking of behavioral states to positive, as compared with neutral or negative, affect increased participants' wanting to accomplish these states. Furthermore, participants worked harder on tasks that were instrumental in attaining behavioral states when these states were implicitly linked to positive affect, thereby mimicking the effects on motivational behavior of preexisting individual wanting and explicit goal instructions to attain the states. Together, these results suggest that positive affect plays a key role in nonconscious goal pursuit. Implications for behavior-priming research are discussed.     

A Contextual Approach to Scientific Understanding

Achieving understanding of nature is one of the aims of science. In this paper we offer an analysis of the nature of scientific understanding that accords with actual scientific practice and accommodates the historical diversity of conceptions of understanding. Its core idea is a general criterion for the intelligibility of scientific theories that is essentially contextual: which theories conform to this criterion depends on contextual factors, and can change in the course of time. Our analysis provides a general account of how understanding is provided by scientific explanations of diverse types. In this way, it reconciles conflicting views of explanatory understanding, such as the causal-mechanical and the unificationist conceptions.     

The excluded player in coalition formation

Coalition research generally assumes that people strive to maximize their share of the coalition payoff and that they exclude others from joining a coalition if these others are not needed to obtain the coalition payoff. In two experiments, the authors show that this view is too narrow and that willingness to include such others is dependent on the extent to which people feel that exclusion affects the payoff of the excluded player. This finding was moderated by social value orientations. Proselfs were not affected by the consequences for the excluded players. Prosocials were less willing to exclude others the more harmful were the consequences of exclusion. Results are related to research on social exclusion, the do-no-harm principle, and social value orientations.     

Bad news transmission as a function of the definitiveness of consequences and the relationship between communicator and recipient

There is ample evidence suggesting (e.g., A. Tesser & S. Rosen, 1975) that people are reluctant to transmit bad news. Research on rumors, on the other hand, suggests that people sometimes are less reluctant to transmit bad news. It is argued that differences between the 2 lines of research include the definitiveness of the consequences of the news and the relationship between communicator and recipient. The influence of these 2 factors on news transmission was investigated in 3 experiments. Results showed that bad news with indefinite consequences was transmitted more often than bad news with definite consequences and that both kinds of bad news were transmitted more often if the recipient was a friend rather than a stranger. Differences in feelings of moral responsibility to transmit the news largely accounted for both effects. The 2 factors did not affect the likelihood of good news transmission.     

How Long Do Offenders Escape Arrest? Using DNA Traces to Analyse when Serial Offenders Are Caught

Why is it that some serial offenders are arrested quickly and others only after a long period, or never at all? What characterises offenders who continue to escape arrest despite their continued involvement in crime? To be able to answer these questions, arrested (identified) offenders must be compared with never arrested (unidentified) offenders. In this paper, data from the Dutch DNA database are used to assess which characteristics of the criminal behaviour of unidentified offenders influence the probability that they will subsequently be arrested. DNA data offer a unique opportunity to compare crime series of identified offenders with crime series of yet unidentified offenders. Using the Cox proportional hazards model, we tested whether the number of crimes committed, offence specialization, and offence seriousness affect the probability of arrest of serial offenders. Results showed that as an offender commits more crimes, the probability that he will be arrested increases and that offence specialization decreases the probability of arrest. Another conclusion drawn is that DNA traces offer unique opportunities for criminological research. We discuss the limitations of this new data source and make suggestions for future research using DNA traces and for future research that might improve the current study. Copyright © 2012 John Wiley & Sons, Ltd.     

Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder

This randomized controlled trial compared the effectiveness of metacognitive therapy (MCT) and intolerance-of-uncertainty therapy (IUT) for generalized anxiety disorder (GAD) in an outpatient context. Patients with GAD (N = 126) consecutively referred to an outpatient treatment center for anxiety disorder were randomly allocated to MCT, IUT, or a delayed treatment (DT) condition. Patients were treated individually for up to 14 sessions. Assessments were conducted before treatment (pretreatment), after the last treatment session (posttreatment), and six months after treatment had ended (follow-up). At posttreatment and follow-up assessments, substantial improvements were observed in both treatment conditions across all outcome variables. Both MCT and IUT, but not DT, produced significant reductions in GAD-specific symptoms with large effect sizes (ranging between 0.94 and 2.39) and high proportions of clinically significant change (ranging between 77% and 95%) on various outcome measures, and the vast majority of the patients (i.e., 91% in the MCT group, and 80% in the IUT group) no longer fulfilled the diagnostic criteria for GAD. Results further indicate that MCT produced better results than IUT. This was evident on most outcome measures, and also reflected in effect sizes and degree of clinical response and recovery.