The hyperreality of clinical ethics: A unitary theory and hermeneutics

Medical ethics nowadays is dominated by a conception of ethics as the application of moral theories and principles. This conception is criticized for its depreciation of the internal morality of medical practice and its narrow view of external morality. This view reflects both a lack of interest in the empirical realities of medicine and a neglect of the socio-cultural value-contexts of medical ethical issues, including the creative development of a broader philosophical framework for a practicable medical ethics. Several alternative approaches and conceptions have been proposed. The unified clinical ethics theory, developed by Graber and Thomasma, is an interesting attempt to synthesize these alternative approaches. It correctly identifies as the crucial problem the present disconnectedness of medical ethics from theoretical philosophy as well as the practice of medicine. In this paper, however, it is argued that the unitary theory should take more serious attention to the hermeneutic character of medicine as well as ethics. This implies that the unitary theory must in fact transform itself into aninterpretive clinical ethics theory. The theoretical characteristics and practical consequences of an interpretive theory of medical ethics are discussed in the present paper.     

Some uniqueness results for PARAFAC2

Whereas the unique axes properties of PARAFAC1 have been examined extensively, little is known about uniqueness properties for the PARAFAC2 model for covariance matrices. This paper is concerned with uniqueness in the rank two case of PARAFAC2. For this case, Harshman and Lundy have recently shown, subject to mild assumptions, that PARAFAC2 is unique when five (covariance) matrices are analyzed. In the present paper, this result is sharpened. PARAFAC2 is shown to be usually unique with four matrices. With three matrices it is not unique unless a certain additional assumption is introduced. If, for instance, the diagonal matrices of weights are constrained to be non-negative, three matrices are enough to have uniqueness in the rank two case of PARAFAC2. The authors are obliged to Richard Harshman for stimulating this research, and to the Associate Editor and reviewers for suggesting major improvements in the presentation.     

Philosophy of medicine in the Netherlands

This report explores the relationship between philosophy and medicine in the Netherlands. In Section 1 we outline the ups and downs of medico-philosophical research in our country: pre-war flourishing, post-war decline, and modern renaissance. In Section 2 we review recent Dutch literature in the philosophy of medicine. The topics dealt with include methodology of medical science, alternative medicine, the basic concepts of medicine, anthropological medicine, medicalization, medicine and culture, and health care ethics.     

Some clarifications of the CANDECOMP algorithm applied to INDSCAL

Carroll and Chang have claimed that CANDECOMP applied to symmetric matrices yields equivalent coordinate matrices, as needed for INDSCAL. Although this claim has appeared to be valid for all practical purposes, it has gone without a rigorous mathematical footing. The purpose of the present paper is to clarify CANDECOMP in this respect. It is shown that equivalent coordinate matrices are not granted at global minima when the symmetric matrices are not Gramian, or when these matrices are Gramian but the solution not globally optimal.Part of this research has been supported by The Netherlands Organization for Scientific Research (NWO), PSYCHON-grant (560-267-011).     

Situational determinants of inpatient self-harm

Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed.     

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.