Autonomy in the medical profession in the United Kingdom – an historical perspective

This paper reviews the concept of professional autonomy from anhistorical perspective. It became formalised in the United Kingdom onlyafter a long struggle throughout most of the nineteenth century. In itspure form professional autonomy implies unlimited powers to undertakemedical investigations and to prescribe treatment, irrespective of cost.Doctors alone should determine the quality of care and the levels ofremuneration to which they should be entitled. In the second half of thetwentieth century a steady erosion of professional autonomy occurred inthe United Kingdom. The level of remuneration has been restricted formost doctors for nearly fifty years, whilst the costs of health carehave steadily reduced the doctor's ability to provide unrestricted carewithin the health care system. Reorganisation of the National HealthService in 1983 and 1991 has substantially eroded professional autonomy,to the point where research developments, clinical judgement and ethicalstandards are all now being placed at risk.     

Functional assessment: Contributions and future directions

Functional assessment is at once redefining the standards for clinical interventions and reemphasizing the importance of studying basic behavioral mechanisms. This commentary describes one perception of what we are learning from current research on functional assessment and suggests directions for the future.     

The relationship between predictability and problem behavior for students with severe disabilities

Two single-case studies were conducted to examine the extent to which signaled (predictable) and unsignaled (unpredictable) events were associated with changes in the level of problem behavior during instruction. Two students with moderate-to-severe intellectual disabilities and autism participated in the study. Each student was nominated for the study based on a teacher's report that problem behaviors were much more likely when novel or unsignaled events occurred. Functional assessments were conducted with each student and the specific predictability features (signals) associated with low and high levels of problem behavior were identified. Multi-element and reversal designs were employed to examine the extent to which increased predictability was associated with reduced problem behavior. Results supported the use of functional assessment procedures to determine whether signals that provide information about the content, duration, timing, and/or consequences of future events could reduce problem behaviors.     

Exploring the utility of functional analysis methodology to assess and treat problematic verbal behavior in persons with acquired brain injury

Functional analyses were conducted on four adults with acquired brain injuries who regularly displayed instances of inappropriate verbal behavior including depressive, aggressive, suicidal, profane, and sexually inappropriate utterances. After the functional analysis yielded a maintaining variable for each participant, a function‐based intervention consisting of differential reinforcement of alternative verbal behavior was implemented. Results of the behavioral interventions show that instances of vocal behavior can be assessed and subsequently treated using the functional analysis methodology often reserved for nonverbal forms of behavior. The utility of functional analysis for assessing complex human behavior is discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

What the HEC-C? An Analysis of the Healthcare Ethics Consultant-Certified Program: One Year in

Abstract

Efforts to professionalize the field of bioethics have led to the development of the Healthcare Ethics Consultant-Certified (HEC-C) Program intended to credential practicing healthcare ethics consultants (HCECs). Our team of professional ethicists participated in the inaugural process to support the professionalization efforts and inform our views on the value of this credential from the perspective of ethics consultants. In this paper, we explore the history that has led to this certification process, and evaluate the ability of the HEC-C Program to meet the goals it has set forth for HCECs. We describe the benefits and weaknesses of the program and offer constructive feedback on how the process might be strengthened, as well as share our team’s experience in preparing for the exam.     

What are the important visual features for coin discrimination?

Previous research has shown that memory for the surface detail of coins is poor. One explanation might be that gross features, such as size, colour and edging, are more important than surface detail when discriminating among coins and hence are more memorable. In a 2×4 within‐groups experiment, 33 participants visually identified coins in 128 coin pairs with surface detail present or obscured, and possibly one of three gross features also eliminated. While the presence of surface detail maintained very high accuracy, when only surface detail was eliminated and the other gross features were still present, participants' accuracy remained high. If surface detail and any gross feature were eliminated concomitantly, accuracy fell significantly. These findings indicate that both surface detail and gross features provide important information for coin discrimination in the real world, and that the gross features of a coin are not more important for visual discrimination than surface detail. Copyright © 2005 John Wiley & Sons, Ltd.