Death, organ transplantation and medical practice

A series of papers in Philosophy, Ethics and Humanities in Medicine (PEHM) have recently disputed whether non-heart beating organ donors are alive and whether non-heart beating organ donation (NHBD) contravenes the dead donor rule. Several authors who argue that NHBD involves harvesting organs from live patients appeal to "strong irreversibility" (death beyond the reach of resuscitative efforts to restore life) as a necessary criterion that patients must meet before physicians can declare them to be dead. Sam Shemie, who defends our current practice of NHBD, holds that in fact physicians consider patients to be dead or not according to physician intention to resuscitate or not. We suggest that criteria for a concept are not necessarily truth conditions for assertions involving the concept. Hence, non-heart beating donors may be declared dead without meeting the criterion of strong irreversibility even though strong irreversibility is implied by the concept of death. Our perception that a concept applies in a given case is determined not by the concept itself but by our necessary skill and judgment when using it. In the case of deciding that a patient is dead, such judgment is learned by physicians as they learn the practice of medicine and may vary according to circumstances. Current practice of NHBD can therefore be defended without abandoning death as an empirical concept, as Shemie appears to do. We conclude that the dead donor rule continues to be viable and ought to be retained so as to guarantee what the public most cares about as regards organ donation: that physicians can be trusted to make determinations of eligibility for organ donation in the interests of patients and not for other purposes such as increasing the availability of organs.     

Psychotropic medication from an object relations theory perspective: an analysis of vignettes from group psychotherapy

In this article we explore the content and dynamics of patients' verbalizations within a "living with medications" group. Patients' perceptions of their psychotropic medications are interpreted and classified within the framework of object relations theory. One's perception of the role of medication in one's life can serve as a gateway to one's inner world and the way that he or she perceives authority figures, peers, and oneself. We suggest that working through patients' relationships with their medications can help them to achieve better integration of internal object relations. Discussing patients' views about medications should therefore be seen as an important part of psychotherapy with many individuals. Such a discussion may enhance and improve efficacy of both psychotherapy and pharmacotherapy. It is of particular importance in group therapy, within milieu environments and with individuals reluctant to explicitly discuss interpersonal matters. Vignettes from the group sessions illustrate the way in which discussing medication advances group process.     

The influence of personality and anxiety on the oral performance of Japanese speakers of English

This study investigated the relationship between personality and anxiety characteristics of Japanese students and their oral performance in English. The participants were 73 native‐speakers of Japanese who were studying English at various language schools in New Zealand. They were administered the Maudsley Personality Inventory, the Spielberger State Anxiety Inventory, and a story‐retelling task which was scored in terms of oral fluency, accuracy, complexity, and global impression. Significant correlations were found between extraversion and global impression scores, and state anxiety and clause accuracy scores. These findings suggest that participants who were more extraverted produced better global impressions during their oral performance, and those who were experiencing higher levels of state anxiety made more errors in their spoken use of clauses. Copyright © 2004 John Wiley & Sons, Ltd.     

Intellectual ability and aggressive behavior in nonclinical-nonforensic males

The purpose of this study was to test the relationship between IQ and physical aggression in a nonclinical-nonforensic male sample in a laboratory setting. Thirty males completed an abbreviated version of the Wechsler Adult Intelligence Scale—Revised. Aggression was measured using a modified version of the Taylor reaction-time (RT) aggression paradigm in which subjects competed on a RT task and both received and delivered shocks to a fictitious opponent in provoking and nonprovoking conditions. Provocation conditions (High and Low) were defined by the intensity of shocks the subjects received. Results demonstrated strong inverse correlations between IQ and aggressive behavior under both High and Low Provocation conditions.     

A hierarchy of information sources for inferring emotional reactions

The ability of children and adults to infer emotional reactions from different sources of information was investigated. Preschoolers (mean age, 4–9), second graders (mean age, 4–9), and college students were asked to infer emotional reactions from verbally presented stories in which sources of information occurred either singly, in conflict, or in congruence. The sources investigated were situational (the protagonist's social or physical situation), normative (the dispositions of a group to which the protagonist belongs), and personal (the dispositions of the protagonist in particular). Subjects indicated the protagonist's emotional reaction to an event in the story by choosing one of three facial expressions, representing happy, upset, and afraid. A hierarchy of sources for making emotional inferences was found at all three grade levels: personal information was preferred over normative information, and both were dominant over situational information. The relevance of present methods and findings to the study of the development of “empathy” is discussed.     

Spatial versus tree representations of proximity data

In this paper we investigated two of the most common representations of proximities, two-dimensional euclidean planes and additive trees. Our purpose was to develop guidelines for comparing these representations, and to discover properties that could help diagnose which representation is more appropriate for a given set of data. In a simulation study, artificial data generated either by a plane or by a tree were scaled using procedures for fitting either a plane (KYST) or a tree (ADDTREE). As expected, the appropriate model fit the data better than the inappropriate model for all noise levels. Furthermore, the two models were roughly comparable: for all noise levels, KYST accounted for plane data about as well as ADDTREE accounted for tree data. Two properties of the data proved useful in distinguishing between the models: the skewness of the distribution of distances, and the proportion of elongated triangles, which measures departures from the ultrametric inequality, Applications of KYST and ADDTREE to some twenty sets of real data, collected by other investigators, showed that most of these data could be classified clearly as favoring either a tree or a two-dimensional representation.A portable PASCAL program implementing the Sattath and Tversky [1977] ADDTREE algorithm is available from J. Corter, Department of Psychology, Stanford University, Stanford, California 94305.     

The Beck Anxiety Inventory: Psychometric Properties with Older Adults

The assessment of anxiety disorders in late life is often hindered by the lack of measures specifically validated with older adults. Because anxiety manifestations may vary across age groups, it is important to design new instruments or validate existing measures with older adults. This study examined the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 281 older adults who were community-dwelling (82.6%) or living in residential care facilities (17.4%). The mean total BAI score was 6.5 (SD = 7.2), indicating minimal anxiety symptomatology in this older sample. There was a trend for older subjects to score higher. Females scored higher than males, and subjects living in a residential facility scored higher than did community dwellers. Item-total correlations were in the moderate range and the internal consistency of the BAI was adequate (alpha = 0.89). A factor analysis yielded a six-factor structure accounting for 64.6% of the variance, with a somatic factor accounting for the largest portion of the variance (32.2%). Because somatic symptoms are more prevalent with aging, such symptoms should not be weighed as heavily in the total BAI score as cognitive or behavioral symptoms. The findings indicate that the BAI is a useful self-report scale for assessing anxiety symptomatology among older adults.     

Recall of common and distinctive features of verbal and pictorial stimuli

Subjects first rated similarity of verbal and of pictorial stimuli. The same pairs of stimuli were presented again, without one common component and one distinctive component. Subjects were asked to recall the missing components and identify them as common or distinctive. The results show that components encoded as common are recalled relatively better than components encoded as distinctive, and the difference in recall is significantly greater in verbal than in pictorial stimuli.     

Visual angle and the word superiority effect

Two experiments are reported in which a word superiority effect is obtained under conditions where a fixed set of alternatives are employed with positional certainty as to the critical letter, trial type (word or nonword) is mixed, and the subject is told to fixate the position of the critical letter. A third experiment employed the same methodology except for the fact that the stimuli subtended a larger retinal angle. No word superiority effect was observed in the third experiment. It is suggested that the visual angle of the stimulus display is a crucial factor in experiments on the word superiority effect.