The rationing of health care: A doctor's dilemma

Physicians are currently presented with very difficult ethical issues regarding who receives what level of medical care and for how long. A meaningful response to these perplexing issues necessitates a collaboration of doctors with others steeped in religious and ethical traditions. This paper addresses the complicated issue of the rationing of health care, and this issue is then addressed by responses from representatives of the religious community. This symposium took place at the New York Hospital—Cornell Medical Center in March 1991.The Rev. Curtis W. Hart, M.Div. is Director of Pastoral Care and Education at the New York Hospital—Cornell Medical Center.The Rev. Paul Conner, O.P., is Associate Professor and Director of the Master's Program in Public Health Care Ethics at New York Medical College. Larry Rasmussen, Th.D., is Reinhold Niebuhr Professor of Social Ethics at Union Theological Seminary in New York. Dr. Harlan J. Wechsler is Rabbi of Congregation Or Zarua and Visiting Professor of Philosophy at Jewish Theological Seminary in New York.     

Concurrent Use of Cigarettes,Alcohol, and Coffee1

The interrelationships between cigarette, alcohol, and coffee use were examined in 307 U.S. army trainees and 304 U.S. enlisted army personnel. Usage patterns indicated distinct gender differences in this occupational setting. Among women, cigarette use and alcohol consumption were positively correlated; whereas for men, cigarette and coffee use were positively related. For both males and females, alcohol and coffee use were only weakly correlated. As demonstrated in other studies, nonsmokers showed a consistent pattern of abstention from coffee and alcohol or moderate alcohol use.     

The rule learning behavior of reading disabled and normal children as a function of task characteristics and instruction

The purpose of this research was to investigate rule learning in reading disabled (RD) and normal children (chronological age and reading age (RA) match) when required to (a) abstract rules independently, and (b) use rules after instruction. Study 1 required the children to solve problems using shapes and letters. Although there was no difference between groups in the rate of problem solving when children were asked to abstract rules independently, the pattern of errors was different. The RD children made a greater proportion of errors on the negative instance for the more complex problems. In particular, this occurred on the letter task which involved psycholinguistic categorization. After instruction, the RA controls made more errors than the other groups. Study 2 was an analogous pseudoword reading task. Even with statistical adjustment for differences in prior grapheme-phoneme (g-p) rule knowledge, the RD children performed less accurately than the RA controls when they had to abstract rules, although this was restricted to the most difficult rule (rule of e). There was no difference after instruction in rule application, although the pattern of errors and post-test results indicated that the RD children continued to experience decoding difficulty. These results suggest a phonologically based productive deficit which interferes with the learning of g-p rules. This may be part of a more general language deficit which includes psycholinguistic categorization. Despite the severity of this handicap, RD children seem responsive to instruction.     

The myth of science education

It is argued that the manner in which we teach science in the high schools represents an outdated positivistic conception of science. The standard presentation of a year of each of chemistry, biology and physics should be replaced by an integrated science plus history, philosophy, and sociology of science which would take a total of three years to complete. A proper appreciation for the true nature of science is essential to the continued health of the scientific enterprise.     

Affective influences on individual and group judgments

Do emotional states influence the social judgments made by groups and individuals? Based on affect-cognition theories and research on group judgmental shifts, we predicted that group discussion will enhance positive mood effects on judgments, but inhibit affectively-based distortions in dysphoric moods. Positive, neutral and negative moods were induced using audiovisual presentations. Individual and group consensus judgments of nine person categories on three judgmental dimensions (evaluation, competence and self-confidence) were obtained in two experimental sessions separated by a two-week interval. Results showed that individuals made more positive judgments when happy, and more negative judgments when sad than did controls. Group discussion resulted in a further polarization of positive judgments, and the attenuation of negative judgments. The findings are interpreted as evidence for the important role affect plays in mediating both individual cognitive processes and interactive social behaviours. The implications of the results for contemporary affect-cognition theories and models of group behaviour are considered.     

An on-line assessment of causal reasoning during comprehension

Fletcher and Bloom (1988) have argued that as readers read narratives, clause by clause, they repeatedly focus their attention on the last preceding clause that contains antecedents but no consequences in the text. This strategy allows them to discover a causal path linking the text's opening to its final outcome while minimizing the number of times long-term memory must be searched for missing antecedents or consequences. In order to test this hypothesis, we examined the reading times of 25 subjects for each clause of eight simple narrative texts. The results show that: (1) causal links between clauses that co-occur in short-term memory (as predicted by the strategy) increase the time required to read the second clause; (2) potential causal links between clauses that never co-occur in short-term memory (again as predicted by the strategy) have no effect on reading time; and (3) reinstatement searches are initiated at the end of sentences that are causally unrelated to the contents of short-term memory or that contain clauses that satisfy goals no longer in short-term memory. These results support the claim that subjects engage in a form of causal reasoning when they read simple narrative texts.     

Internalizing and externalizing characteristics of sexually and/or physically abused children

This study evaluates the behavioral consequences of childhood abuse (sexual, physical, or both), with particular focus on prevalence of posttraumatic stress disorder (PTSD). Three abuse type groups and nonabused controls were contrasted on behavioral rating scales and on structured psychiatric interview data. The participants (109 abused children and 16 normal control children) were recruited from Arkansas Children’s Hospital and local agencies for abused children. As expected, proportionately more females than males were sexually abused. Overall, males were rated as more disturbed than females. Type of abuse did not consistently influence behavioral ratings. Externalizing scores were significantly higher than internalizing scores in all abused groups. PTSD was diagnosed in 50% of the abused children, with a higher rate for boys who had been sexually abused as opposed to physically abused only (58% versus 13%). The most frequent comorbid condition with PTSD was Separation Anxiety. Sexually abused boys were hospitalized for psychiatric treatment at a higher rate than were other abused children.     

On the dynamics of dying

This study is concerned with dynamic processes that underly the rapid, degenerative changes associated with the “dying” stage of the multicellular organism's life cycle. The interaction between negative and positive feedback cycles is discussed: negative feedback cycles underly the superstability characteristic of health and illness. When negative feedback cycles fade in the dying phase of life, positive feedback cycles, previously held in check by the negative feedback cycles to which they had been coupled, rise explosively, driving physiologic variables from their normal values towards extremes. This results in the rapid downturn that we associate with dying—an accelerating disintegration terminating in death. A medical case history is analyzed.     

Associations Between Clinic-Referred Boys and Their Fathers on Childhood Inattention-Overactivity and Aggression Dimensions

The question asked in this study of 70 clinically referred 6- to 12-year-old boys with behavior problems was whether or not childhood inattention-overactivity and aggression are transmitted specifically from biological fathers to sons. Fathers' self-reported childhood inattention-overactivity on a retrospectively valid measure was exclusively associated with parents' ratings of their sons' current attention problems on the Mothers' Operational Measure for Sub-grouping (MOMS), the Revised Child Behavior Checklist (RCBCL), and an approximated DSM-IV inattention dimension. Fathers' self-reported childhood aggression was not associated with ratings of their sons' aggression on the MOMS or DADS (a parallel instrument for fathers), nor on DSM-III oppositional or conduct disorder dimensions, but it was exclusively associated with RCBCL ratings of sons' aggressive and delinquent behavior. None of the nonspecific correlations (father inattention-overactivity with son aggression or father aggression with son inattention-overactivity) was significant.