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.     

Followup of psychoanalysis five to ten years after termination: III. The relation between the resolution of the transference and the patient-analyst match

As part of a long-term followup study of the outcome of psychoanalysis, we examined the relation between the extent of resolution of the transference at termination and the characteristics of the patient-analyst match. For twelve of the seventeen patients interviewed five to ten years after termination of psychoanalysis, the researchers found that the patient-analyst match played a role in the outcome of the analysis. Illustrations of the influence of the match in cases where the transference was resolved and those where it was not are presented.     

Followup of psychoanalysis five to ten years after termination: I. Stability of change

Seven out of 17 patients interviewed in a long-term followup of psychoanalysis showed either improvement in psychological functioning or a retention of psychological gains they had made during the course of psychoanalysis. Six patients deteriorated in their psychological functioning, but their gains were restored with subsequent treatment. Four patients deteriorated in psychological functioning without restoration, whether or not treatment was reentered. Neither analysts' assessments at the time of termination nor patients' assessments of themselves or assessments based on psychological tests one year after termination predicted which patients would improve or retain psychological change. No causal generalizations about factors related to psychological change can be made from these data. Different factors in interaction are suggested to account for the stability and instability of psychological change.     

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 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.     

A kinematic analysis of anticipatory coarticulation in the speech of anterior aphasic subjects using electromagnetic articulography

An investigation was made into the extent and time course of anticipatory coarticulation in the speech of two normal and two anterior aphasic, German-speaking subjects. Both labial and velar coarticulation gestures were investigated. Subjects produced sentences containing target words contrasting in postconsonantal vowel rounding (e.g., [geli:ge]/[gely:gel]) and in nasality (e.g., [ti:de]/[ti:ne]). Speech kinematics were monitored by means of electromagnetic articulography. The data revealed that for correct productions, aphasic speakers' coarticulatory patterns were more highly variable than those of control subjects. These differences, however, were found chiefly for spatial displacement characteristics, while the temporal aspects of articulator movement necessary for anticipatory coarticulation appeared largely intact. Articulator mistiming did not appear to explain a small corpus of stop/nasal substitution errors produced by one of the aphasic speakers.     

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.     

Compensation for Jaw Fixation by Aphasic Patients

The ability to compensate for fixation of the jaw by a bite block was investigated in 6 nonfluent aphasics, 6 fluent aphasics, and 10 normal control subjects. Acoustic analyses of the vowels [i u a æ] and fricatives [s s] revealed substantial but incomplete compensation for the perturbation in all three subject groups. Perceptual identification scores and quality ratings by naive and phonetically trained listeners indicated poorer identification of the high vowels [i u] under compensatory conditions relative to normal production. Of particular interest was the fact that all three groups of subjects exhibited similar patterns of results. The findings suggest that any deficit in speech motor programming demonstrated by the nonfluent aphasic patients did not affect compensatory abilities. Results are discussed with respect to normal speech adaptation skills and the nature of articulatory breakdown in nonfluent aphasia.