Pluralism,philosophies of medicine and the varieties of medical ethics: A commentary on Thomasma and Pellegrino

Some problems that arise in the account given by Thomasma and Pellegrino [6] of the foundations of medical ethics in a philosophy of medicine are addressed, in particular questions of a conceptual character about treating therelatum of medicine as health. Which concept of health is appropriate and which will bear the burden of the position thomasma and Pellegrino advance? It is argued that the proper relationship of medicine is one between a healer and developing embodied minds. As a consequence, the project of providing a univocal account of the nature of medicine fails. Instead, pluralism infects philosophy and medicine, resulting in different philosophies of medicine. From these philosophies of medicine will follow not a single medical ethics but a variety.     

Note on the computation of biserial correlations in item analysis

A rapid method is described for machine computation of biserial correlations in item analysis with several criteria. This method has been found to yield biserial correlations from punched IBM cards at the rate of about 41 per hour.     

Capitalism versus Marx's Communism

Conclusion In this paper, I have assessed Marx's criticism of capitalism, and the practice of divided labor, from the standpoint of two important senses of worth which persons can have, namely self-respect and self-esteem. I have tried to show that in either case, Communism, as Marx envisioned it, is not the superior to capitalism he might have supposed. Along the way, I hope to have also shown the importance of distinguishing between two concepts, namely self-respect and self-esteem.This paper has benefited from the criticisms of several individuals: Elizabeth Rapaport, who commented upon the version which was read at the Western Meetings of the American Philosophical Association in 1977; Allen Buchanan, who sent me a number of comments, as well as a quite helpful paper of his entitled Exploitation, Alienation, and Injustice; and a referee forStudies in Soviet Thought. My concern to meet their criticisms have made this paper immeasurably better.     

Laying medicine open: understanding major turning points in the history of medical ethics

At different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenonmenon of laying medicine open has sometimes resulted in major turning points in the history of medical ethics. In this paper, I examine two examples of when the laying open of medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724-1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician's fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.     

Responding to allegations of scientific misconduct

Institutions in France are not yet well prepared to respond to allegations of scientific misconduct. Following a serious allegation in late 1997. INSERM,* the primary organization for medical and health-related research in France, began to reflect on this subject, aided by scientists and jurists. The conclusions have resulted in establishing a procedure to be followed in cases of alleged misconduct, and also in reinforcing the application of good laboratory practices within each laboratory. Guidelines for authorship practices and scientific assessment must also be considered. Even though each institution must remain responsible for responding to allegations of scientific misconduct within its doors, INSERM would like to see national, European, and international co-ordination about the methods of such response. Institut National de la Santé et de la Recherche Médicale (eng. French National Medical Research Institute) is known as INSERM. An earlier version of this paper was presented at a symposium, Scientific Misconduct: An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.     

The puzzle of responding maintained by response-contingent shock.

Four squirrel monkeys were first exposed to a sequence of procedures that reliably generate responding maintained by brief response-contingent electric shocks arranged according to a fixed-interval schedule. After responding had become stable on the fixed-interval schedule, additional contingencies were added in tandem, whereby after completion of the interval, the spacing of responses affected shock delivery. In one procedure, responses had to be spaced more widely than their previous median value if shock were to be delivered. In the other procedure, responses had to be spaced more closely to produce shock. On the first of these procedures, decreased but stable responses rates would indicate that shock functioned as a positive reinforcer; on the second, increased response rates would indicate the positively reinforcing function. Instead, response rates accelerated on the procedure that targeted more widely spaced responses for shock delivery, and decelerated or ceased on the procedure that arranged for shocks to be produced by more closely spaced responses. Consistent with other recent findings, these results question the interpretation of performances maintained by response-contingent shock as engendered by positive reinforcement and are consistent with aversive-control interpretations. The details of that aversive control are not entirely clear, however, and these same procedures would be informative if applied to shock-maintained behavior that is generated in other ways.     

Putting the mind back into the body a successor scientific medical model

This paper examines today's received scientific medical model with respect to its ability to satisfy two conditions: (1) its explanatory adequacy relative to the full range of findings in the medical literature, including those indicating a correlation between psychosocial variables and disease susceptibility; and (2) the fit between its physicalist patient and disease concepts and what today's basic sciences, so-called sciences of complexity, tell us about the way matter, notably complex systems (e.g. patients), behave and the nature of scientific explanation. I conclude that the received (biomedical) model falls short on both counts and to satisfy these conditions is to articulate a formal successor model. This successor must be guided by premises consistent with the findings and methods of today's basic sciences on which an applied science like medicine depends for its validity. Additionally, the successor model must be able to explain (and predict) the full range of clinical findings, both those that its predecessors explains and at least some of those that it does not. The aim of the paper is to identify such a model.     

A methodology for teaching ethics in the clinical setting: A clinical handbook for medical ethics

The pluralism of methodologies and severe time constraints pose important challenges to pedagogy in clinical ethics. We designed a step-by-step student handbook to operate within such constraints and to respect the methodological pluralism of bioethics and clinical ethics. The handbook comprises six steps: Step 1: What are the facts of the case?; Step 2: What are your obligations to your patient?; Step 3: What are your obligations to third parties to your relationship with the patient?; Step 4: Do your obligations converge or conflict?; Step 5: What is the strongest objection that could be made to the identification of convergence in step 4 or the arguments in step 4? How can this objection be effectively countered?; and Step 6: How could the ethical conflict, or perceived ethical conflict, have been prevented?     

Control and legacy as functions of perceived criticality in major incidents

This paper outlines a model that captures the experiences of 28 Senior Officers who have managed some of the most significant police incidents in the UK in the past 5 years. The process for capturing the model rests on ‘pragmatic psychology’ (Fishman, 1999; Alison, West & Goodwill, 2003), a paradigm that recognizes practitioners' experiences as a central component of research and policy development. We utilized a set of connected electronic notebooks to enable each critical incident manager to log their experiences and views of the case that they managed. As each individual logs this information, it is simultaneously distributed to all participants. Thus, information is rapidly shared, stimulating further thought and discussion. Following the initial knowledge‐sharing phase, participants reorder the material into themed categories that can then be scored against specific criteria (in this case ‘impact’ and ‘ease’). This session revealed that senior officers consider a combination of two co‐occurring issues as most significant in defining the ‘criticality’ of the incident: (i) how direct an impact the facet has on the enquiry at hand; and (ii) whether that issue will influence how the service will be judged (by the community, the victims and the media). These issues were perceived as the most complex and difficult to deal with. We argue that this perception is a joint function of perceived lack of control alongside the belief that judgment and blame regarding the incident will ultimately reside with them as managers. Copyright © 2004 John Wiley & Sons, Ltd.