Justice and care: The implications of the Kohlberg-Gilligan debate for medical ethics

Carol Gilligan has identified two orientations to moral understanding; the dominant ‘justice orientation’ and the under-valued ‘care orientation’. Based on her discernment of a ‘voice of care’, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.     

The effects of baby bath and massage by fathers on the family system: The sunraysia australia intervention project

Instruction in baby massage and the Burleigh Relaxation Bath technique was given to one-half of our sample of 32 couples who had just had their first child. This brief intervention, given at 4 weeks post-partum, led to beneficial behavioural and psychological effects for the family system when assessed at 12 weeks postpartum. Depression and marital satisfaction were assessed with mothers and fathers at 4 weeks and 12 weeks after the birth of their child, and self-esteem was measured at 12 weeks only. The mothers and fathers who were shown baby bathing and massage techniques showed higher degrees of marital satisfaction and self-esteem, as well as lower levels of depression at 12 weeks post-partum, than parents who did not receive instruction. It seems likely that brief interventions which educate new parents concerning functional techniques of baby care may favourably affect their feelings of competence and be of benefit to the entire family system.     

Influence of Family Support on Men in a Minimum Security Detention Center

The authors explored the relationship between family support and adjustment for adult men in a detention center, as measured by a staff rating scale completed by the appropriate counselor.     

A tether system for cardiovascular studies with the behaving micropig

A tether system has been developed for continuous monitoring of blood pressure in the micropig. The micropig is a suitable model for blood-pressure research because of the similarity of its cardiovascular system to that of humans and because of its sensitivity to high sodium intake. The system consists of a metal boom, attached via a universal joint to a wall 6 ft above floor level, that extends horizontally to the center of the enclosure. A fluid and electronic swivel affixed to the boom is connected to a flexible, hollow, metal tether that descends to a vest worn by the micropig. The vest contains a pressure transducer to which an indwelling arterial catheter is connected via a stopcock. The transducer cable and an infusion line ascend through the interior of the tether to the swivel. The system remains in equilibrium through a system of pulleys and counterweights. Continuous, 24-h recording shows a diurnal variation characterized by higher heart rate but lower blood pressure during the day than at night. The system has been found to be effective for continuous studies over intervals of a month or more.     

Convergent methods in psychomusical research based on integrated,interactive computer control

Much of what we learn from an experiment depends on what we ask of the subjects and how we ask it. Most music perception and cognition research is implemented using a single methodology. Recently, questions have been raised about the validity and generalizability of such a limited approach, particularly regarding such complicated theoretical constructs as musical tonality. We propose that a useful technique is to converge on the answer to experimental questions by applying multiple methods, in essence, simultaneously investigating the central research question as well as ancillary questions of method. Such an approach is facilitated by a computer hardware and software system that integrates experimental design, data collection, data analysis, and data dissemination, linking off-the-shelf components through standard file formats and data-exchange protocols. The list-based system, using an IBM-type PC running Windows 3.0, handles real-time natural sound sampling and playback, signal synthesis and analysis, MIDI input and output, digitized picture display, and various subject-response mechanisms. On the basis of graphical icons, the integrated system can be used to build custom experimental designs. Examples of convergent psychomusical experiments that were designed, implemented, and analyzed using the system are discussed.     

Analysis of periodic data using Walsh functions

Data often contain periodic components plus random variability. Walsh analysis reveals periodicities by fitting rectangular functions to data. It is analogous to Fourier analysis, which represents data as sine and cosine functions. For many behavioral measures, Fourier transforms can produce spurious peaks in power spectra and fail to resolve separable components. Walsh analysis is superior for strongly discontinuous data. The strengths and weaknesses of each transform are discussed, and specific algorithms are given for the newer Walsh technique.     

Amplitude rise time and the perception of the voiceless affricate/fricative distinction

Variation of amplitude envelope at stimulus onset has been considered to be of primary importance for distinguishing voiceless affricates from fricatives (e.g., |t∫| and |∫|). In earlier perceptual experiments, however, variation in amplitude rise time was confounded with variation in frication duration. In two experiments, these variables were independently manipulated, and their individual and combined effects for perception of |t∫| and |∫| were examined. Variation in amplitude rise time alone was not sufficient to signal the voiceless affricate/fricative contrast in these experiments, but variation in frication duration alone was sufficient.     

The role of physical attractiveness in adjustment.

This article presents a model of how attractiveness influences adjustment and reviews the relevant evidence. The model suggests that attractiveness influences adjustment through a three-stage process. Varying levels of physical attractiveness create differential responses in other people (Stage 1). These differential responses in others as a function of a person's appearance then result in differential treatment of the person (Stage 2), with such differential treatment eventually resulting in differential adjustment (Stage 3). These three stages are considered to occur in a reciprocal manner across the life span. Empirical support is found for each stage from early childhood to adulthood. Attractiveness accounts for 6% to 16% of the variance in measures of subjective adjustment as well as sociometric and behavioral measures of interpersonal adjustment.     

Primacy of dimensions in vibrotactile perception: An evaluation of early holistic models

Early holistic models of perception presume that stimuli composed of interacting dimensions can be experienced initially as undifferentiated. This view, formalized through recourse to a Euclidean geometry of perceptual space, predicts that the orientation of axes used to create stimulus sets is unimportant to performance in speeded classification. We tested this idea by using the interacting vibrotactile dimensions of pitch and loudness. Despite perceivers’ relatively poor experience with these dimensions, we showed that the orientation corresponding to pitch and loudness was unique in vibrotactile perceptual space; subjects classified stimuli more efficiently at this orientation than at other orientations. Certain holistic models also claim that when stimulus differences are small, perceivers can recognize change without distinguishing the kind of change. We tested this idea by using a signal detection analysis of unspeededsame—different decisions. We found that subjects’ ability to notice the kind of change equaled their ability to notice the change alone. In view of these results, which indicate that pitch and loudness are primary in vibrotactile perception, we detail a new conception of dimensional interaction.     

Increasing the intelligibility of speech through multiple phonemic restorations

Outside of the laboratory, listening conditions are often less than ideal, and when attending to sounds from a particular source, portions are often obliterated by extraneous noises. However, listeners possess rather elegant reconstructive mechanisms. Restoration can be complete, so that missing segments are indistinguishable from those actually present and the listener is unaware that the signal is fragmented. This phenomenon, called temporal induction (TI), has been studied extensively with nonverbal signals and to a lesser extent with speech. Earlier studies have demonstrated that TI can produce illusory continuity spanning gaps of a few hundred milliseconds when portions of a signal are replaced by a louder sound capable of masking the signal were it actually present. The present study employed various types of speech signals with periodic gaps and measured the effects upon intelligibility produced by filling these gaps with noises. Enhancement of intelligibility through multiple phonemic restoration occurred when the acoustic requirements for TI were met and when sufficient contextual information was available in the remaining speech fragments. It appears that phonemic restoration is a specialized form of TI that uses linguistic skills for the reconstruction of obliterated speech.