The ethics of enforced medical treatment: the balance model

ABSTRACT When is it right to enforce medical treatment on a patient who is refusing that treatment? English law recognises two ethical principles as of paramount importance: the autonomy of the patient; and the consequences of not treating compared with treating. The law, by and large, operates these principles in succession. Thus, in the case of a patient refusing treatment, the law asks first, is the patient competent? Only if the answer is no, are the consequences considered. We criticise the position taken by English law and argue, first, that competence is a graded and not a binary concept, and secondly, that the two ethical principles should be applied not sequentially but at the same time. These two ideas form what we have called the balance model. This model could be used for an empirical study of individuals’ ethical beliefs, and in particular to test the hypothesis that the ethical beliefs of most individuals conform to the balance model rather than to the position taken by English law.     

CPM领导行为评价量表的建构

国外关于领导行为评价的研究,都把领导行为划分为两个因素:一是组织目标达成,另一个是团体维系。本研究用聚类分析得出了三个因素:组织目标达成,团体维系和个人品德。从而验证了我们提出的三因素假设。这种不同,可能是由于中国和西方文化不同所造成的。     

Spare the rod and spoil the icon

Short-term visual storage was investigated with a successive field paradigm, so that correct performance depended upon combining visual information from two targets that were never on simultaneously. In the first two experiments, the stimuli consisted of two slides, each containing a 10' red dot on a gray surround, and separated by an interstimulus interval (ISI) from 20 to 400 msec. Subjects had to determine if the dots were vertically or horizontally aligned. In Experiment 1, the stimuli had either no contrast for the rods or no luminance contrast for the cones or high contrast. At short ISIs the cone contrast determined performance, whereas at long ISIs the rod contrast determined performance. In fact, when the dots were invisible to the rods, the task was impossible for long ISIs. In Experiment 2, performance was compared for zero log rod contrast and for small departures from zero. Even a small departure from zero log rod contrast resulted in above-chance performance. In Experiment 3, the stimuli were luminous rectangles and the task was to decide whether or not a 4' spatial gap was present between the two successively presented rectangles. Wavelength, luminance, and ISI were varied under both photopic and scotopic adapting conditions. The result was that the rods performed the task for ISIs of 150 msec or longer under scotopic conditions and under the photopic conditions that we were able to test. The results of the experiments taken together are consistent with the hypothesis that the cone icon is short, whereas the rod icon is robust and long lasting.     

Target duration effects on iconic memory: the confounding role of changing stimulus dimensions

Observers' accuracy in detecting a narrow spatial gap between two brief, luminous rectangles presented successively was determined within a two-alternative, forced-choice procedure. This successive-field task requires iconic memory, because the information (rectangle position) in the two presentations must be combined for successful gap detection. On this task, the effect of varying the duration of the first rectangle was systematically investigated over several target luminance levels and for several ISI conditions between rectangles. At the long ISI conditions (100 and 300 ms), the effects of increasing stimulus duration was to improve performance. However, at the brief ISI condition (20 ms), increasing stimulus duration initially depressed task performance. It was found that, with practice, this initial performance drop largely disappeared, and the beneficial influence of increasing target duration was again obtained. These results are discussed in terms of (a) a proposed retinal locus for the iconic memory involved and (b), at a more general level, the potentially distracting role of changing stimulus dimensions on a task employing transient stimuli as in the present study.     

Non-Informative Effects of Stimuli Functioning as Cues

The category of a first stimulus (S₁) serving as a cue may allow a subject to predict the category of a second stimulus (S₂). However, a cue may have effects on RT to S₂ that are independent of those derived from its intended role as a predictor. These non-informative effects of a cue may add to or subtract from the benefits associated with its predictive function. Two experiments demonstrate that when S₁ is in the same category as S₂ (as is frequently the case for valid cues in cueing experiments) but provides no information about S₂, RT is slower than when S₁ is in a different category from S₂. It is suggested that this category relation effect arises because inhibition of a response to S₁ is still present when S₂ arrives and that, in some cueing experiments, it may subtract from the RT benefits derived from the cue as a predictor of S₂. Also, RT to a visual but not to an auditory S₂ was faster after an auditory S₁ than after a visual S₁. It is argued that this modality combination effect is consistent with the view that auditory signals are more alerting than visual ones and that this is another factor to be taken into account in the design of cueing and other experiments.     

Assessing text representations with recognition: The interaction of domain knowledge and text coherence

Readers construct at least 2 interrelated mental representations when they comprehend a text: a textbase and a situation model. Two experiments were conducted with recognition memory to examine how domain knowledge and text coherence influence readers' textbase and situation-model representations. In Experiment 1, participants made remember-know judgments to text ideas. Knowledge and coherence interacted to influence remember judgments differently than know judgments. In Experiment 2, the authors used the process-dissociation procedure to obtain recollection and familiarity estimates. Knowledge and coherence interacted to influence recollection estimates but not familiarity estimates. The authors claim that recollection and familiarity can be used as markers of the different processes involved in constructing a textbase and a situation model.     

Schedule thinning following communication training: using competing stimuli to enhance tolerance to decrements in reinforcer density

Functional communication training (FCT) is a widely used treatment for individuals with developmental disabilities who exhibit severe behavior problems. One inherent challenge of employing FCT as a treatment in the community is that reinforcement for appropriate communication cannot always be immediate or even possible in some circumstances. Of the few studies that have incorporated some form of schedule thinning for communication, most have reported disruption of communication or increases in problem behavior when the schedule of reinforcement is thinned. In the current study, we compared FCT with extinction to FCT with extinction and access to competing stimuli. After conducting a functional analysis, a competing stimulus assessment was performed to identify stimuli that produce reinforcement that ostensibly competes with reinforcement that maintains problem behavior. It was hypothesized that FCT with competing stimuli would result in more stable reductions in problem behavior during schedule thinning, which would ultimately result in quicker achievement of the treatment goal (low levels of problem behavior under the terminal reinforcement schedule for communication) than FCT without competing stimuli. Results confirmed this hypothesis.     

The propositional structure of discourse in the two cerebral hemispheres

Readers construct at least two interrelated representations when they comprehend a text: (a) a representation of the explicit ideas in a text and the relations among them (i.e., a propositional representation) and (b) a representation of the context or situation to which a text refers (i.e., a discourse model). In a recent study, found evidence that readers' representations were structured according to propositional relations, but only in the left hemisphere. Both hemispheres, however, appeared to represent contextually relevant semantic information. The goal in the current study was to examine further the organization of explicit text concepts in the two hemispheres. We used an item-priming-in-recognition paradigm in combination with a lateralized visual-field manipulation. We found evidence for a propositionally structured representation in the left hemisphere, that is, priming effects that reflected the linear distance between primes and targets in the propositional structure of passages. We also found that the right hemisphere represented explicit text concepts, but we found no evidence that these concepts were organized structurally. In a second experiment, we found our item priming effects reflected the representation of text information in memory and did not reflect lexical-semantic priming at test.     

An evaluation of carbon dioxide as a short acting anesthetic

The use of carbon dioxide (CO₂) as a quick-acting anesthetic of short duration was studied. Sixteen rats were exposed to a CO₂ atmosphere for 10 and15 sec on separate days. Records were taken of the time required for the administration of intramuscular and gavage injections as well as recovery of motor functions. Recovery following both exposure times was less than 2 min Data are presented that show that there are no prograde effects of CO₂: exposure on subsequent variable-interval (VI-15 sec) behavior.