Philosophy of medicine: should it be teleologically or socially construed?

This response to Kevin Wildes's article in the previous issue of the Kennedy Institute of Ethics Journal addresses several major points of disagreement between Pellegrino and Wildes regarding the nature and scope of a philosophy of medicine, in particular how it is derived and by what method of philosophical enquiry it is best pursued.     

The Institute on Human Values in Medicine: Its Role and Influence in the Conception and Evolution of Bioethics

For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in defining thefield, training faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education.     

Managed care at the bedside: how do we look in the moral mirror?

Managed care per se is a morally neutral concept; however, as practiced today, it raises serious ethical issues at the clinical, managerial, and social levels. This essay focuses on the ethical issues that arise at the bedside, looking first at the ethical conflicts faced by the physician who is charged with responsibility for care of the patient and then turning to the way in which managed care exacts costs that are measured not in dollars but in compromises in the caring dimensions of the patient-physician relationship.     

Acquisition of route and survey knowledge in the absence of vision

The ability of sighted, blindfolded individuals to navigate while walking was assessed in two types of tasks, one requiring knowledge of a route that previously had been navigated and another requiring more complex spatial inference or computation. A computerized measurement system monitored spatial position. The route tasks included maintenance of a heading, distance and turn reproduction and estimation, and turn production. The inferential task required completion of a multisegment pathway by returning directly to the origin. pathways were replicated at two different scales. Measures for the route-knowledge tasks indicated a substantial ability to navigate in the absence of visual cues. Route reproduction performance was particularly accurate despite intrinsic veering tendencies. A substantial increase in error was observed in the pattern-completion task. Errors in pathway completion increased with pathway complexity and were quite similar in the two scales. Correlational data suggested that performance on different route-knowledge tasks reflected differing underlying representations. The completion task led to a high correlation between absolute turn and distance error but had minimal correlations with the route tasks. The data suggest that a survey representation with some degree of scale independence was constructed for use in the pathway completion task.     

Process training derived from a computer simulation theory

Kotovsky and Simon (1973) identified four basic subprocesses in their computer simulation of adult and adolescent performance on Thurstone letter series completion problems. In Experiment I, children from Grades 1 to 6 were pretested on those problems, and then experimental subjects were trained on two of the four processes as an attempt to experimentally support a correspondence between the computer subroutines and human cognitive processes. A posttest administered in the experimental and control conditions revealed a significantly greater improvement for experimental subjects, although both groups made significant gains. The children's distributions of errors were consistent with Kotovsky and Simon's predictions. In Experiment II, children from Grades 3 and 5 took four series completion tests without intervening training. The additional practice was sufficient for Grade 5 subjects to make improvements similar in magnitude to those produced by training. Grade 3 subjects, however, made no gains. These results are related to Tulving and Pearlstone's (1966) distinction between the availability and the accessibility of memory traces.     

CER suppression, passive-avoidance learning, and stress-induced suppression of drinking in the Syracuse high- and low-avoidance strains of rats (Rattus norvegicus)

The Syracuse strains of Long-Evans rats were selectively bred for good (SHA) or poor (SLA) avoidance learning in a two-way shuttle box, which resulted in a phenotypic difference that is correlated with behavior patterns indicative of emotional reactivity, SLA animals showing evidence of greater emotional reactivity than SHA animals. The first three experiments examined conditioned suppression of bar pressing and compared paired and unpaired conditioned- and unconditioned-stimulus presentations to evaluate the influence of conditioning versus primary aversive stimulation on baseline responding. SLA animals acquired conditioned suppression faster than SHA animals and also showed greater suppression of baseline responding than SHA animals. In Experiment 4, SLA animals learned a passive-avoidance task faster than SHA animals. In Experiment 5, SLA animals showed greater stress-induced suppression of drinking a weak quinine solution than SHA animals. These data are consistent with the hypothesis that SLA animals are more emotionally reactive than SHA animals.     

A general measure of organization in free recall for variable unit size and internal sequential consistency

A general procedure that can be applied to any type of free recall data for the quantitative measurement of subjective organization intertrial repetitions (ITRs) is described. The procedure makes it possible to examine any unit size with any type of internal consistency criterion. The application of this procedure and the corresponding expected value formula to four distinct data measurement cases is described, and several applied subjective organization measures are discussed. In addition, the relationship of clustering as a special case of subjective organization is demonstrated.     

Individual differences in process outcomes for verbal analogy and classification solution

Adult performance on verbal analogy and classification problems was assessed in terms of the outcomes of process execution. Measures were obtained for the accuracy of stem processing and subsequent alternative processing. The process-outcome measures obtained within each task accounted for overall performance scores and were differentially related to ability. This was shown by ability differences in the models accounting for subjects' overall accuracy and in the correlational patterns. Analogy and classification problem forms differed in the measures most important for predicting individual differences. Specifically, measures of alternative processing were more important in classification than analogy solution and application was shown to be important for analogy solution. In addition, common process-outcome measures showed the highest correlations across problem forms, consistent with the assumption that both induction tasks tap similar psychological processes. The results are discussed with respect to previous studies assessing commonality and individual differences among children in process-outcomes.