Medical ethics in an era of bioethics: Resetting the medical profession’s compass

What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This presentation summarizes the history of medical professionalism and refocuses attention on the interpersonal relationship of doctor and patient. This keynote address was delivered at the Founders of Bioethics International Congress (June, 2010).     

Lexical processes and eye movements in neglect dyslexia

Neglect dyslexia is a disturbance in the allocation of spatial attention over a letter string following unilateral brain damage. Patients with this condition may fail to read letters on the contralesional side of an orthographic string. In some of these cases, reading is better with words than with non-words. This word superiority effect has received a variety of explanations that differ, among other things, with regard to the spatial distribution of attention across the letter string during reading. The primary goal of the present study was to explore the interaction between attention and lexical processes by recording eye movements in a patient (F.C.) with severe left neglect dyslexia who was required to read isolated word and non-word stimuli of various length. F.C.'s ocular exploration of orthographic stimuli was highly sensitive to the lexical status of the letter string. We found that: (1) the location to which F.C. directed his initial saccade (obtained approximately 230 ms post-stimulus onset) differed between word and non-word stimuli; (2) the patient spent a greater amount of time fixating the contralesional side of word than non-word strings. Moreover, we also found that F.C. failed to identify the left letters of a string despite having fixated them, thus showing a clear dissociation between eye movement responses and conscious access to orthographic stimuli. Our data suggest the existence of multiple interactions between lexical, attentional and eye movement systems that occur from very initial stages of visual word recognition.     

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.     

Short-term retention of pictures and words: evidence for dual coding systems.

The recall of picture and word triads was examined in three experiments that manipulated the type of distraction in a Brown-Peterson short-term retention task. In all three experiments recall of pictures was superior to words under auditory distraction conditions. Visual distraction produced high performance levels with both types of stimuli, whereas combined auditory and visual distraction significantly reduced picture recall without further affecting word recall. The results were interpreted in terms of the dual coding hypothesis and indicated that pictures are encoded into separate visual and acoustic processing systems while words are primarily acoustically encoded.     

Knowledge about hand shaping and knowledge about objects

Our two experiments investigated associations between cognitive representations of objects and hand-shape categories. Hand configurations were partitioned according to prehensility and the size of the contacting surface, resulting in the classes: pinch, poke, palm, and clench. Experiment 1 elicited object names in response to configuration-name cues, provided ratings of the relevance of each configuration to a set of objects, and probed for the functions determining such relevance. Cueing with a configuration class elicited an associated object category with substantial intersubject agreement, and vice versa. Both the object categories and the functions associated with the four hand-configuration classes differed substantially, although the same object could be associated to some extent with multiple configurations, given variations in function. Experiment 2 elicited the names of hand-configuration classes in response to unfamiliar forms, which varied systematically in depth and the size of the projecting picture-plane surface. The modal response, response time, and degree of intersubject agreement were directly related to these variables. These structural variables, however, did not adequately predict shaping responses to real objects, as ascertained from Experiment 1. The results have implications for cognitive representation of motor categories and hand shaping in response to objects.