Understanding the Trusted Doctor and Constructing a Theory of Bioethics

This paper offers a constructivist account of bioethics as an alternative to previous discussions that explained the ethics of medicine by an extrapolation of principles or virtues from ordinary morality. Taking medicine as a higher and special calling, I argue that the practice of medicine would be impossible without the trust of patients. Because trust is a necessary condition for medical practice, the ethics of the profession must provide the principles for guiding physician behavior and the profession toward promoting trust and being trustworthy. In a phrase, that principle is “seek trust and deserve it.” I sketch out how the concept of trust provides a different justification for common sense principles of bioethics and explain how the concept of trust provides reasonable guidance for resolving moral conflicts within medicine. The trust-seeking approach provides a new and unexpected ordering of some traditional medical values, it reveals the weightiness of previously undervalued bioethical precepts, and illuminates the centrality of some largely ignored obligations of medicine. It also has the power to guide clinical practice and to inform the profession about standards for medical institutions. This revised version was published online in August 2006 with corrections to the Cover Date.     

Rethinking research ethics

Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research.     

The order of recall and the recall of order

Adelphi University, Garden City, Long Island, New York 11530 Four experiments are described. The first three lend support to the assertion that retrieval from short-term storage (STS) is improved, possibly to a maximum, if items are recalled in their originally presented order. In the fourth experiment a modified recall condition was introduced in which written position of recall reflected order information. Although the subject was not constrained to recall the items in order under this modified recall condition, both item and order retention increased in comparison to both free and serial recall conditions. Within the theoretical framework adopted, the results indicate that retrieval from STS is improved by recalling in order; while long-term storage (LTS) is reduced by the constraint to recall in order. However, LTS is increased by the retention of order information when recalling in order is not required.     

Test-retest reliability of the functional rotation test in healthy adults

Test-retest reliability and concurrent validity for a Functional Rotation Test, developed as a clinical tool for quantifying the extent of body rotation while sitting or standing, were evaluated with healthy adults in this study. Participants, ages 20 to 72 years (n = 36) donned laser-pointing devices, stood or sat in the center of a room calibrated for the test, and actively turned and pointed to the right (or left) as far as they could comfortably. The locations of the lasers were recorded and subsequently scored. Testing was repeated after a brief rest. Concurrent measurements between a clinical goniometer and the Functional Rotation Test were also compared. Intraclass correlation coefficients (ICCs) indicated good to excellent test-retest reliability indices, ranging from .89 to .96 for standing and .87 to .95 for sitting tests. Agreement between the Functional Rotation Test and the goniometer was excellent (ICC = 1.0). The relevance and possible applications of the Functional Rotation Test are discussed.     

Alexithymia, Cumulative Feedback, and Differential Response Patterns on the Iowa Gambling Task

ABSTRACT Although the role of emotional processing is central to contemporary models of risky decision making, to date the role of trait emotional understanding has not been explored experimentally in this context. The current experiment ( N =326) explores the role of alexithymia with respect to performance on the standard Iowa Gambling Task (IGT) and a version where cumulative financial feedback is obscured. Standard learning on the IGT was observed for those low in alexithymia. Those high in alexithymia learned to avoid disadvantageous decks over the first half of the task. However, over the later trials they showed a change in performance, shifting from advantageous to disadvantageous and back to advantageous decks again (termed an "explore-learn-change-return" strategy). It is argued that this is due to an inability to fully consolidate earlier learning and reduced sensitivity to losses. The absence of cumulative feedback independently resulted in reduced performance.