Philosophy of medicine in 2021

Theoretical Medicine and Bioethics -     

‘Mutual Obligation’ and ‘New Deal’: Illegitimate and Unjustified?

It is now commonplace for governments in Western countries to require the unemployed to work in exchange for their unemployment benefits. In this article I raise some serious doubts about the most promising and philosophically interesting defence of this argument, which relies on the ‘principle of reciprocity’. I argue that it is seriously unclear whether the obligations imposed on welfare claimants by ‘workfare’ schemes are legitimate and justified according to the principle of reciprocity. I do this by reconstructing the arguments for the obligations of the unemployed put forward in both the United Kingdom and Australia.     

Six-year follow-up of three treatment programs to personality disorder

Previous studies of long-term outcome for personality disorder (PD) were either retrospective in design or did not include a control condition. In this paper we report results for three PD cohorts (N = 111) treated in two different specialist psychosocial programs (step-down and long-term inpatient) and in general psychiatric treatment as usual (TAU), which were prospectively followed up for 72-months after intake. The three PD samples were compared on symptom severity, social adjustment, global functioning and other clinical indicators (self-mutilation, parasuicide and readmission rates) at intake, 6, 12, 24, and 72 months. Results indicated that a specialist step-down model showed significantly greater change than a purely inpatient model and TAU in most key dimensions of functioning, a difference maintained at 72-months follow-up. Improvement in the samples was not associated with amount of intercurrent treatment received in the year prior to the follow-up assessment. This study confirms that a step-down program retains significant improvement associated with a specialist psychosocial approach for PD. However, this conclusion should be qualified by design limitations. The samples were not randomly allocated to the three conditions and the naturalistic geographical allocation used in the study created a potential for a number of confounds. Whilst we used extensive statistical controls, the possibility that the differences found between the groups may be due to population differences cannot be discounted.     

A Socioecological Approach to Relational Demography: How Relative Representation and Respectful Coworkers Affect Job Attitudes

Purpose

This paper advances a socioecological perspective toward understanding the relationship between demography and job attitudes by considering the joint effects of individual ethnicity and ethnic group relative representation—the degree to which an individual’s own demographic group is represented similarly in their organization and the community in which the organization is located.

Design/Methodology/Approach

Hierarchical polynomial regression analyses of census and survey data from 57,000 employees of 142 hospitals in the United Kingdom suggest that ethnic group relative representation is related to ethnic minority employees’ job satisfaction and turnover intentions.

Findings

An asymmetric pattern emerged wherein the effect of under-representation on turnover intentions was stronger than the effect of over-representation. Moreover, the effects of relative representation varied with respectful treatment by coworkers; relative representation had little effect on attitudes of employees who reported low levels of coworker respect but generally enhanced attitudes when respect was high.

Originality/Value

This work points to the meaningful role that socioecological factors can play in what are typically considered to be intraorganizational phenomena, thereby highlighting the need for organizational research to assess relevant aspects of the communities in which organizations are embedded.

     

Persistence and relapse of reinforced behavioral variability

The present study examined persistence and relapse of reinforced behavioral variability in pigeons. Pigeons emitted four‐response sequences across two keys. Sequences produced food according to a lag schedule, in which a response sequence was followed by food if it differed from a certain number of previous sequences. In Experiment 1, food was delivered for sequences that satisfied a lag schedule in both components of a multiple schedule. When reinforcement was removed for one component (i.e., extinction), levels of behavioral variability decreased for only that component. In Experiment 2, food was delivered for sequences satisfying a lag schedule in one component of a multiple schedule. In the other component, food was delivered at the same rate, but without the lag variability requirement (i.e., yoked). Following extinction, levels of behavioral variability returned to baseline for both components after response‐independent food delivery (i.e., reinstatement). In Experiment 3, one group of pigeons responded on a lag variability schedule, and the other group responded on a lag repetition schedule. For both groups, levels of behavioral variability increased when alternative reinforcement was suspended (i.e., resurgence). In each experiment, we observed some evidence for extinction‐induced response variability and for variability as an operant dimension of behavior.     

Peer Victimization and Suicidal Thoughts and Behaviors in Depressed Adolescents

Suicide is a leading cause of death among youth worldwide, and depressed adolescents are at a significantly elevated risk to report suicidal ideation, planning, and attempts. Peer victimization is a robust predictor of adolescent suicidal thoughts and behaviors (STBs), but little research has focused on why bullying leads to suicidal thoughts and behaviors. To address this empirical gap, we recruited 340 (246 female) depressed adolescents ages 13–19 (M = 15.59, SD = 1.41) within 48 h of admission for acute psychiatric treatment. At the initial assessment, participants were administered clinical interviews characterizing psychopathology, nonsuicidal self-injury, and STBs (ideation, plans, and attempts). Further, they completed questionnaires assessing 3 forms of victimization (overt, relational, and reputational), recent risky behavior engagement, and psychiatric symptom severity. Controlling for internalizing symptoms and age, overt and reputational bullying were associated with more frequent past month suicide attempts, but not suicide ideation. Past month risky behavior engagement, but not NSSI, mediated the relation between victimization and attempts. However, sex differences revealed that this effect only held for males whereas bullying was directly associated with suicide attempts among females. In contrast, overt and relational bullying were non-linearly associated with suicide plans, and these relations were not mediated by risky behaviors or NSSI. Results highlight the complex network of factors that lead victimized adolescents to engage in STBs and may inform targeted suicide prevention and intervention programs.