Authenticity as a foundational principle of medical ethics

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.     

Towards authentic conversations. Authenticity in the patient-professional relationship

The purpose of this paper is to evaluate the significance of the existential notion of authenticity for medical ethics. This is done by analyzing authenticity and examining its implications for the patient-professional relationship and for ethical decision-making in medical situations. It is argued that while authenticity implies important demand for individual responsibility, which has therapeutic significance, it perpetuates ideas which are antithetical both to authentic interaction between patients and professionals and to fruitful deliberation of moral dilemmas. In order to counteract these consequences, an alternative idea of authenticity is introduced. According to this idea, authenticity is not regarded primarily as individual sovereignty, but as an ability to participate in a dialogue in which the subjectivity of both partners is respected. Such practice, based on mutual trust and responsibility, would enhance common decision-making and overcome the alienation between patients and professionals.     

Sensorimotor synchronization: Motor responses to pseudoregular auditory patterns

Musically trained and untrained subjects (N=30) were asked to synchronize their finger tapping with stimuli in auditory patterns. Each pattern comprised six successive tonal stimuli of the same duration, the first of which was accented by a different frequency. The duration of interstimulus onset intervals (ISIs) gradually increased or decreased in constant steps toward the end of the patterns. Four values of such steps were used in different trials: 20, 30, 45, and 60 msec. Various time-control mechanisms are hypothesized as being simultaneously responsible for subjects’ incorrect reproduction of the internal temporal ratios of the stimulus patterns. The mechanism of assimilation (of a central tendency) led subjects to enforce a regular (isochronous) structure on the patterns. The influence of other time-control mechanisms (distinction, subjective expression of an accent, sequential transfer) was expressed mainly in differences between intertap onset intervals (ITIs) and the corresponding ISIs at the beginning of the patterns. The duration of the first two ITIs was in the majority of the trials in an inverse ratio to the ratio of the respective ISIs. The distortions resulting from the timing mechanisms concerned were more pronounced in the performance of nonmusicians than in that of musicians.     

The calibration and resolution of confidence in perceptual judgments

Carleton University, Ottawa, Ontariot Canada Confidence rating based calibration and resolution indices were obtained in two experiments requiring perceptual comparisons and in a third with visual gap detection. Four important results were obtained. First, as in the general knowledge domain, subjects were underconfident when judgments were easy and overconfident when they were difficult. Second, paralleling the clear dependence of calibration on decisional difficulty, resolution decreased with increases in decision difficulty arising either from decreases in discriminability or from increasing demands for speed at the expense of accuracy. Third, providing trial-by-trial response feedback on difficult tasks improved resolution but had no effect on calibration. Fourth, subjects can accurately reportsubjective errors (i.e., trials in which they have indicated that they made an error) with their confidence ratings. It is also shown that the properties of decision time, conditionalized on confidence category, impose a rigorous set of constraints on theories of confidence calibration.     

Human Signal-detection Performance: Effects Of Signal Presentation Probabilities And Reinforcer Distributions

University students participated in one of four standard two-choice signal-detection experiments in which signal presentation probability was varied and the reinforcement distribution was held constant and equal. In Experiments 1, 3 and 4, subjects' performance showed a systematic response bias for reporting the stimulus presented least often. Experiments 1 and 4 showed that this effect was reliable with extended training and monetary, rather than point, reinforcement. In Experiment 2, all correct responses were signaled in some way, and this produced the opposite relationship between signal presentation probability and response bias. Experiments 1 and 3 found that explicitly deducting money (intended as punishment) for equal numbers of incorrect responses on each alternative, or varying the obtained overall rate of reinforcement, produced no clear change in response bias. The bias, shown by humans, for reporting the stimulus presented least often remains a challenge for theories of stimulus detection.     

The conversion of Paul

This essay extrapolates from recent psychological data on the phenomena of guilt and splitting to possible implications for the understanding of the experience of the Apostle Paul.     

When More is Better than Less; Three Theories of Psychosis—Projection, Double Bind, and Possession

Three psychological theories of psychosis are described, each of which has standing in psychiatry. Defined by the terms projection, double bind, and possession, they initially appear to have little or nothing in common to explain psychosis, but converge at four points: (1) A high degree of anxiety precipitated by a dilemma or conflict perceived to be unsolvable by the person; (2) the anxiety triggers a shift from one thought or motive in the direction of its opposite, because the original was believed too antagonistic to the wishes of significant others; (3) the opposite, in order to remain opposite, requires that the original thought or motive be forgotten, (4) a singular means to produce and reinforce forgetting is the interposition of psychiatric symptoms. In psychiatry today treatment would fit more consistently with the three theories taken as a whole rather than any one, and a rationale for this viewpoint is elaborated.     

Interviewer evaluations of interviewee nonverbal behavior

Personnel representatives (N = 52) were shown one of four videotaped job interviews in which the verbal content of the 16-min interview was identical, but the interviewee's nonverbal behavior was manipulated. A “low nonverbal” interviewee was defined by minimal eye contact, low energy level, lack of affect and voice modulation, and a lack of speech fluency. The “high nonverbal” interviewee demonstrated the opposite behavior on each of these components. The subjects were asked to rate the videotaped candidates on dimensions previously identified as critical in influencing a job interviewer's decisions. Nonverbal behavior was found to have a significant effect on almost every rating made by subjects in this study. After reviewing the entire 16-min interview, 23 of the 26 subjects who saw the “high nonverbal” candidate would have invited him/her for a second interview. All 26 of the subjects who saw the “low nonverbal” candidate would not have recommended a second interview.