Toward a Reconstruction of Medical Morality

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.     

Fear response to dissociation challenge

Abstract

Participants (N = 101) scoring high or low on a new scale for assessing fear of dissociative sensations (Dissociation Sensitivity Index) underwent an audio/visual sensory challenge using a device called the D.A.V.I.D. Participants' report of subjective fear and level of dissociation were measured before and after completing the audio/visual sensory challenge. Consistent with prediction, participants scoring high on the DSI responded to the challenge with significantly greater increases in subjective fear and dissociative symptoms relative to those scoring low on the DSI. Contrary to prediction, the DSI performed poorer than the Anxiety Sensitivity Index in predicting participants' response to the audio/visual sensory challenge. Theoretical and clinical implications of the findings are discussed.     

Effects of membership change on open discussion and team performance: The moderating role of team tenure

This study identified temporal conditions when membership change may enhance or diminish team functioning. Using a longitudinal repeated measures design surveying 41 R&D teams, this study examined whether team tenure moderated the relationship of membership change with open discussion and team performance. The results illustrated that increasing membership change was positively associated with both open discussion and team performance for newly formed teams, whereas this association was negative for long-serving teams. Thus, what matters is not so much whether a team's membership changes but rather whether the team's longevity supports or impedes adaptation to personnel changes.     

Goal-driven reasoning overcomes cell D neglect in contingency judgements

Research on contingency judgement typically shows cell weight inequality such that the information in cell A of a contingency table is considered more relevant than the information in cell D, even though both kinds of information have the same confirmatory meaning. Two studies tested whether goal-driven reasoning can lead people to realise the value of the information in cell D. Participants' goal to defend a particular conclusion for which the information in cell D was helpful was manipulated. Whereas participants who did not have that goal displayed the usual cell D neglect, goal-driven participants for whom cell D contained goal-relevant information considered it important. More importantly, in subsequent tasks with different contents where participants were no longer driven by any goal, they continued to consider information in cell D relevant (Study 1), and they were more likely to make correct contingency judgements, which depended on considering cell D (Study 2).     

Challenges to Audi's Ethical Intuitionism

Robert Audi's ethical intuitionism (Audi, 1997, 1998) deals effectively with standard epistemological problems facing the intuitionist. This is primarily because the notion of self-evidence employed by Audi commits to very little. Importantly, according to Audi we might understand a self-evident moral proposition and yet not believe it, and we might accept a self-evident proposition because it is self-evident, and yet fail to see that it is self-evident. I argue that these and similar features give rise to certain challenges to Audi's intuitionism. It becomes harder to argue that there are any self-evident propositions at all, or more than just a few such propositions. It is questionable whether all moral propositions that we take an interest in are evidentially connected to self-evident propositions. It is difficult to understand what could guide the sort conceptual revision that is likely to take place in our moral theorising. It is hard to account for the epistemic value of the sort of systematicity usually praised in moral theorising. Finally, it is difficult to see what difference the truth of Audi's ethical intuitionism would make to the way in which we (fail to) handle moral disagreement.     

Age and Education Differences in Marriages and their Effects on Life Satisfaction

Within marriages husbands typically tend to be older and higher educated than their wife. This paper tries to explain this by analyzing whether age and education differences between spouses have an effect on happiness. Two alternative hypotheses are tested on the relation between age and education gaps between partners and life satisfaction. It is found that a positive age gap between husband and wife increases both male and female life satisfaction, while female life satisfaction increases if the education gap is smaller.     

A case of subcortical dementia due to sarcoidosis of the hypothalamus and fornices

A patient with sarcoidosis involving predominantly the hypothalamus and fornices was evaluated for dementia. He showed a relative sparing of fund of knowledge and orientation. Memory skills, particularly short-term memory, were severely impaired. Behavioral changes included apathy and a lack of spontaneity. Insight was relatively preserved. The pattern of his deficits showed some similarities to the pattern reported in patients with Huntington's disease and was different from that described in Alzheimer's disease. The dementia caused by subcortical pathology may differ in important respects from that caused by diffuse cortical dysfunction.     

Evidence for differentiation of right hemisphere visual-perceptual functions

Performance on tasks sensitive to right hemisphere dysfunction (facial discrimination and perceptual closure) are reported in eight patients with right hemisphere lesions. Patients demonstrated an apparent double dissociation of performance on the two measures. Site-by-task specificity for the closure task was strongly suggested. Implications for right hemisphere organization and underlying psychological processes are considered.     

Moderate Intuitionism and the Epistemology of Moral Judgment

This paper outlines and defends a moderate intuitionism. The point of departure is the intuitionism of W. D. Ross (1930) in The Right and the Good, conceived as ethically pluralist and epistemologically rationalist. The paper articulates a conception of self-evidence – including mediate as well as immediate kinds – appropriate to a moderate intuitionism, explores some of the resources and varieties of that position, and considers some problems and prospects for a rationalist version of intuitionism. The final section addresses the issue of how best to conceive the nature and grounds of prima facie duty, the problem of whether intuitionism can adequately deal with conflicts of prima facie duties, and the question of how satisfactorily a moderate intuitionism can account for the epistemic status of moral judgments of overall duty and their connection with rational action.     

The relationship between expressed social fears and assertiveness and its treatment implications

Behavior therapists have speculated about the relationship between social fears or social anxieties and lack of assertive behavior. Wolpe (1958) perhaps most clearly suggested such a relationship. “If he [the patient] has been ineffectual in such situations—unable, for instance, to return a faulty garment—I explain how unadaptive fears are at the bottom of this ineffectualness. … p. 116.” Wolpe further assumed that engaging in assertive behavior reciprocally inhibited fear in these same social situations and that assertive responses can be programmed for use in overcoming these fears.In later writings (Wolpe. 1969; Wolpe and Lazarus, 1966) Wolpe seems to have broadened his position concerning the cause of non-assertive behavior. Specifically, he now allows that an individual also may be non-assertive, “… not because of anxiety but because they have never had the opportunity of acquiring the necessary habits. p. 40” (Wolpe and Lazarus, 1966). For these individuals direct efforts in assertive training such as behavior rehearsal, operant conditioning or direct instruction are in order. For these individuals whose lack of assertiveness is due to a ‘phobic reaction’ or strong extrinsic fears, systematic desensitization is recommended in addition to assertive training.Despite this apparent change in position, the intuitively appealing notion that the more socially fearful an individual is the more non-assertive he is likely to be has not received the empirical attention it deserves. Rathus (1973) seems to have provided some indirect evidence pertaining to the relationship between social fears and assertiveness. In the context of evaluating the efficacy of an assertive training method he administered both the 100-item Temple Fear Survey Inventory (TFSI) (Braun and Reynolds, 1969) and the Rathus Assertiveness Schedule (RAS) (Rathus, 1973) to groups of female students receiving either assertive training, a placebo treatment or no treatment. He found that at post-test the assertive training group scored significantly higher than either the placebo or no treatment groups on the RAS and that there were no significant differences in post-test Full Scale TSFI Scores. Fear of Social Criticism Factor Scores or Fear of Social Incompetence Factor Scores although in each case the mean changes toward less fear were greater for the group receiving assertive training. This finding gives little support to the reciprocal relationship between social fears and assertiveness. What is needed is a direct determination of the degree to which social fears and assertiveness are related in a sizeable sample of subjects.