A study of the foundations of ethical decision making of clinical medical ethicists

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values.     

循证医学的辩证思维

随着临床医学的发展,临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据,如随机对照研究的结果,特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题,同时强调不断进行知识更新,掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗,因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据,为了提高服务质量并且充分把握特殊专业领域的现状,临床工作者也需要不断了解新的依据信息。在众多的研究信息中,我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析,确定该结论是否真实并适合我们的实际,从而制定有据可查的诊疗方案。     

Post-decision consolidation: group members in different social settings compared to individual decision makers

Two experiments were conducted to examine how making decisions in a 3-member group affects the degree of post-decision consolidation, defined as attractiveness changes in favor of the chosen alternative. Both experiments were conducted in two sessions one week apart. In the first session (decision phase), participants estimated the importance of each of four different attributes describing two decision alternatives. They were then shown predetermined attractiveness ratings on each of the attributes and were to decide on the two alternatives, either individually or as a group. In the second session (post-decision phase), the participants were to attempt to recall the attractiveness ratings for the attributes as presented to them in session one. In both experiments, significant post-decision consolidation was found for individual decision makers but not for group members. In experiment 2, this result was replicated, no difference in consolidation being found between group members with face-to-face interaction and without.     

Postdecision consolidation in a trend prediction task

To be able to learn from experience it is necessary to correctly apprehend experienced feedback and the situation in which it is provided. The results indicate how post-decision consolidation in complex domains may affect learning. The problem may be particularly pertinent in recurrent decision making where considerable risk is involved. The study explores the changes in aspect (signal) importance from pre- to postdiction as a function of outcome information. By postdiction we mean the remembering of an earlier prediction (cf. Hawkins & Hastie, 1990). Subjects were asked to decide on which of four alternative future price developments would follow a historical price trajectory for different commodities, and to rate the importance of each of the chosen alternative's corresponding aspects. The subjects revealed a bias in their support ratings of aspects--seeing support in aspects that traditionally (by themselves and in many contexts) would be seen as neutral or even counter-indicative of the alternative chosen. After an intermission, the subjects were also given information about what was indicated to be the actual development of the market. One group was told that their decisions were correct (irrespective of what the decisions were), another group that they were incorrect but close, a third group that they were incorrect by far, while a fourth group served as a control. Following this information the subjects were again asked to judge the importance of the aspects for their own prior decision on the most likely future development. The results indicated that outcome feed-back had an effect on post decision restructuring of facts. Subjects in the correct condition showed an average consolidation that increased the support, while the wrong conditions lead to negative consolidation (in retrospect indicating that they never found as much support for their decision in the past as they actually did). Thus, in a choice between consolidating their own initial prediction and the price trajectory they would have to live with, the decision makers consolidated the outcome. Therefore, the results of the study were related to the hindsight bias phenomenon (Fischhoff, 1975) and to Kahneman and Miller's (1986) mutability concept.     

多特征决策策略的信息搜索模式分析

决策策略的使用是不可见的内在过程 ,有效识别出决策者在信息整合时使用的策略对研究策略学习与转换、决策辅助与训练有重要意义。本文介绍了用过程追踪技术获取的信息搜索模式识别多特征决策策略的方法 ,即单步与多步跳转分析 ,并比较了两种方法的应用效果 ,讨论了跳转分析法的优点和局限。     

On the Meaning of Words and Dinosaur Bones: Lexical Knowledge Without a Lexicon

Although for many years a sharp distinction has been made in language research between rules and words—with primary interest on rules—this distinction is now blurred in many theories. If anything, the focus of attention has shifted in recent years in favor of words. Results from many different areas of language research suggest that the lexicon is representationally rich, that it is the source of much productive behavior, and that lexically specific information plays a critical and early role in the interpretation of grammatical structure. But how much information can or should be placed in the lexicon? This is the question I address here. I review a set of studies whose results indicate that event knowledge plays a significant role in early stages of sentence processing and structural analysis. This poses a conundrum for traditional views of the lexicon. Either the lexicon must be expanded to include factors that do not plausibly seem to belong there; or else virtually all information about word meaning is removed, leaving the lexicon impoverished. I suggest a third alternative, which provides a way to account for lexical knowledge without a mental lexicon.