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.     

THE “WHERE IS IT?” REFLEX: AUTOSHAPING THE ORIENTING RESPONSE

The goal of this review is to compare two divergent lines of research on signal-centered behavior: the orienting reflex (OR) and autoshaping. A review of conditioning experiments in animals and humans suggests that the novelty hypothesis of the OR is no longer tenable. Only stimuli that represent biological “relevance” elicit ORs. A stimulus may be relevant a priori (i.e., unconditioned) or as a result of conditioning. Exposure to a conditioned stimulus (CS) that predicts a positive reinforcer causes the animal to orient to it throughout conditioning. Within the CS-US interval, the initial CS-directed orienting response is followed by US-directed tendencies. Experimental evidence is shown that the development and maintenance of the conditioned OR occur in a similar fashion both in response-independent (classical) and response-dependent (instrumental) paradigms. It is proposed that the conditioned OR and the signal-directed autoshaped response are identical. Signals predicting aversive events repel the subject from the source of the CS. It is suggested that the function of the CS is not only to signal the probability of US occurrence, but also to serve as a spatial cue to guide the animal in the environment.     

The second offspring of General Process Learning Theory: Overt behavior as the ambassador of the mind

Wasserman suggested in a recent book review that the study of intervening cognitive processes represents a current focus of interest in animal learning and that this has led to a revitalization of comparative psychology. An examination of the volume reviewed suggests that he may have overstated the case. Most of the authors to whom he refers expressed dissatisfaction with traditional stimulus-response associationism but few argued for the extreme (information processing) sort of cognitive approach described by Wasserman.     

Stimulus discriminability in free-operant and discrete-trial detection procedures.

Six pigeons were trained to discriminate different light intensities in four experimental procedures. Experiment 1 compared stimulus discriminability in a yes-no signal-detection task with discriminability measures obtained from two free-operant procedures. Discriminability estimates were significantly lower in the detection procedure. Experiment 2 showed this lowered discriminability to be a function of the delay between stimulus presentation and the availability of the choice-response keys in the standard detection task. In addition, reinforcement sensitivity was lowest when correct choice responses were intermittently, rather than continuously, reinforced.     

Methodological and theoretical issues in neuropsychological assessment

While there are philosophical and theoretical differences between neuropsychologists and behavior therapists, it is suggested that a significant reconciliation can be achieved in regard to assessment and treatment of the brain-damaged patient. While brain damage is often viewed as an irreversible disorder, there is evidence that substantial recovery of function can occur, particularly when adequate retraining is provided. There are practical and empirical considerations that suggest that neuropsychological tests are currently the best tools available for behavioral assessment of brain-damaged patients. However, the results of these tests can be used not only diagnostically but also to identify target behavioral deficits that may be rehabilitated through systematic retraining efforts. Such rehabilitation efforts can be optimally planned, implemented, and evaluated through an alliance between the neuropsychologist, who identifies the ability and deficit pattern, and the behavior therapist, who devises and evaluates the retraining program. It is possible that the successes of behavior therapy in numerous clinical and educational applications can be repeated in the cases of brain-damaged patients. However, such success would appear to be contingent on appreciation of the high degree of specificity often seen in neurological deficit patterns and the great complexities involved in the relationships between brain function and behavior.     

Reducing residential electrical energy use: payments, information, and feedback

Monetary payments, energy information, and daily feedback on consumption were employed to reduce electricity use in four units of a university student housing complex. A combined multiple-baseline and withdrawal design permitted both within- and between-unit comparisons. Payments produced immediate and substantial reductions in consumption in all units, even when the magnitude of the payments was reduced considerably. Feedback also produced reductions, but information about ways to conserve and about the cost of using various appliances did not. It was also found that, in general, payments combined with either information or feedback produced no greater effect than payments alone.     

Considerations in the choice of interobserver reliability estimates

Two types of interobserver reliability values may be needed in treatment studies in which observers constitute the primary data-acquisition system: trial reliability and the reliability of the composite unit or score which is subsequently analyzed, e.g., daily or weekly session totals. Two approaches to determining interobserver reliability are described: percentage agreement and "correlational" measures of reliability. The interpretation of these estimates, factors affecting their magnitude, and the advantages and limitations of each approach are presented.     

Two simple classes of mastery scores based on the beta-binomial model

Two simple classes of mastery scores which are suitable for hand calculations are presented for beta-binomial test score distributions combined with linear and cubic referral success. The models provide a simple way to explore the consequences of selecting an arbitrary mastery score. Such assessment would be useful whenever the test user is not willing to posta priori a loss ratio, but wishes to look at the various consequences before aiming at a particular score.     

Fitting and testing carroll's weighted unfolding model for preferences

A quadratic programming algorithm is presented for fitting Carroll's weighted unfolding model for preferences to known multidimensional scale values. The algorithm can be applied directly to pairwise preferences; it permits nonnegativity constraints on subject weights; and it provides a means of testing various preference model hypotheses. While basically metric, it can be combined with Kruskal's monotone regression to fit ordinal data. Monte Carlo results show that (a) adequacy of true preference recovery depends on the number of data points and the amount of error, and (b) the proportion of data variance accounted for by the model sometimes only approximately reflects true recovery.This study is based on a doctoral dissertation submitted to the University of Illinois at Urbana-Champaign. The author wishes to thank the members of his dissertation committee—Lawrence E. Jones, Chairman, Charles Lewis, Stephen Golding, Ledyard Tucker, and Nancy Wiggins—for their helpful comments.     

Clock control of human performance on avoidance and fixed-interval schedules

The avoidance and fixed-interval performances of human subjects were studied in two experiments. Addition of time-correlated stimuli (added clock) improved behavioral efficiency, since response rates decreased without decreases in reinforcement rates. Response-dependent display of the clock maintained a second, observing response and reductions in clock duration weakened such observing behavior. Generally, the reinforcing properties of the clock were more apparent with the avoidance than with the fixed-interval schedule, a finding attributed to temporal cues already provided by delivery of the fixed-interval reinforcers. Reduced rates of the main response when the clock was dependent on an observing response were more than offset by rates of the observing response in the majority of subjects. Thus, the results do not support an interpretation of the reinforcing properties of added clocks simply in terms of work reduction.