Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.     

Global Progress I: Empirical Evidence for ongoing Increase in Quality-of-life

This paper argues that both the relativist and the pessimist critiques of the idea of progress are inadequate. Progress is defined as increase in global quality of life (QOL). Such QOL is intrinsically subjective, but not relative. It can be reliably measured through life satisfaction-type questions. The World Database of Happiness provides extensive data on social, economic and psychological factors that correlate with overall QOL. They include wealth, health, security, knowledge, freedom and equality. Various statistical data suggest that all these QOL indicators have undergone significant improvements during the last half century, in most of the world. This gives strong support to the thesis that progress objectively occurs.     

Peter Singer’S Argument for Utilitarianism

The paper begins by situating Singer within the British meta-ethical tradition. It sets out the main steps in his argument for utilitarianism as the ‘default setting’ of ethical thought. It argues that Singer’s argument depends on a hierarchy of reasons, such that the ethical viewpoint is understood to be an adaptation – an extension – of a fundamental self-interest. It concludes that the argument fails because it is impossible to get from this starting-point in self-interest to his conception of the ethical point of view. The fundamental problem is its mixing the immiscible: the Humean subordination of reason to interest with the Kantian conception of reason as universal and authoritative.     

鬼谷子的测谎心理思想研究

鬼谷子的测谎心理思想其目的在于帮助统治者考察权变、征召远近人才、谋划国家事物、献说陈情、决安危、定亲疏、察同异、辨真伪。其基本依据的是阴阳观。他认为阴阳是宇宙变化的一贯之道,把握了阴阳之道,就获得了开启人内心隐秘的基本原理。其所遵循的原则是：知己知人原则,隐秘性原则,把握时机原则。其具体技术有捭阖术,即根据阴阳变化原理提出的开启和闭藏的技术;钩言术,即通过语言表达的动静状态窥探他人内心情报的方法;飞箝术,是以激励、褒扬的言语诱导对方获得实情而抓住对方心理的一种测谎技术。揣摩术,又分揣术和摩术。揣术是根据情感的两极变化和惯常行为表现推测对方心理真实情报的方法。摩术是指将内在情感与外在符验相结合进行推测、切磋、体会获得对方真实情报的方法。     

略论《周易》史观

《周易》的形成出于占筮,古人以此来求知国之兴衰、人之穷通,具有一种“通古今之变”的思维倾向。所以它有别于其他类型的迷信,那蕴含其中的某种逻辑推演和理智分析的因素,被后来的易学及其哲学发展出一套《周易》的世界观、人生观和历史观。这些观点集中到一点就是:以阴阳变异的法则说明一切事物。本文主要从《周易》的特有思维模式及其古奥的言词来探讨其中所蕴含的历史观。并规约出两点:第一,《周易》所体现的历史演变方式;第二,《周易》史观中的历史动力。     

Morality and the View from Here

According to one influential conception of morality, being moral is a matter of acting from or in accordance with a moral point of view, a point of view which is arrived at by abstracting from a more natural, pre-ethical, personal point of view, and recognizing that each person's personal point of view has equal standing. The idea that, were it not for morality, rational persons would act from their respectively personal points of view is, however, simplistic and misleading. Because our nonmoral reasons cannot all be adequately captured as falling within any single, unified and coherent point of view, morality cannot be adequately understood as a matter of abstracting from such points of view and taking them all equally into account. After considering several ways of modifying the initial conception of morality in a way that accommodates the variety of nonmoral reasons that do not have their source in a personal point of view, the paper concludes with the suggestion that we free ourselves more thoroughly from the grip of the metaphor that takes morality as a whole to be a matter of acting in accordance with the judgments of a single unified and coherent point of view.     

Adult Attachment Dimensions,World View Schemas,and the Psychological Health of Parents of Infants in a Neonatal Intensive Care Unit

This study reports the results of an exploration of the relationship of adult attachment dimensions (closeness, dependence, and anxiety) and world view assumptions (benevolence, meaningfulness, and worthiness) to psychological distress and psychological well-being in 142 parents (71 couples) of newborns recently hospitalized in a neonatal intensive care unit. The results of the Actor-Partner Interdependence Model, hierarchical multiple regression, and mediation analyses showed that parents who were more comfortable with attachment-dependence and parents who held more positive beliefs about benevolence and worthiness had less psychological distress and more well-being. In addition, parents with partners who were more comfortable with attachment-dependence had less psychological distress and more well-being. Attachment-dependence partially mediated the relationships of benevolence and worthiness with psychological distress and the relationship of benevolence with psychological well-being, whereas worthiness had a direct relationship with psychological well-being.     

Fix and sample with rats in the dynamics of choice

The generality of the molar view of behavior was extended to the study of choice with rats, showing the usefulness of studying order at various levels of extendedness. Rats' presses on two levers produced food according to concurrent variable-interval variable-interval schedules. Seven different reinforcer ratios were arranged within each session, without cues identifying them, and separated by blackouts. To alternate between levers, rats pressed on a third changeover lever. Choice changed rapidly with changes in component reinforcer ratio, and more presses occurred on the lever with the higher reinforcer rate. With continuing reinforcers, choice shifted progressively in the direction of the reinforced lever, but shifted more slowly with each new reinforcer. Sensitivity to reinforcer ratio, as estimated by the generalized matching law, reached an average of 0.9 and exceeded that documented in previous studies with pigeons. Visits to the more-reinforced lever preceded by a reinforcer from that lever increased in duration, while all visits to the less-reinforced lever decreased in duration. Thus, the rats' performances moved faster toward fix and sample than did pigeons' performances in previous studies. Analysis of the effects of sequences of reinforcer sources indicated that sequences of five to seven reinforcers might have sufficed for studying local effects of reinforcers with rats. This study supports the idea that reinforcer sequences control choice between reinforcers, pulses in preference, and visits following reinforcers.     

A sub-process view of working memory capacity: Evidence from effects of speech on prose memory

In this article we outline a “sub-process view” of working memory capacity (WMC). This view suggests that any relationship between WMC and another construct (e.g., reading comprehension) is actually a relationship with a specific part of the WMC construct. The parts, called sub-processes, are functionally distinct and can be measured by intrusion errors in WMC tasks. Since the sub-processes are functionally distinct, some sub-process may be related to a certain phenomenon, whereas another sub-process is related to other phenomena. In two experiments we show that a sub-process (measured by immediate/current-list intrusions) is related to the effects of speech on prose memory (semantic auditory distraction), whereas another sub-process (measured by delayed/prior-list intrusions), known for its contribution to reading comprehension, is not. In Experiment 2 we developed a new WMC task called “size-comparison span” and found that the relationship between WMC and semantic auditory distraction is actually a relationship with a sub-process measured by current-list intrusions in our new task.     

What Counts as Behavior? The Molar Multiscale View

Because the definition of behavior changes as our understanding of behavior changes, giving a final definition is impossible. One can, however, rule out some possibilities and propose some others based on what we currently know. Behavior is not simply movement, but must be defined by its function. Also, our understanding of behavior must agree with evolutionary theory. I suggest 4 basic principles: (a) only whole organisms behave; (b) behavior is purposive; (c) behavior takes time; and (d) behavior is choice. Saying that parts of an organism behave is nonsense, and, moreover, evolutionary theory explains the existence of organisms mainly through their adaptive behavior. Behavior is purposive in that behavior is shaped by its consequences, through an organism''s lifetime or through interactions with the environment across many generations of natural selection. Behavior takes time in that behavior is interaction with the environment that cannot take place at a moment. Moreover, at a moment in time, one cannot definitely identify the function of behavior. Identification of an activity requires a span of time. Behavior is choice in the sense that a suitable span of time always includes time spent in more than 1 activity. Activities include parts that are themselves activities on a smaller time scale and compete for time. Thus, behavior constitutes time allocation. An accounting problem arises whenever any behavior is attributed to multiple consequences. In the molar multiscale view, this raises the question of whether 2 activities can occur at the same time. The question remains open.