Just health care (II): Is equality too much?

In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence [1]. Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than strong egalitarian lines. Further, given the empirical complexity associated with the distribution of contemporary health care, I argue that what we really need to address the relevant policy issues adequately is a theory of health care justice, as opposed to an all-purpose conception of justice. Daniels has made an important start toward that goal, though there are some large policy areas which I discuss that his account of health care justice does not really speak to. Finally, practical matters of health care justice really need to be addressed in a ‘non-ideal’ mode, a framework in which philosophers have done little.     

New approaches to demystifying insight

After a person has become stuck on a problem, they sometimes achieve a clear and sudden solution through insight--the so-called Aha! experience. Because of its distinctive experience, the origins and characteristics of insight have received considerable attention historically in psychological research. However, despite considerable progress in characterizing insight, the underlying mechanisms remain mysterious. We argue that research on insight could be greatly advanced by supplementing traditional insight research, which depends on a few complex problems, with paradigms common in other domains of cognitive science. We describe a large set of mini-insight problems to which multiple methods can be applied, together with subjective reports to identify insight problem-solving. Behavioral priming and neuroimaging methods are providing evidence about what, where, and how neural activity occurs during insight. Such evidence constrains theories of component processes, and will help to demystify insight.     

The prepared mind: neural activity prior to problem presentation predicts subsequent solution by sudden insight

Insight occurs when problem solutions arise suddenly and seem obviously correct, and is associated with an "Aha!" experience. Prior theorizing concerning preparation that facilitates insight focused on solvers' problem-specific knowledge. We hypothesized that a distinct type of mental preparation, manifested in a distinct brain state, would facilitate insight problem solving independently of problem-specific knowledge. Consistent with this hypothesis, neural activity during a preparatory interval before subjects saw verbal problems predicted which problems they would subsequently solve with, versus without, self-reported insight. Specifically, electroencephalographic topography and frequency (Experiment 1) and functional magnetic resonance imaging signal (Experiment 2) both suggest that mental preparation leading to insight involves heightened activity in medial frontal areas associated with cognitive control and in temporal areas associated with semantic processing. The results for electroencephalographic topography suggest that noninsight preparation, in contrast, involves increased occipital activity consistent with an increase in externally directed visual attention. Thus, general preparatory mechanisms modulate problem-solving strategy.     

Increasing meal consumption in individuals with competing protective equipment

Individuals diagnosed with autism spectrum disorder may engage in self‐injurious behavior that can cause tissue damage. Protective equipment is sometimes used to decrease the severity of tissue damage when self‐injury occurs. However, wearing protective equipment may be incompatible with some forms of adaptive behavior, such as meal consumption. The purpose of the present analysis was to identify a treatment for increasing meal consumption in two adolescent males diagnosed with an autism spectrum disorder who wore protective equipment that interfered with self‐feeding. Three interventions were evaluated: modifying the protective equipment, manipulating the reinforcing efficacy of the meal, and arranging additional positive reinforcement for meal consumption in the absence of protective equipment. Modifying protective equipment and manipulating the reinforcing efficacy of the meal were effective for both participants. Additional positive reinforcement was evaluated and effective for one participant.     

Quality of Life (QoL) in a Brazilian Sample of Older Adults: The Role of Sociodemographic Variables and Depression Symptoms

The aim of the present study was to identify relevant variables associated with Quality of Life (QoL) in older adults. Older adults, up to 60 years old, were interviewed. Subjects were recruited through convenience sampling. 339 paticipants, who were stratified by gender, age, and subjective perception of health and illness, answered questions on sociodemographic issues, QoL (WHOQOL-100) and depressive symptomathology (Beck Depression Inventory—BDI). The multiple linear regression analysis showed associations of overall perception of QoL with depression levels, subjective perception of health status and gender. The individual analysis of each domain concluded that depression levels are correlated to all QoL domains, while health status was associated with physical, psychological, independence level and social relationship domains. Other variables were also assessed. The assessment of older adults concerning their QoL perceptions is associated with gender, age, marital status, social class, literacy rate, perception of health, and more substantially associated with depressive symptoms levels. Nevertheless, some limitations of this study and further ones are suggested.     

Four studies on how past and current suicidality relate even when "everything but the kitchen sink" is covaried

T. E. Joiner's (2004, in press) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across 4 populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior.