Justice and care: The implications of the Kohlberg-Gilligan debate for medical ethics

Carol Gilligan has identified two orientations to moral understanding; the dominant ‘justice orientation’ and the under-valued ‘care orientation’. Based on her discernment of a ‘voice of care’, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.     

Counseling: A conversion experience

In this article, the experience of conversion, which is usually delegated to the realm of spiritual studies, is applied to the counseling experience. It is posited that a person who goes through a successful counseling process will experience a turning around, will cease leading life in a dysfunctional way, and will move forward in a manner by which the person experiences life in a new perspective. This new perspective brings the person wholeness and balance.     

The escape-to-Israel syndrome: Variations on the geographic cure

The author conceptualizes a pattern of thought and behavior that can be called the escape-to-Israel syndrome. This pattern is a contemporary variety, appearing primarily in the Jewish population, of the geographic cure: that is, one can solve one's personal dilemmas by moving from one place to another. The syndrome is characterized by a tendency to idealize life in Israel. This idealization, and the viewers' fantasy of their own future in Israel, deflect solid confrontation with genuine personal problems. If, in fact, they do move to Israel, they may experience shock and trauma at the gap between expected reality and the discovered one. This may only compound their emotional difficulties.The author wishes to express his gratitude to Professor Shamai Davidson, Clinical Director of the Shalvata Mental Health Center, Hod HaSharon, Israel, for his critical comments during the preparation of this article.     

Specific language impairment in children: A cross-linguistic study

A common profile in English-speaking specifically language-impaired children is a moderate deficit across a broad range of linguistic features and a more marked, selective impairment in using bound morphemes and components of the verb system. To gain a clearer understanding of the nature of these more serious problems, we examined the speech of monolingual Italian-speaking as well as English-speaking children with specific language impairment. The evidence suggested that phonological factors contributed significantly to these children's extraordinary problems with particular linguistic features. Contrary to expectations, other marked deficits seemed more related to the opacity of the rules involved and homonymity with other morphemes than to problems with formal grammatical devices in general or components of the verb system in particular.     

The development of socialization skills in an electively mute child

In a booth designed especially for work with both autistic and electively mute children, a 4-yr-old girl named Dolly, who had no communicative speech or imitative skills, was given a preliminary session in which her verbal output was assessed. To elicit sounds from Dolly, an instrument called a “color organ” was used as a positive reinforcer. After this baseline assessment, in 40 half-hour sessions, Dolly was taught to make eye contact with E, and to obey instructions—although it was first necessary to extinguish her disruptive behavior, particularly her opérant crying. In addition, she learned non-verbal imitative behavior, such as hand clapping; and verbal imitative behavior, such as saying “Hi!” Social (play) sessions were begun after session 21, and continued for the remaining time. These were helpful in generalizing Dolly's learned skills to an environment other than the booth; and to other tasks, such as singing “Ee-eye-ee-eye-oh” in the refrain of the song, “Old McDonald”; and pointing to E's eyes, saying “ice”.     

The differential validity of hyperactivity/attention deficits and conduct problems among mentally retarded children

The independence of hyperactivity, attention deficits, and conduct problems among mentally retarded children was addressed using factors of the Conners' Teacher Rating Scale-39 (CTRS-39) and the more recently developed IOWA Conners' inattention/overactivity (IO) and aggression (A) subscales. CTRS-39 ratings were obtained for children of normal intelligence and for mentally retarded children. Differences between the groups were examined as were intercorrelations of the Conners' factors and IOWA subscales. Conduct problems proved to be less strongly associated with hyperactivity and attention deficits among mentally retarded children compared to children of normal intelligence. However, attention problems and conduct problems may be associated with mental retardation in general. Implications of these data and CTRS scoring system recommendations for mentally retarded children are discussed.