PARADIGMS OF BELIEF, THEORY AND METATHEORY

Abstract. My account of the recent turnabout in the treatment of mental states in science and its basis in a modified concept of causal determinism and my claim that this opens the way for beliefs and values consistent with science are here reaffirmed in response to perceived weaknesses and "inherent incompleteness." Contested issues are reviewed to better clarify the main thesis. An inherent weakness in respect to deep spiritual needs is recognized and tentative remedial measures explored.     

The elderly and high technology medicine: A case for individualized,autonomous allocation

The issues involved in decision making about the aggressiveness of future medical care for older persons are explored. They are related to population trends, the heterogeneity of older persons and a variety of factors involved in individual preferences. Case studies are presented to illustrate these points, as well as a review of pertinent literature. The argument is offered that, considering these many factors, a system of flexible, individualized care by informed patient preference, is more rational than the rationing of technological services by age.     

Ethics in health care and medical technologies

In this paper a case is used to demonstrate how ethical analysis enables health care professionals, patients and family members to make treatment decisions which ensure that medical technologies are used in the overall best interests of the patient. The claim is made and defended that ethical analysis can secure four beneficial outcomes when medical technologies are employed: (1) not allowing any medical technologies to be employed until the appropriate decision makers are identified and consulted; (2) insisting that medical technologies be employed not merely to promote the medical interests of the patient but rather on the basis of their ability to contribute to the overall well-being of the patient; (3) challenging caregivers to reflect on the dynamic interplay between their conscious and unconscious values and consequent determinations of what is in the patient's best interests; and (4) providing a justification for selected interventions which makes possible rational dialogue between caregivers espousing different viewpoints about treatment options.     

Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

Linear Analogue Self-Assessment and Procrustean Measurement: A Critical Review of Visual Analogue Scaling in Pain Assessment

Visual analogue scales (VASs) are one of the most widely used self-report measures of clinical pain. This article reviews the empirical literature on linear analogue self-assessment (LASA) and critically examines the features that appear to have made it such an attractive measurement option in pain assessment. It is concluded that analogue scaling does not withstand critical scrutiny as a primary measure of either pain intensity or pain affect and that, in most circumstances, the overall clinical utility of VASs is inferior to that of more structured pain indices.     

Circular definitions,circular explanations,and infinite regresses

This paper discusses some of the ways in which circular definitions and circular explanations entail or fail to entail infinite regresses. And since not all infinite regresses are vicious, a few criteria of viciousness are examined in order to determine when the entailment of a regress refutes a circular definition or a circular explanation.I would like to thank Professors Robert Tully, Howard Sobel, and Derek Allen for their constructive comments.     

Pre-screening education in multiple marker screening programs: The effect on patient anxiety and knowledge

Previous studies have shown that unexplained deviations in maternal serum multiple marker screening (MMS) generate considerable anxiety during the remainder of pregnancy. While the role of education in decreasing anxiety is documented, to date there has been no prospective evaluation of which educational practices might minimize this emotional stress. In a pilot study, we prospectively examined the effects on anxiety and knowledge by providing information about MMS (1) by genetic counselor, (2) by pamphlet, and (3) by primary physician. Women randomized to one of these three modalities were administered the Spielberger State- Trait Anxiety Inventory [STAI] and knowledge questionnaires at their initial obstetrics visit, at their second visit after educational intervention and 1–2 weeks after MMS results were provided to patients. Education resulted in an increase in knowledge and post-education knowledge was different between educational modalities. Anxiety declined in patients educated through genetic counseling or a pamphlet.     

Concurrent fixed-interval variable-ratio schedules and the matching relation

Five rats responded under concurrent fixed-interval variable-ratio schedules of food reinforcement. Fixed-interval values ranged from 50-seconds to 300-seconds and variable-ratio values ranged from 30 to 360; a five-second changeover delay was in effect throughout the experiment. The relations between reinforcement ratios obtained from the two schedules and the ratios of responses and time spent on the schedules were described by Baum's (1974) generalized matching equation. All subjects undermatched both response and time ratios to reinforcement ratios, and all subjects displayed systematic bias in favor of the variable-ratio schedules. Response ratios undermatched reinforcement ratios less than did time ratios, but response ratios produced greater bias than did time ratios for every subject and for the group as a whole. Local rates of responding were generally higher on the variable-ratio than on the fixed-interval schedules. When responding was maintained by both schedules, a period of no responding on either schedule immediately after fixed-interval reinforcement typically was followed by high-rate responding on the variable-ratio schedule. At short fixed-interval values, when a changeover to the fixed-interval schedule was made, responding usually continued until fixed-interval reinforcement was obtained; at longer values, a changeover back to the variable-ratio schedule usually occurred when fixed-interval reinforcement was not forthcoming within a few seconds, and responding then alternated between the two schedules every few seconds until fixed-interval reinforcement finally was obtained.