谈《疏五过论》的五种过错对当今医生的教育意义

传统的医学道德观认为：“医乃仁术”、“生命至贵”等就是“‘大医精诚”。医者要做到“大医精诚”,就要避免《疏五过论》中医者的五种过错,使患者保持健康的生命。所以,医生要以严谨认真的工作态度,充分了解患者的病情;以生物心理社会医学模式来处理患者;不能急功近利,追求名誉,应常怀仁爱之心建立和谐的医惠关系。医生处理患者的态度及自身的道德修养直接影响患者的健康和生命,这种理念应该成为医生终生追求的目标,这样才能顺应新医改的要求。     

The Religious and Social Principles of Patients’ Rights in Holy Books (Avesta, Torah, Bible, and Quran) and in Traditional Medicine

Health protection and promotion in healthy people and restoring patients’ health have been the most important themes in medicine and health throughout our history. Therefore, discussion of different aspects of patients’ rights includes implementation of these objectives by the medical community, including physicians, nurses, pharmacists, etc., and the people in charge of health affairs. The principal objective of our research is the study of medical ideology and the approaches of our ancestors in relation to different aspects of patients’ rights. To study the different ideologies of traditional medicine in relation to patients’ rights, appropriate data were extracted from the original resources of traditional medicine and from religious books. By means of library research we studied these resources in addition to electronic versions of the Alhavi book (by Rhazes), the Kamel-al-Sanaah (by Ahvazi), the Canon of Medicine (by Avicenna), the Zakhireye Khawrazmshahi (by Jorjani), the Avesta, the Torah, the Bible, the Quran, and many other resources, and, finally, after searching, gathering, and encoding the findings, analyzed them qualitatively for thematic content. The holy Avesta book clearly insists on the competence of physicians and setting the appointment fee in accordance with peoples’ income. The Old Testament (holy Torah) warned government officials who did not observe patients’ rights. In the four gospels (holy Bible) the importance of treatment and taking care of the patient is stressed. After the emergence of Islam, medical students, before beginning the principal courses, had to study Islamic jurisprudence, ethics, logic sciences, natural sciences, geometry, astrology, calculus, and similar courses so that after purifying their soul they could enter the saintly profession of physicians. The holy Quran refers to saving the life of a human irrespective of social class, race, and religion, and insists on exemption of patients from physical activity, including the physical aspects of prayer. In these resources, some warnings are offered in relation to fake drugs, the lack of awareness of some physicians, the need for complete preparedness of medical society, and the need to manufacture appropriate drugs and offer a suitable medical service. This information is to familiarize medical and health authorities and persons receiving health services. According to the evidence available about traditional medicine, there was no specific difference between public and professional ethics, public and professional rights, or rights and ethics—ethics were no different from rights nor rights from ethics. So ethics are similar to the soul in the body of rights, and rights are similar to the litter of ethics, and they have developed in parallel with each other. Traditional medicine is community-based and preservation of the health of healthy people is given priority over the treatment of patients; there is insistence that “health rights” has wider scope than “patients’ rights”. It can be stated that health rights in Iran both before and after the emergence of Islam have been based on guidance from divine religions, observation of humanist ethics, passing suitable courses in the basic sciences, and an introduction to the practical piety of our ancestors, in addition to the syllabus of medical and health education.     

Grit and Different Aspects of Well-Being: Direct and Indirect Relationships via Sense of Coherence and Authenticity

Grit, passion and perseverance for long-term goals, is strongly related to success in goal attainment even under challenging circumstances. We investigated how grit relates to three aspects of well-being: psychological well-being (PWB), satisfaction with life, and harmony in life. This relationship is approached through organismic valuing theory, which proposes that people are naturally motivated to grow towards their highest potential; grit is proposed as being akin to such growth motivation. In two studies (Study 1 with 196 university students, and Study 2 with 396 non-students), direct and indirect (mediating) effects between grit and well-being were investigated. Sense of coherence (SOC) and authenticity were used as mediators, and gender as a moderator. Grit was positively related to all well-being factors, and SOC and authenticity were significant mediators (complementary for PWB and indirect-only for satisfaction with life and harmony in life). This suggests that grittiness in goal pursuits requires both a sense that the world is coherent and an authentic connection with the self in order for it to fully benefit well-being. No gender moderation was found.     

Feminist Interventions: Accountability Beyond Symptom Reduction

Feminist interventions to facilitate women's psychological well-being are forging new pathways to achieving the goals of the Decade of Behavior. In emphasizing the complex interplay between internal and external factors in women's lives, feminist interventions are designed to promote women's safety, health, positive life styles, personal strength, competence, and resilience. In contrast, prevailing medical models locate the problem within the woman by concentrating on diagnosis and treatment of pathology and internal disorders. I offer a model here for implementing and assessing intervention strategies that targets both the effects of unsupportive or negative environments and the imperative to strengthen and empower girls and women, their families, and their communities. The obligation to be accountable for the outcomes of feminist interventions encompasses a major focus of this article. Evolving developments in research on accountability are reviewed in relation to conceptualization, goal setting, and assessment of feminist interventions. I encourage continuing collaboration between the feminist-informed research and practitioner communities to promote women's health, safety, and well-being in the Decade of Behavior.     

The Contribution of Music to Positive Aging: A Review

Many people value music as an important part of their everyday lives. The published literature reveals that the role of music in life is varied: it can be recreational, educational, social, emotional, therapeutic, and spiritual. The importance and relevance of music depends on the life needs and interests of the individual and the social group within which he/she lives. It is now widely recognized that music for many older people is crucial in supporting a sense of well-being. The article reviews the evidence on the role of music in promoting health and well-being, and how it can produce positive psychological and physiological benefits for individuals. The aim of this article is to increase awareness among health professionals of the importance of music and discuss how it can be used to add to older people's lives.     

Inclusion of Alternative and Complementary Therapies in CACREP Training Programs

Abstract

Given a heightened focus within the mental health profession on creative, complementary, and alternative practices, the authors surveyed CACREP programs with respect to their inclusion of such approaches in counselor training. For the purpose of this study, these approaches were designated as complementary and alternative methods (CAM) and defined as those therapeutic practices that fall outside of the established traditional realm of medical, psychiatric, and psychological practice (hypnotherapy, breath work, meditation, Qigong, Reiki, Thought Field Therapy, etc.). Sixty-two programs responded. Over half (54%) stated that they currently include these approaches in course offerings. This article includes a discussion of creativity, expressive arts, and energy psychology as they relate to complementary and alternative therapies in mental health and medicine.     

Age and subjective well-being revisited: a discrepancy perspective

The hypothesis that the age effect on subjective well-being was entirely mediated by goal discrepancies (GDs) was tested with structural equation modeling. Six GDs grouped into 3 broad categories (relationships, health, and others) were differentially related to age. Whereas GD relationships and GD others (e.g., materials) decreased with age, GD health increased with age. GD health had smaller effects on subjective well-being than GDs in relationships and other life domains. Hence, the net effect of all the GDs on well-being was positive. GD variations because of age could completely explain the age trends in life satisfaction and positive affect, and partially the age trend in negative affect.     

Protestant Spirituality and Well-Being of People in Hong Kong: The Mediating Role of Sense of Community

While literature demonstrates that the relationship between religion and well-being is generally positive, information about the mechanisms is still far from clear. Two hundred and sixty-eight Chinese were recruited to examine how Protestant spirituality is related to well-being in Hong Kong. Path analysis demonstrated the complex relationship between various spirituality dimensions (religious belief, experience, and practice) and well-being variables, manifested in life satisfaction, social trust and sense of community. While spirituality may directly predict life satisfaction, the relationship between spirituality and social trust are fully mediated through sense of community. Furthermore, the well-being at the community level (feeling sense of community and social trust) appears to affect the well-being on the personal level (life satisfaction). These findings not only show that the influence of religion on people’s well-being can be richly diverse, but also match with the emerging literature on the positive effects of social capital on health and well-being.     

Different pathways, same effects: Autonomous goal regulation is associated with subjective well-being during the post-school transition

Using self-determination theory as a theoretical framework, this study examines the associations between autonomous goal regulation and subjective well-being (life satisfaction, positive and negative affect, self-esteem) during the post-school transition. The sample consisted of 2,284 academic track students (62 % female) in Germany who answered a questionnaire at the end of high school and again 2 years later, allowing us to differentiate three post-school trajectories (university, vocational training, not in education). Structural equation modeling showed that autonomous goal regulation measured at Time 1 positively predicted Time 2 life satisfaction, positive affect, self-esteem, and autonomous goal regulation and negatively predicted negative affect, controlling for construct stability. However, subjective well-being indicators at Time 1 did not predict autonomous goal regulation at Time 2. Multigroup analyses indicated comparable associations between goal regulation and subjective well-being across groups, highlighting the strength and generalizability of the effect of autonomous goal regulation on subjective well-being during the post-school transition.     

论医学人文精神的重塑

重塑医学人文精神是一个无法回避而又必须作出回答的紧迫问题。把现代医学技术放到人文哲学的大视野中去体认,从人学本体论意义上现代医学技术的价值理性,进一步澄清人们对医学技术无限崇拜的工具理性的错误认识;阐述了现代医学人文精神的内涵,认为以人为本,确立科学理性对医学技术的指导地位,适时约束医学技术行为应该成为现代医学人文精神的核心理念;提出了重塑现代医学人文精神的基本原则,即：坚持医学技术进步与人的全面发展相一致的原则,坚持医学技术进步与医学工作者道德健全相一致的原则,坚持医学进步与卫生事业持续、协调、健康发展相一致的原则。     

The existential cost of economic insecurity: Threatened financial security undercuts meaning

Financial security (i.e., a person’s sense that they can afford the things they need now and in the foreseeable future) contributes to psychological health and well-being. In the present research, we explored the implications of financial security for perceptions of meaning in life. In Study 1, we found that perceptions of financial insecurity predicted perceptions of meaning in life above and beyond income. Further, income only predicted perceptions of meaning to the extent that it was associated with reduced financial insecurity. In Studies 2 and 3, we found that financial security threats undermined perceptions of meaning in life. Taken together, these studies suggest that maintaining financial security is important for a sense of meaning in life.     

Medical Student Burnout: Interdisciplinary Exploration and Analysis

Burnout—a stress-related syndrome characterized by exhaustion, depersonalization, and a diminished sense of accomplishment—is a common phenomenon among medical students with significant potential consequences for student health, professionalism, and patient care. This essay proposes that the epidemic of medical student burnout can be attributed to a technocratic paradigm that fails to value medical students as persons with human needs and limitations. After briefly reviewing the literature on medical student burnout, the author uses two theories to elucidate potential causes: unsatisfactory aspects of the learning environment and a feeling one’s efforts are meaningless or irrelevant. Cultural factors also facilitate burnout in medical students immersed in a clinical environment that cultivates excessive detachment from patient and self, impairing self-care, damaging a sense of self, and impeding the development of a mature, well-integrated professional identity. The ethical implications of medical student burnout are also addressed. Finally, this paper suggests possible preventive and remediative strategies such as optimizing the learning environment as well as narrative approaches that promise enhancement of both individual and institutional well-being.     

医学阐释学--医学哲学研究新视角

医学阐释学是哲学阐释学在医学领域的应用,是医学与哲学交叉的一个新领域.简述哲学阐释学的发展以及其主要观点,并集中讨论了医学阐释学研究的范畴,其中包括:人体的现象学、健康和病患的意义、医患关系、生命伦理学、医学的目的.指出医学阐释学对医学哲学、医学人文科学研究的影响.     

Finding the authentic self in a communal culture: developmental goals in emerging adulthood

Finding and cultivating a sense of authentic self is an important life goal for emerging adults. In collectivist cultures, youngsters might need to distance themselves to find and discover their authentic selves separate of the expectations of society and significant others. Creating an autonomous time bubble that focuses on the present allows youngsters to forge a sense of personal meaning and authenticity that subsequently paves the way to reintegration into long-term life goals. The results focusing on Israeli emerging adults demonstrate that a sense of authentic self plays a central role in their well-being and socioemotional functioning.     

When Feeling Mixed Can Be Meaningful: The Relation Between Mixed Emotions and Eudaimonic Well-Being

Whilst positive emotions benefit well-being, the role of other more complex emotional experiences for well-being is less well understood. This research therefore investigated the relationship between mixed emotions and eudaimonic well-being. A cross-sectional study (Study 1; N = 429) first demonstrated (using structural equation modelling) that mixed emotions are related to the presence of goal conflict. Importantly, it was also found that mixed emotions are positively related to eudaimonic well-being, and that one potential mechanism linking mixed emotions and eudaimonic well-being is via the search for meaning in life. Study 2 (N = 52) implemented a quasi-experiment regarding a naturally occurring meaningful life event (i.e., graduation day) and again demonstrated that mixed emotions are associated with a greater level of eudaimonic well-being. Implications of these findings include the importance of mixed emotions in the search for meaning in life, and the role of mixed emotions in goal conflict resolution.     

Intervening during crises of life transitions: Promoting a sense of humor as a stress moderator

The numerous crisis situations associated with life cycle transitions present the mental health professional with numerous intervention opportunities. Since a good sense of humor can assist in the mediation of stress, a crisis intervention technique designed to enrich a person's appreciation of humor during and after life cycle transitions has therapeutic merit. Toward this goal, the author has designed an imagery technique which permits the enhancement of a person's sense of humor. Guiding clients towards the generation of humor at the imagery level has been found to be therapeutically beneficial. Methods of intervention utilizing the factors of absurdity, incongruity and exaggeration are discussed in promoting an adaptive sense of humor.     

Hope for the Future and Avoidance of the Present: Associations with Well-being in Older Adults

Positive psychology and third wave cognitive behavioral therapy approaches have seldom been applied to older adults. This study therefore examined whether two concepts drawn from these areas, hope for the future and avoidance in the present, were associated with well-being in a sample of 259 older adults (65–94 years). Hope was measured as a stable trait. Experiential avoidance was measured as avoidance of present internal and external events. Respondents also completed two well-being measures: hedonic (positive and negative affect) and eudeimonic (meaning in life). Path analyses showed that high hope was significantly associated with high positive affect, and high meaning in life; and high experiential avoidance was associated with high negative affect and low meaning in life. This was also true when both (hope and avoidance) were taken into account, along with sociodemographic variables and perceived health. Many of the pathways between hope and well-being, and between experiential avoidance and well-being appear to be bidirectional. However the path from hope to positive affect was stronger than that from positive affect to hope. Further research is needed to clarify each of these points. Both hope for the future and lack of avoidance in the present are important for well-being in older adulthood and interventions targeting these processes may enhance positive aging and contribute to a sense of having a meaningful life.     

对希波克拉底警句的深层解读--审美修养是从医之必需

试图透过医学与艺术的联系,深入到医学与美学关系的层面,进而发掘希波克拉底关于"医学的艺术乃是一切艺术之中最为卓越的艺术"这一论断的深刻内涵,指出希波克拉底警句蕴涵着:医学是美的职业,它具有崇高地位和独特的重要性;医学所追求的是健康而美好的人生,医学所创造的是健康之美、生命之美、至善之美、仁爱之美.既然医学是最为卓越的艺术,医务工作者就应该重视美学修养,并让医学审美意识牢牢植根于自己的医学实践之中.换句话说,审美修养是从医之必需.     

Doping in sport and enhancement medicine

The reason that gives doping in sport a deeper philosophical and ethical dimension is the emergence of a new medical paradigm: enhancement medicine. The question of enhancing performance in sport has become part of a broader societal debate on human enhancement. The gradual blurriness of the boarders between therapeutic medicine and enhancement medicine constitutes the most spectacular and the most troublesome form of these modifications. In the contemporary biomedicine, the new medicines and technologies can be used not only to cure the patients but also to enhance human capacities. This evolution represents a paradigmatic change in the medical practice: it is not the mere restoration of health which is expected anymore, nor the promotion of health. What is required is the improvement of performance and the perfectibility of the human being, including in the field of sport. Competitive sport could become the main laboratory of enhancement medicine. The intersection of science and sport raises fundamental philosophical, ethical and policy issues that cannot be answered easily. The prohibition and the war on doping is not the only solution.     

The Importance of Religious Orientation and Purpose in Life for Dying Well: Evidence from Three Case Studies

ABSTRACT

As older adults approach the end of their lives, it is not uncommon to find a decrease in subjective well-being. However, a number of studies have indicated that elders with an intrinsic rather than extrinsic religious orientation often are able to keep a high level of subjective well-being even if they are close to death. In a previous quantitative study, only intrinsic religiosity was indirectly and positively related to subjective well-being in a sample of 103 relatively healthy older adults and 19 hospice patients (aged 61 +), mediated by shared spiritual activities and purpose in life. Extrinsic religiosity, by contrast, was indirectly and negatively related to subjective well-being. To explore in greater depth how religious orientation might influence subjective well-being at the end of life, we used the method of objective hermeneutics to examine semi-structured qualitative interviews with three older male hospice patients (aged 79, 80, and 98) on religion/spirituality and attitudes about death and dying. Results of the analyses revealed that the intrinsically religious respondent maintained his sense of cosmic purpose in life, which continued to be a source of satisfaction for him, unaffected by his terminal illness. The two extrinsically religious respondents, however, did not find solace in their religion and, hence, were unable to cope with their physical and emotional dependence and vulnerability. The findings suggest that an intrinsic religious orientation is most likely to be related to a cosmic sense of purpose in life, which facilitates subjective well-being even in the face of death.