预立医疗照护计划的国内外发展现状

随着医疗水平的不断提高,原本无法挽救的生命都可通过医疗技术给予维持,而与此同时,人们的自主意识在逐渐增强、生命价值观在不断完善,姑息照护也得到了持续发展.在这样的背景下,预立医疗照护计划慢慢引起人们重视,国外许多国家及我国台湾地区已给予了广泛认可.     

预立医疗照护计划的国内外发展现状

随着医疗水平的不断提高,原本无法挽救的生命都可通过医疗技术给予维持,而与此同时,人们的自主意识在逐渐增强、生命价值观在不断完善,姑息照护也得到了持续发展。在这样的背景下,预立医疗照护计划慢慢引起人们重视,国外许多国家及我国台湾地区已给予了广泛认可。     

Personal Identity, Autonomy and Advance Statements

abstract    Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a sound basis for extending the moral autonomy of an individual — and hence their autonomous wishes expressed through an advance statement — past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient's best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interests judgements concerning an individual's care or treatment.     

In Defence of Advance Directives in Dementia

It has often been claimed that orthodox thinking about personal identity undermines the moral authority of advance directives in dementia by implying that the signer of the directive is numerically different from the severely demented patient. This is the ‘identity problem'. I introduce the problem, outline some well-known solutions, and explain why they might be deemed unattractive. I then propose an alternative solution. It promises to be compatible with orthodox thinking about personal identity. I discuss three ways in which it might be challenged and find that none is convincing. Personal identity is no bar to the moral authority of advance directives.     

Occupational Wellness: The Integration of Career Identity and Personal Identity

Historically, career and vocational counseling have served as cornerstones to the counseling profession. Still, there are several survey studies that indicate that interest in career counseling among counseling professionals has eroded. Conversely, there has been an overwhelming response from counselors to the idea of wellness. The intent of this article is to encourage practicing counselors and researchers to consider career development as a key ingredient in the conceptualization of wellness. Furthermore, it is imperative that we begin to assist clients in achieving this aspect of occupational wellness through the integration of career identity and personal identity.     

The Integration of Personal Identity,Religious Identity,and Moral Identity in Emerging Adulthood

The present study investigated the relative roles of identity structure (i.e., personal identity) and identity contents (i.e., religious identity and moral identity) in predicting emerging adults’ prosocial and antisocial behaviors. The sample included 9,495 college students. A variable-centered analysis (path analysis) used personal identity, religious identity, and moral identity as predictors of prosocial and antisocial behavior and tested interactions of personal identity with religious identity and moral identity. Moral identity was the strongest predictor of both behaviors, and religious identity and moral identity both interacted with personal identity in predicting antisocial behavior. A person-centered analysis (latent profile analysis) found three classes: integrated, moral identity–focused, and religious identity–focused, with integrated being most adaptive on both outcomes.     

Privacy and Personal Identity

What marks the traditional privacy torts of disclosure, intrusion, false light, and appropriation is that they require an invasion, an intrinsic harm caused by someone doing something to us without our consent. But we are now voluntarily giving up information about ourselves--to our physicians, for instance--that is being gathered into databases that are brought and sold and that can be appropriated by those who wish to assume our identities. The way in which our privacy is put at risk is different, and this leads to a new understanding of the concept of privacy. Others appropriate our identities, treating us as objects; by doing so, our standing as autonomous moral agents, controlling how we present ourselves to the world, is thus denied.     

Personal Identity and Thought-Experiments

Through careful analysis of a specific example, Parfit's 'fission argument' for the unimportance of personal identity, I argue that our judgements concerning imaginary scenarios are likely to be unreliable when the scenarios involve disruptions of certain contingent correlations. Parfit's argument depends on our hypothesizing away a number of facts which play a central role in our understanding and employment of the very concept under investigation; as a result, it fails to establish what Parfit claims, namely, that identity is not what matters. I argue that Parfit's conclusion can be blocked without denying that he has presented an imaginary case where prudential concern would be rational in the absence of identity. My analysis depends on the recognition that the features that explain or justify a relation may be distinct from the features that underpin it as necessary conditions.     

生前预嘱、预立医疗指示和预立医疗照护计划的概念关系辨析

通过回顾文献对生前预嘱、预立医疗指示、预立医疗照护计划三个概念产生的背景、定义、内容组成和法律实践等问题进行梳理与澄清,进一步指出概念之间的关系。生前预嘱与预立医疗指示属于归属关系。预立医疗照护计划是继预立医疗指示产生和应用后,为促进其签署而提出的概念,二者在内容、实施的侧重点及实施效果方面存在差异。通过概念辨析,旨在减少医务人员和公众对以上概念的混淆和误解,为后续研究和临床实践开展提供借鉴。