In Defense of “Denial”: Difficulty Knowing When Beliefs Are Unrealistic and Whether Unrealistic Beliefs Are Bad

Bioethicists often draw sharp distinctions between hope and states like denial, self-deception, and unrealistic optimism. But what, exactly, is the difference between hope and its more suspect cousins? One common way of drawing the distinction focuses on accuracy of belief about the desired outcome: Hope, though perhaps sometimes misplaced, does not involve inaccuracy in the way that these other states do. Because inaccurate beliefs are thought to compromise informed decision making, bioethicists have considered these states to be ones where intervention is needed either to correct the person’s mental state or to persuade the person to behave differently, or even to deny the person certain options (e.g., another round of chemotherapy). In this article, we argue that it is difficult to determine whether a patient is really in denial, self-deceived, or unrealistically optimistic. Moreover, even when we are confident that beliefs are unrealistic, they are not always as harmful as critics contend. As a result, we need to be more permissive in our approach to patients who we believe are unrealistically optimistic, in denial, or self-deceived—that is, unless patients significantly misunderstand their situation and thus make decisions that are clearly bad for them (especially in light of their own values and goals), we should not intervene by trying to change their mental states or persuade them to behave differently, or by paternalistically denying them certain options (e.g., a risky procedure).     

An Examination of Race Differences in Patients' Psychological Adjustment to Cancer

Although African Americans are at increased risk of cancer morbidity and mortality, very little is known about their psychological adjustment. African American males may be at especially high psychological risk, considering their disproportionately higher cancer mortality. Subjects were 42 African American and 56 White adults similar in age, cancer stage, marital status, and socioeconomic status. Analyses revealed no significant race or gender effects on global indices of psychological adjustment, depression, or anxiety. However, African Americans were more likely than Whites (a) to use avoidant coping strategies in dealing with the exigencies of their illness, (b) to report more cancer-related disruption in family relations, and (c) to identify fewer individuals in their social support network. No significant race differences were found on a measure of health care satisfaction. These findings highlight the need to provide a more comprehensive examination of individual, family, and socioecological variables and their relationship to psychological adaptation among minorities with cancer.     

Ebola,Team Communication,and Shame: But Shame on Whom?

Examined as an isolated situation, and through the lens of a rare and feared disease, Mr. Duncan's case seems ripe for second-guessing the physicians and nurses who cared for him. But viewed from the perspective of what we know about errors and team communication, his case is all too common. Nearly 440,000 patient deaths in the U.S. each year may be attributable to medical errors. Breakdowns in communication among health care teams contribute in the majority of these errors. The culture of health care does not seem to foster functional, effective communication between and among professionals. Why? And more importantly, why do we not do something about it?     

Ethics and Changing Mental Health Care: Concerns and Recommendations for Practice

Recent developments in health care delivery in the United States have left many professionals baffled by the continuing changes in practice sparked by the relatively new managed care environment. Psychologists who practice in medical settings are struggling to balance the seemingly competing needs to deliver quality care to clients and patients, while meeting the demands of third-party payers and trying to remain true to their ethical responsibilities. Critical elements of managed care, which many suggest compromise the ethical provision of quality care, include utilization review, financial incentives, and threats to confidentiality. Recommendations are proposed so that mental health professionals may be proactive in protecting their ethical responsibilities in this changing environment.     

Psychological science in the public arena: Three cases of dubious influence

Psychological science has a great deal to contribute to social welfare in all societies, because the world's most pressing social problems are behavioral in nature—violence, hunger, drug abuse, environmental pollution, low worker productivity, poor educational outcomes, and so forth. Thus, psychological research can inform public policies to improve approaches to these important social problems. The relationship of psychological science to public policy is often troubled, however, by misunderstandings about the role of science in the policy making process. Many scientists fear that their research results will be "misused" by others whose values differ from those of scientists. Thus, psychologists are reluctant to publish research results that can be used to support policies contrary to their own values and hesitate to ask research questions that can generate politically incorrect results. In this article, I argue that psychological science has a primary responsibility to ask dangerous questions and to report results honestly, without fear of their use; that research is not translated directly into public policies; and that psychological science should not be perverted either by fear of political consequences or by compromising truth in a quest for power. Three research examples are given to illustrate the different faces of temptation to pervert psychological science in a misguided hope that scientists' own values will be reflected in public policies.     

我国农村初级卫生保健制度发微

集中梳理和总结有关中国农民初级卫生保健,特别是农村卫生投入和补偿机制、农村公共卫生和预防保健的文献,结合实地调研中发现的问题和矛盾,分析当今中国初级卫生保健的倾向、面临的问题,和当前我国卫生资源科学、合理利用以及可持续发展的滞碍所在,从理论与实证研究的角度提出未来的工作方向和政策建议。     

Hotep's Story: Exploring the Wounds of Health Vulnerability in the US

A wide variety of forms of domination hasresulted in a highly heterogeneous health riskcategory, ``the vulnerable.' The study of healthinequities sheds light on forces thatgenerate, sustain, and alter vulnerabilities toillness, injury, suffering and death. Thispaper analyzes the case of a high-risk teenfrom a Boston ghetto that illuminatesintersections between ``race' and class in theconstruction of vulnerability in the US.Exploration of his ``wounds' helps specify howlarge-scale social and cultural forces becomeembodied as individual experience of disparatehealth risk. The case demonstrates that healthinequities would not occur if resources –employment, income, wealth, education, housing,profiling in the legal system, and health care– were more justly managed in keeping withstandards outlined in the Universal Declarationof Human Rights. Professional responses to the``wounds of vulnerability' may reveal importantaspects of who we are and what our work asscholars, practitioners, and advocates mustbecome.     

新时代农村公共卫生政策的量化分析研究

基于“供给-需求-环境”分析模型,对中国2013年～2022年出台的242份农村公共卫生政策文件进行量化分析后发现,地区差异明显,东部、中部地区较东北部、西部地区的相关政策更多;从模型看制定供给端政策最多,需求端次之,环境端最少。从公共伦理学视角进行原因分析,提出农村公共卫生政策的公平正义有待提高、农村居民的公共利益应得到更充分维护、政策制定要符合中国式现代化可持续发展要求等政策建议,以不断完善我国农村公共卫生政策、推进农村公共卫生事业发展。     

政府与个人的责任——中国当代医疗改革的责任伦理学剖析

卫生改革的重点必须放在政府部门;公共卫生,预防与初级医疗保健是人类生存的需要,带有鲜明的公益性和福利性。应由政府投资为主筹集资源,以国家投资为主体负担费用,这个层次的卫生服务产品,属非商品经济部分,并不以赢利为目的,不能引进市场经济,个人对健康负有重要责任,包括：选择医疗保健,决定花费数额,生活方式和卫生习惯的养成,主动接受健康教育,抵抗压力,支持国家与地区的卫生保健政策;个人对自身健康负责是一种道德责任,健商（health quotient)这一重要概念,具有伦理价值和普遍的医学人类学意义;个人对健康负责是一种社会风尚。     

生命伦理与制度伦理冲突的终结--"非典"事件的伦理学审读

SARS事件可以为生命伦理与制度伦理历史冲突的终结提供佐证;公民享有的健康权必须平等。应大力矫正医疗与预防的关系,必须重视发展公共卫生事业;应重新思考中国的卫生事业改革,中国医疗改革不能实行市场化,卫生经济伦理学的研究证明,中国的卫生制度改革重点在农村,“适者生存”的原则不适用于卫生事业。创构灾疫伦理学是生命伦理学的一项使命。     

流行病学实践与研究相关的伦理学视角与思考

随着社会的发展,公共卫生领域的伦理学问题不断显露,有必要对其重新审视。探讨了目前在公共卫生领域流行病学实践与研究中存在和涉及到的一些伦理问题,有传染病报告、隔离、免疫规划、艾滋病防治、传染病应急机制、流行病学调查和试验研究等,并就公共卫生领域中的伦理实践原则进行了概括。