权利优先、还是义务优先——对涉及人的生物医学研究中受试者权利与义务关系的理性思考

对“权利与义务”从“公正”方面进行了解读,论述了在涉及人的生物医学研究中,受试者权利与义务之间的复杂关系,提出“受试者权利优先”是平衡两者关系的基本原则;确立了“受试者权利优先”的具体策略：首先尊重受试者的权利（首要性）;当受试者的权利与受试者的义务出现一定矛盾时,应该把尊重受试者的权利放在首位（至上性）;在尊重受试者的权利中,化解两者矛盾。     

Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy.     

Science, Democracy, and the Right to Research

Debates over the politicization of science have led some to claim that scientists have or should have a “right to research.” This article examines the political meaning and implications of the right to research with respect to different historical conceptions of rights. The more common “liberal” view sees rights as protections against social and political interference. The “republican” view, in contrast, conceives rights as claims to civic membership. Building on the republican view of rights, this article conceives the right to research as embedding science more firmly and explicitly within society, rather than sheltering science from society. From this perspective, all citizens should enjoy a general right to free inquiry, but this right to inquiry does not necessarily encompass all scientific research. Because rights are most reliably protected when embedded within democratic culture and institutions, claims for a right to research should be considered in light of how the research in question contributes to democracy. By putting both research and rights in a social context, this article shows that the claim for a right to research is best understood, not as a guarantee for public support of science, but as a way to initiate public deliberation and debate about which sorts of inquiry deserve public support.     

Teleology,Deontology, and the Priority of the Right: On Some Unappreciated Distinctions

The paper analyses Rawls’s teleology/deontology distinction, and his concept of priority of the right. The first part of the paper aims both 1) to clarify what is distinctive about Rawls’s deontology/teleology distinction (thus sorting out some existing confusion in the literature, especially regarding the conflation of such distinction with that between consequentialism and nonconsequentialism); and 2) to cash out the rich taxonomy of moral theories that such a distinction helpfully allows us to develop. The second part of the paper examines the concept of priority of the right. It argues that such a concept should not be identified with that of deontology—indeed, deontological theories do not necessarily assign priority to the right over the good. However, it contends that the concept of priority of the right is essential to explaining what specific kind of deontological theory “justice as fairness” is. Justice as fairness is a deontological theory which assigns priority to the right as a consequence of its commitment to a neutral position with respect to different accounts of what is ultimately valuable and good.     

Sexual Health Research Among Youth Representing Minority Populations: To Waive or Not to Waive Parental Consent

Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) significantly burden youth 13–24 years of age in the United States. Directly engaging youth in sexual health research is a public health priority and urgently needed to develop targeted, youth-friendly, and culturally relevant HIV/STI prevention interventions. Controversies arise, however, regarding informed assent and consent, parental permission or consent, and the definition of “child”/“minor” as it relates to medical, legal, and ethical issues. In this article, we describe challenges in the human subjects review processes that were undertaken before beginning an HIV/STI prevention research project with sexually active youth in an urban setting. These findings provide important contextual information to facilitate youth sexual health research and care, and Institutional Review Board approval processes with fewer delays.     

On the biomedicalization of alcoholism

The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of alcoholism. The second claim is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism.     

Women's Future Travel, Driving, and Transit Use

Women's future community travel needs have not yet been analyzed to determine how changes in society will affect or be affected by women's car driving and public transit use. The author infers from limited available data that automobiles will accommodate more of women's travel needs because transit might not satisfy many trip requirements, including those for mental well-being and personal security and for continued homemaking and childrearing responsibilities. Insensitive government restrictions on women's auto use should be discouraged; positive investment and management strategies for automobile and transit systems should be encouraged to help women travelers. Research, employment efforts, and increased public input within the transportation industry are among the recommended long term strategies to improve industry and public awareness and to foster constructive actions on the behalf of women.     

Vexing,Veiled, and Inequitable: Social Distancing and the “Rights” Divide in the Age of COVID-19

Abstract

Although unprecedented in scope and beyond all our life experiences, sweeping social distancing measures are not without historical precedent. Historically, racism, stigma, and discrimination resulted in grossly inequitable application of disease containment measures. But history also provides examples in which broad measures enjoyed remarkable public support. When it comes to COVID-19, blame and division continue to shape containment responses. But the COVID-19 pandemic also resonates with moments in which there was broad social support for containment precisely because lockdowns or stay at home orders are, on the surface, remarkably equitable. Yet even in a context in which a majority of Americans support social distancing, small but coordinated conservative groups are challenging social distancing as a matter of individual rights. In sharp contrast, vulnerable populations, who bear the heaviest burden of disease, have claimed a right to social distancing as a matter of protection.     

公共卫生的作用及政府职责

从20世纪人类健康的进步的贡献和2003年非典危机的爆发,都反映了公共卫生的作用,公共卫生投入对国家社会经济发展和政治及宏观经济的稳定具有不可忽视的作用和不可取代的贡献.理论研究和实证研究揭示了政府公共卫生投入与健康指标的关联,政府为全体人民提供基本公共卫生产品的必要性.而政府提供基本公共卫生服务和保障基本公共卫生产品供给的重要前提是确保政府预算对公共卫生的投入,使其对人民健康产生正向的积极促进作用.明确各级政府在公共卫生中的责任,实行分级管理和考核监督机制,是急待研究和解决的问题.进一步加大政府对公共卫生政府投入水平和改善投入机制,是今后强化中国政府公共卫生职责的一个突破口.     

An historical commentary on the physiological effects of music: Tomatis, Mozart and neuropsychology

This article provides an overview of the theoretical underpinnings of the Tomatis Method, along with a commentary on other forms of sound/music training and the need for research. A public debate was sparked over the “Mozart Effect.” This debate has turned out to be unfortunate because the real story is being missed. The real story starts with Alfred Tomatis, M.D., scientist and innovator. Dr. Tomatis was the first to develop a technique using modified music to stimulate the rich interconnections between the ear and the nervous system to integrate aspects of human development and behavior. The originating theories behind the Tomatis Method are reviewed to describe the ear’s clear connection to the brain and the nervous system. The “neuropsychology of sound training” describes how and what the Tomatis Method effects. Since Dr. Tomatis opened this field in the mid 20th century, no fewer than a dozen offshoot and related systems of training have been developed. Though each new system of treatment makes clains of effectiveness, no research exists to substantiate their claims. Rather, each simplified system bases its “right to exist and advertise” on the claimed relationship to Tomatis and his complex Method. Research is desperately needed in this area. The 50 years of clinical experience and anecdotal evidence amassed by Tomatis show that sound stimulation can provide a valuable remediation and developmental training tool for people of all ages. Offshoot systems have watered down the Tomatis Method without research to guide the decisions of simplifying the techniques and equipment.     

The future of genetics in public health

During the 1980s, we have witnessed an erosion in federal and state funding for the coordination of genetic services in state health departments. As this decade begins, the federal budget for the support of the national genetics program is less than half of the total available in 1980. In addition, priorities in state maternal and child health programs have changed, and genetic services have often received lower rankings aside of programs to improve prenatal care and to address problems such as teenage pregnancy. Clearly we are at a critical point for the future of genetics programs in the public health arena. Fortunately, despite the problems with funding and priority setting, important coalitions have been built during the past decade and continued advances in medical genetics have made it difficult for public health officials to ignore the potential impact of genetic services. Council of Regional Networks for Genetic Services (CORN) and the regional genetic services networks have provided opportunities for interaction and coordination between genetic services providers and public health officials that had not been available to any significant extent. The full potential of these coalitions has yet to be realized, but efforts in data collection, development of national guidelines and standards, and information sharing and networking have already had an influence on state genetic services programs. Continuing research on the genetics of chronic diseases and the influence of discoveries in molecular genetics will undoubtedly broaden the current scope of state public health programs in genetics, which all too often have been limited to newborn screening and administration of grants for genetic services. The regional and national genetic services programs should be strengthened and appropriate training programs should be developed in Schools of Public Health to provide the expertise and leadership that will be needed to guide the future of genetics in public health.     

Similarities and differences in dream content at the cross-cultural, gender, and individual levels

The similarities and differences in dream content at the cross-cultural, gender, and individual levels provide one starting point for carrying out studies that attempt to discover correspondences between dream content and various types of waking cognition. Hobson and Kahn’s (Hobson, J. A., & Kahn, D. (2007). Dream content: Individual and generic aspects. Consciousness and Cognition, 16, 850–858.) conclusion that dream content may be more generic than most researchers realize, and that individual differences are less salient than usually thought, provides the occasion for a review of findings based on the Hall and Van de Castle (Hall, C., & Van de Castle, R. (1966). The content analysis of dreams. New York: Appleton-Century-Crofts.) coding system for the study of dream content. Then new findings based on a computationally intensive randomization strategy are presented to show the minimum sample sizes needed to detect gender and individual differences in dream content. Generally speaking, sample sizes of 100–125 dream reports are needed because most dream elements appear in less than 50% of dream reports and the magnitude of the differences usually is not large.     

Why Should I Respect You? A Critique and a Suggestion for the Justification of Mutual Respect in Contractualism

Contractualism is a normative theory which characterizes principles of right in terms of the idea of mutual respect. In this theory, mutual respect is regarded as having deliberative priority over other values. This essay aims to examine how contractualists can provide a satisfactory justification for prioritizing mutual respect. I will argue that the “value of mutual respect argument,” which is a justification commonly adopted by contractualists, is inadequate because an unconditional priority of mutual respect cannot be grounded on the desirability of a relationship of mutual respect. Then, I will suggest that a “consistency argument” can provide a better justification of why the idea of mutual respect should have priority. Mutual respect is of special importance, not because it is highly desirable, but rather because it is required by an a priori guiding principle of consistency. Individuals become inconsistent if they ask others to respect them as reason-assessing individuals, while at the same time refusing to respect others in the same way.     

Investing in Children, Families, and Communities: Challenges foran Interdivisional Public Policy Collaboration

An interdivisional collaboration to foster the development of strengths-based policies for children, youth, families, and communities is described. The initiative includes (1) producing a book that integrates scholarly research and policy; (2) developing materials for policymakers to use, including a policy-oriented summary of the book; (3) enhancing the capacities of the divisions to communicate with and influence policymakers; and (4) taking action steps to influence policymakers. During the process of developing these products, a number of tensions emerged between the academically-based and policy-based authors of the book, many of which centered around how the information should be presented and, in particular, how to formulate and present policy recommendations. Tensions fell into four general categories: understanding the appropriate scope for recommendations, using the right language, understanding the kind of information that is needed, and understanding the bottom line. The author concludes by urging psychologists to become adept at understanding and participating in the public policymaking process.     

Giving Voice to Patients: Developing a Discussion Method to Involve Patients in Translational Research

Biomedical research policy in recent years has often tried to make such research more ‘translational’, aiming to facilitate the transfer of insights from research and development (R&D) to health care for the benefit of future users. Involving patients in deliberations about and design of biomedical research may increase the quality of R&D and of resulting innovations and thus contribute to translation. However, patient involvement in biomedical research is not an easy feat. This paper discusses the development of a method for involving patients in (translational) biomedical research aiming to address its main challenges.After reviewing the potential challenges of patient involvement, we formulate three requirements for any method to meaningfully involve patients in (translational) biomedical research. It should enable patients (1) to put forward their experiential knowledge, (2) to develop a rich view of what an envisioned innovation might look like and do, and (3) to connect their experiential knowledge with the envisioned innovation. We then describe how we developed the card-based discussion method ‘Voice of patients’, and discuss to what extent the method, when used in four focus groups, satisfied these requirements. We conclude that the method is quite successful in mobilising patients’ experiential knowledge, in stimulating their imaginaries of the innovation under discussion and to some extent also in connecting these two. More work is needed to translate patients’ considerations into recommendations relevant to researchers’ activities. It also seems wise to broaden the audience for patients’ considerations to other actors working on a specific innovation.     

Priority rule signalization under two visibility conditions: Driving simulator study on speed and lateral position

In literature, priority-controlled and right-hand priority intersections have rarely been compared on other elements than the number of right-of-way violations and collisions. This study investigates the effect on speed and lateral position of five priority rules under two visibility conditions at an intersection (without hierarchy between branches), which is, at this moment, a knowledge gap.Fifty participants drove five different routes in a simulator and were exposed to the following manipulations: priority to the right rule applying and indicated (road sign and road sign with road marking), priority to the right rule applying but not indicated (no sign), priority to the right rule not applying and indicated (priority road and priority at next intersection), under good and bad visibility.Results show a significant speed decrease for both situations where the priority to the right rule was indicated compared to situations with no priority to the right rule, especially when visibility was bad. Priority to the right signs with additional road marking resulted in lowest speed under both visibility conditions. For all priority rules, lateral position shifted more towards the middle of the road when visibility was bad.Since speed was higher in case of priority roads or roads with priority at next intersection, it can be concluded that a higher level of control (priority-controlled intersections) does not necessarily result in a traffic safety improvement. Therefore, policy makers should take into account the results of this study and not generally change all the priority to the right intersections by priority-controlled intersections.     

Children's Sensitivity to Ulterior Motives When Evaluating Prosocial Behavior

Reasoning about ulterior motives was investigated among children ages 6–10 years (total N = 119). In each of two studies, participants were told about children who offered gifts to peers who needed help. Each giver chose to present a gift in either a public setting, which is consistent with having an ulterior motive to enhance one's reputation, or in a private setting, which is not consistent with having an ulterior motive. In each study, the 6‐ to 7‐year olds showed no evidence of understanding that the public givers might have ulterior motives, but the 8‐ to 10‐year olds rated the private givers more favorably. In 3. , the older children were more likely than the younger children to refer to impression management when explaining their judgments of the givers. The younger children who mentioned impression management did so to justify a preference for public givers (e.g., by explaining that public givers are nicer because more of their peers will know that they are nice). Results from 4. suggest that developmental change in children's reasoning about intentions and social outcomes contributes to their understanding of ulterior motives.     

Sensitizing Medical Residents to Fantasies and Alignments in the Family: Mastering Psychosocial Skills in the Medical Encounter

In this paper, it is proposed that a) psychosocial medicine is best taught in a setting that provides technical and emotional support, while seizing for teaching only those moments when the learner is most receptive; and b) that the setting should avoid the development of a separate psychosocial skills curriculum, but should take the student where he or she is and integrate the psychosocial skills into his or her everyday biomedical practice. The paper gives specific case examples in which family based psychosocial issues were preeminent in the clinical problem-solving medical residents faced.     

Making the case for dedicated infant mental health services

SUMMARY

This paper seeks to demonstrate the case for establishing dedicated Infant Mental Health Services. It is argued that the 0–3 age-group is not well served by the current arrangement for the provision of mental health services along child/adult lines, and falls between these two stools. It is further argued that priority should be given to services for this group because of the immense potential of early intervention programmes. The nature and ethos of such services are discussed, and it is suggested that the time is now ripe for Infant Mental Health to be given institutional recognition as a distinct specialism in its own right.     

Mediation in experimental and nonexperimental studies: new procedures and recommendations

Mediation is said to occur when a causal effect of some variable X on an outcome Y is explained by some intervening variable M. The authors recommend that with small to moderate samples, bootstrap methods (B. Efron & R. Tibshirani, 1993) be used to assess mediation. Bootstrap tests are powerful because they detect that the sampling distribution of the mediated effect is skewed away from 0. They argue that R. M. Baron and D. A. Kenny's (1986) recommendation of first testing the X --> Y association for statistical significance should not be a requirement when there is a priori belief that the effect size is small or suppression is a possibility. Empirical examples and computer setups for bootstrap analyses are provided.