Luck Egalitarianism,Universal Health Care,and Non-Responsibility-Based Reasons for Responsibilization

In recent literature, there has been much debate about whether and how luck egalitarianism, given its focus on personal responsibility, can justify universal health care. In this paper we argue that, whether or not this is so, and in fact whether or not egalitarianism should be sensitive to responsibility at all, the question of personal responsibilization for health is not settled. This is the case because whether or not individuals are responsible for their own health condition is not all that is relevant when considering whether we should somehow hold them responsible for their own health condition, e.g. cost-wise. There may also be efficiency-based reasons to hold them responsible, and there may even be egalitarian reasons. Defining universal health care as an insurance system where everyone’s deductible and premium is 0, we will argue that efficiency-based reasons for cost-responsibilization are not convincing, but that there are egalitarian reasons for cost-responsibilization. Luck egalitarianism, therefore, cannot, at least not on its own term, justify universal health care.

     

HOW PATIENTS COMMUNICATE ABOUT THEIR ILLNESS

This article presents two empirical investigations of how patients communicate about their illness. A review of the literature on provider-patient communication is offered. From this review, we conclude that we know intuitively more about the interaction between health care providers and their patients than the research literature has revealed. A series of research questions are advanced concerning the patient's communicative contributions to the provider-patient relationship. The first study offers evidence of distinct patient-communication typologies. How patients communicate about their illness is also closely related to how they utilize the health care system. The second study uses independent raters to validate patient self-reports about their communication behavior. The findings suggest that how patients communicate to health care providers is a factor worthy of further study. Several specific avenues for future research are discussed in light of these findings.     

对“医疗服务商品和市场”存在客观性和必然性的理性思考——兼评《对中国医疗卫生体制改革的评价与建议》

针对国务院发展研究中心课题组发表的《对中国医疗卫生体制改革的评价与建议》提出的卫生改革带来“问题的根源在于商业化、市场化的走向违背了医疗卫生事业发展的基本规律。”提出“医疗服务商品”、“医疗服务市场”的存在是客观的,并通过反驳《评价与建议》提出的四对矛盾,提出“医疗服务商品”、“医疗服务市场”的存在也是必然的,最后分析了所谓“卫生改革失败”的真正原因。     

The Maternal lineage: identification,desire and transgenerational issues

In this paper I argue that close attention should be paid to the changes that have been taking place in the National Health Service over the last 15 years as a result of governmental initiatives. The identification of the direction that the recent health reforms have been taking should allow us to draw significant conclusions regarding the possible fate that the NHS is facing in the not‐too‐distant future. The introduction of the internal market in health care, the Private Finance Initiative, private Diagnostic & Treatment Centres and Foundation Trusts may indicate that the privatization of the NHS has begun in earnest. The relevance of such considerations to all NHS workers and users needs to be appreciated, as it may go some way towards answering the important question of what kind of NHS we will be having and using in the future. The implications for the NHS in general, and for psychotherapy services in particular, of the insidious but invasive process of privatization inherent in the ongoing changes in the structure and funding of the NHS are discussed.     

从深层次研究和认识卫生改革的方向与目标

20年的卫生改革是伴随着社会经济改革与发展的过程慢慢地进行摸索,改革的‘彼岸’并没有一个清晰的图景;由于改革的目标模式所提供的信息是不充分的,我们没有更多的信息来判断我们改革的进程与结果。因此,卫生改革最迫切的事情是需要更大的耐心,以新的认识,新的理念和勇气,来进行系统的反思,以促进卫生改革从一种经验性的改革进入到一种理性的改革过程。     

Practicing psychology in the era of managed care. Implications for practice and training

Beginning with the HMO Act of 1973, managed care, a system for controlling health care costs, rapidly expanded and gained influence as the main vehicle for health care delivery in the United States. Implementation of managed care principles in the mental health arena has generated much debate, particularly with respect to issues of quality of care. The authors briefly trace the development of managed care and evaluate its impact on the practice of psychology. The extant literature is reviewed with specific attention to issues of quality of care, confidentiality of patient information, and shifting practice patterns of clinicians. Finally, the future of professional psychology within the context of managed care is examined, and the implications of newly created mental health roles for practitioners, training programs, and organized psychology are discussed.     

Telepsychiatry with rural American Indians: issues in civil commitments

The use of live interactive videoconferencing to provide psychiatric care, telepsychiatry, has particular relevance for improving mental health treatment to rural American Indian reservations. There is little literature on civil commitments in telepsychiatry and none specifically addressing this topic among American Indians. This article reviews telepsychiatry in the mental health care of American Indians, civil commitments and telepsychiatry in general, and the current state of civil commitments in American Indian communities. We conclude by considering commitment through telepsychiatry in rural reservations and offering guidelines to assist practitioners in navigating this challenging landscape. Civil commitments of American Indian patients residing in rural reservations can be successfully accomplished through videoconferencing by thoughtful and informed clinicians. However, much more work is needed in this area, including research into the cultural attitudes and perspectives towards commitments and further inquiry regarding potential legal precedents, as well as case reports and examples of this work.     

Prevalence,Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review

Research suggests that posttraumatic stress disorder (PTSD) is common, debilitating and frequently associated with comorbid health conditions, including poor functioning, and increased health care utilization. This article systematically reviewed the empirical literature on PTSD in primary care settings, focusing on prevalence, detection and correlates. Twenty-seven studies were identified for inclusion. Current PTSD prevalence in primary care patients ranged widely between 2 % to 39 %, with significant heterogeneity in estimates explained by samples with different levels of trauma exposure. Six studies found detection of PTSD by primary care physicians (PCPs) ranged from 0 % to 52 %. Studies examining associations between PTSD and sociodemographic variables yielded equivocal results. High comorbidity was reported between PTSD and other psychiatric disorders including depression and anxiety, and PTSD was associated with functional impairment or disability. Exposure to multiple types of trauma also raised the risk of PTSD. While some studies indicated that primary care patients with PTSD report higher levels of substance and alcohol abuse, somatic symptoms, pain, health complaints, and healthcare utilization, other studies did not find these associations. This review proposes that primary care settings are important for the early detection of PTSD, which can be improved through indicated screening and PCP education.     

Gewalt und Vertrauen

Puzzles are often the result of wrong questions. Not the question is interesting, how it is possible that “quite normal men” are capable of extreme violence, rather the question why in face of world history this question persists and is still considered as being interesting. This article is an attempt to find an answer to this question by discussing the special relation developed by the cultural formation named “modern age” to violence in general and last but not least to its own violence. Violence underlies in modern age a pressure of legitimation which strongly differs from other cultures, and the trust in modern age is to a great extent based on the – all too often counterfactual – assumption that it is non-violent or at least on the way to that. In the course of these considerations it should be examined why there is no satisfying sociology of violence although just this lack is known and bemoaned –, as well as the question on which bases such a sociology could be established: systematically, considering a phenomenology of physical violence and the analysis of the relation of power and violence as well as the communicative function of violence; historically, considering the question how the special relation of modern age to violence was developing and to which changes it is subjected in face of the excesses of violence of the 20th century.     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

Transpersonal psychology,physical health,and mental health: Theory,research, and practice

Abstract

Throughout its existence, transpersonal psychology has held a strong interest in exploring the implications of consciousness and spirituality for health, both physical and mental. This article provides a brief overview of the theoretical, empirical, and clinical contributions of transpersonal psychology to the understanding and facilitation of human health and well‐being. It also critiques the methodological basis of some of these contributions, concluding that transpersonal psychological studies of the relationship between spirituality and health are still in their infancy and that practitioners interested in using approaches based on these findings need to exercise caution as well as excitement about the interesting developments unfolding at an ever increasing rate.     

Respecting Autonomy Through the Use of Force: the Case of Civil Disobedience

Acts of civil disobedience, which imply the open violation of a legal directive, often result in the forceful imposition of a choice upon others (e.g. blockades). This is sometimes justifiable, within a democracy, in cases of ‘democratic deficit’, namely, when fundamental rights of an oppressed minority are at stake. In this article, I claim that the use of physical force, in a democracy, may also be justified by the rights of (at least some of) the very people upon whom force is applied. Focusing on the nature of civil disobedience as a ‘form of address’, I argue: (1) using physical force to address others in the democratic arena does not entail infringing upon their status as autonomous agents; (2) using physical force to address others in the democratic arena may contribute to the fulfilment of a positive duty to promote the autonomy of (at least some of) those very people upon whom force is applied. This is not a defence of paternalism: I claim that using force against others, in the democratic arena, may be constitutive of a behaviour that treats others with the respect due to their status as autonomous agents.     

Civil commitment: A review of empirical research

This article presents a comprehensive review of empirical micro-level research which has attempted to evaluate changes in civil commitment law in the United States. It groups studies by category of the general question they address: Who are being processed through civil commitment and who are being committed? How dangerous are civil commitment candidates on admission, in the hospital, and after release? To what extent are court officers adhering to procedural protections in form and in intent? To what extent have restrictive criteria influenced the behavior of medical professionals in processing individuals through civil commitment? and What happens to individuals after their civil commitment experience and their involuntary hospitalization? The article points to needed research and concludes by summarizing existing research from the perspective of finding a balance between civil liverty and benevolence.     

Emotion Regulation of Preschool Children in Foster Care: The Influence of Maternal Depression and Parenting

Emotion regulation is a core developmental process that is related to children’s academic success and mental health. A small body of research has documented that maltreated children show deficits in this developmental arena. The current study was designed to add to the limited literature on emotion regulation in maltreated children in foster care. Emotion regulation tasks were administered to preschool foster children, videotaped, and later coded. Parenting was assessed via coded observations of mother-child interactions. Mothers reported on their experience of depressive symptomatology. We examined the relation of foster parenting and foster mother depression, as well as child characteristics and child welfare experiences, to emotion regulation, specifically in the joy and anger domains. Findings revealed that maternal depression and parental structuring significantly contributed to children’s anger regulation, but not to their regulation of joy. These findings are considered in the context of future research with respect to young maltreated children in foster care.     

The professional identity of counselling psychologists in health care: a review and call for research

Despite (a) anecdotal evidence which suggests that it is possible to be a counselling psychologist in non-traditional settings, and (b) the potential integration of counselling psychology foci with the medical model, there has been some discussion about whether counselling psychologists who practice in health care settings might experience a change in their professional identity. Professional identity is defined here as a sense of connection to the values and emphases of counselling psychology. The retention of professional identity seems important for counselling psychologists in health care settings. This is considering that the application of counselling psychology principles has the potential to make their contributions unique among mental health professionals in the health care arena. Here, the authors describe the evolution of ‘counselling health psychology’ and address issues of professional identity. Limitations of existing literature are examined. Recommendations for future research are also made.     

Military psychology in the age of managed care: The Wilford Hall model

Military medicine is currently being overhauled through Tricare, a comprehensive, managed care program designed to reduce costs and increase clients' access to health care. This article presents reforms initiated by the psychologists at Wilford Hall Medical Center, the largest military hospital in the world, in response to Tricare. These reforms have resulted in adult, outpatient services that are immediately accessible, effective, and cost efficient. The Wilford Hall approach to psychological services is offered as model that can be used in other outpatient settings. Additionally, potential limitations of this approach to psychological care are presented.     

Governmentality, Critical Scholarship, and the Medical Humanities

Foucault's work has had a profound impact on the medical humanities over the last decade or so. However, most work to date has focused on Foucault's earlier writings rather than his later contributions on the self and governmentality. This article assesses the significance of the concept of governmentality for critical scholarship in the medical humanities, particularly in creating ethical awareness in the field of health care. It examines the context for Foucault's later work, and contributions arising from scholarship building on this work. The governmentality literature, it is argued, raises novel questions about the ways we have come to think about health care in late modern societies. However, there are some limitations with this body of work which have not been fully acknowledged by scholars. The article discusses some of these limitations and offers some suggestions for a fruitful way forward.     

Justice and the market for health insurance

After reviewing some of the insurance-related obstacles to access to health care, some ethical criteria for evaluating proposals aimed at reforming the health insurance marketplace to achieve universal access are developed. The additional reforms needed to eliminate many of the deficiencies in the current health insurance marketplace are discussed. It is suggested that without such substantial reforms some of the other goals such as expanded consumer choice and overall societal health care cost savings may not be effectively promoted.     

Use of Technology to Provide Mental Health Care for Racial and Ethnic Minorities: Evidence,Promise, and Challenges

Mental health disparities among racial and ethnic minorities (R&EM) are well documented. Some of the variables driving these disparities are limited care availability, difficulty accessing services, and attitudinal barriers. Although no single approach will eliminate all these obstacles, the use of technology to provide mental health services represents a paradigmatic shift in care delivery that could reduce unmet mental health need. Despite increasing evidence supporting the feasibility and efficacy of behavioral intervention technologies (BITs), such evidence is more limited among R&EM. For BITs to truly reduce disparities in care, these interventions need to overcome common barriers to treatment that disproportionally affect R&EM. This article reviews the empirical support of different BIT modalities with R&EM. We then provide informed clinical recommendations for the use of BITs with these groups, as well as a case example illustrating these guidelines. We conclude this article by discussing future directions that can inform the development and refinement of BIT approaches for R&EM.