论临床代理决策中的“患者最佳利益原则”

对于无行为能力患者的代理决策,传统的预先指令与替代决策模式已暴露其局限性,如误读患者利益或者掺杂代理人的利益.基于最佳利益原则的决策模式能最大限度维护他们的利益,医学最佳利益与拓展的最佳利益是其两种模式.前者将生命质量作为核心要素;后者还包括患者个体的价值观与宗教信仰等个体利益.在我国社会语境中,应当实施医学最佳利益标准.在临床实践中,判断最佳利益依然遭遇不少障碍,包括理性人视角、代理人情感投射等.因此,需要合理的医疗判断、明确其构成要素、设置必要的程序以及完善的法律制度.     

The Client's Theory of Change: Consulting the Client in the Integrative Process

This article casts a critical eye upon the integration literature and asserts that, as in psychotherapy in general, the client has been woefully left out of the therapeutic process. An alternative that privileges the client's voice as the source of wisdom and solution is presented. It is proposed that conducting therapy within the context of the client's own theory of change offers ways of integrating multiple therapy perspectives. An argument is made for not only recasting the client as the star of the drama of therapy, but also giving the heroic client directorial control of the action as it unfolds.     

Fiduciary Duties and the Ethics of Public Apology

The practice of official apology has a fairly poor reputation. Dismissed as ‘crocodile tears’ or cheap grace, such apologies are often seen by the public as an easy alternative to more punitive or expensive ways of taking real responsibility. I focus on what I call the role‐playing criticism: the argument that someone who offers an apology in public cannot be appropriately apologetic precisely because they are only playing a role. I offer a qualified defence of official apologies against this objection, considering them through the lens of fiduciary duties. This focus draws our attention to formal or impersonal relationships that are nevertheless normatively rich, capable of sustaining trust, concern, and care. At the same time, I highlight several pitfalls for fiduciary apologisers, including the tension between apology as a mode of truth telling and the duty of confidentiality. I consider whether the fiduciary apologiser, in reflecting on her fiduciary obligations, has ‘one thought too many’ for genuine apology, and argue that the issue of mixed motives is not limited to fiduciary contexts, cautioning against excessive idealism in our conception of apology. I conclude with some reflections on possible conflicts between fiduciary obligations and the conscientious desire to apologise.     

Acting Up and Acting Out: Conduct Disorder and Competing Media Frames

This article compares diverse symbolic frames for the childhood psychiatric diagnosis “Conduct Disorder” (CD) found in the popular media with the dominant medicalized frame in the professional literature. Although vestiges of earlier frameworks remain, almost all professional accounts frame the disorder as a way of “acting out” the sick role. In contrast, the popular media use various culturally consistent frames, including delinquently “acting up.” However, unlike other instances in which the public and professionals lack a common understanding about a health condition, there has been no overt contestation about the definition of CD. Social, policy, and theoretical implications are explored.     

The Berkeley Civic Courage and Heroism Experiment: The Group Dynamics of Individuals Acting in Concert to Advance Ethical Goals in the Public Interest

Many studies have investigated how to get individuals to obey external authority, as noted in the obedience experiments (Miller, 1986). But next to none have investigated how individuals obey their conscience as they act as members of a group committed to taking nonviolent courageous action in the defense of ethical principles and the public interest. The present study investigates the situational group context and group dynamics that allow individuals to act in concert with others to carry out ethical goals, even at personal cost to themselves.     

Exploring the Edges: Boundaries and Breaks

In this article, we examine conceptual and practical issues pertaining to relationship boundaries within the helping profession. Although our focus is primarily on relationships between mental health professionals and clients, there are considerable implications for a new approach to ethically structuring and understanding the construct of "required distance" in many human-interactive professions, such as teaching, religious leadership, public administration, and others. We define the concept of boundary as applied to human relationships, provide examples of boundary breaks, and raise questions regarding how to evaluate the significance and morality issues raised by specific boundary breaks. Questions and dilemmas are presented regarding boundary setting and accidental or deliberate boundary breaking. Representative dangers present in boundary breaks are identified, and examples are provided. Possible beneficial outcomes are also discussed. Finally, a suggested protocol for assessing a proposed boundary break is provided, much of which is drawn from the work and thinking of Laura Brown, applied more generally in this article, with additions from our perspectives.     

Using the Client's Religious Values to Aid Progress in Therapy

The client's religious values could be put to use to promote growth in therapy, as detailed in this brief report.     

Assessing Professional Boundaries in Clinical Settings: The Development of the Boundaries in Practice Scale

This article reports on the Boundaries in Practice (BIP) Scale developed to measure knowledge, comfort, ethical decision making, and experience. Few instruments used in studies conducted on professional/?client boundaries have been validated. The BIP demonstrated sound face, content and construct validity, and adequate internal consistency reliability. The BIP Scale provides the first reliable and valid means of investigating multiple boundary domains across health disciplines and teams. The sensitivity and complexity of boundary issues and the serious consequences of breaches highlight the importance of a valid and reliable measure in building empirical knowledge in this field.     

表层表演和深层表演的关系:来自元分析的证据

采用元分析的方法探讨两种主要情绪劳动策略(表层表演、深层表演)之间的相关.经筛选,共有150篇文献的162个独立样本(N = 63629)符合标准.元分析结果发现,表层表演与深层表演呈显著正相关(r = 0.17).量表的作答方式、测量工具、职业类型对表层表演与深层表演的相关具有显著影响.具体表现为,量表的作答方式为频...     

Examining Sex Work from the Client's Perspective: Assessing Johns Using on-line Data

Academic research on prostitution focuses on the prostitute, rather than the clients, who are called johns. This limits our understanding of the methods and reasons individuals solicit sex. However, johns increasingly use computer mediated communications to discuss sex work. Their comments provide insight into the attitudes and methods of johns. This qualitative study utilizes a sample of posts from active Web forums for johns in 10 U.S. cities. The findings indicate the importance of on-line discussions for johns to identify and solicit sex workers, as well as manage external risks. Implications for law enforcement and deviance research are also discussed.     

作为义务的诚信以及诚信义务的豁免

作为义务的诚信是将诚信看作超越功利的,不管对行为者及其相关人员有利与否,也不管行为主体愿意与否都必须履行的道德责任。当下社会普遍存在的诚信缺失现象有复杂的原因,但将诚信仅仅作为手段来强调而忽视了义务层面的要求,并由此导致人们出于利益的追求而逃避诚信义务则无疑是最主要的原因。因此,要在全社会打造诚信,就必须树立诚信是必须被履行之义务的理念,并努力在全社会形成自觉履行诚信义务的习惯。当然,诚信义务的履行并不是无条件的,在特定的情况下是可以因为更重要更迫切的其他义务的出现而豁免的。     

Boundaries in the doctor-patient relationship

Boundaries in the doctor–patient relationshipis an important concept to help healthprofessionals navigate the complex andsometimes difficult experience between patientand doctor where intimacy and power must bebalanced in the direction of benefitingpatients. This paper reviews the concept ofboundary violations and boundary crossings inthe doctor–patient relationship, cautions aboutcertain kinds of boundary dilemmas involvingdual relationships, gift giving practices,physical contact with patients, andself-disclosure. The paper closes with somerecommendations for preventing boundaryviolations.