Managed Care: Ethical Considerations for Counselors

Key factors and trends in health care will have an impact on the ethical practice of counselors. Ethical challenges to clinical practice presented by trends in managed care are discussed in relation to the American Counseling Association (1995) Code of Ethics and Standards of Practice. Recommendations for practice are also included.     

Rights, Wrongs, and Aristotelian Egoism: Illuminating the Rights/Care Dichotomy

Since the recent work of Carol Gilligan, Nel Noddings, and others, it has become commonplace in moral philosophy to employ a dichotomy between an ethics of "Care" and an ethics of "Rights." Gilligan claims that men and women view moral issues in fundamentally divergent ways. Responses to moral problems tend to divide along lines emphasizing respect for rights, in the case of men, and caring for others, in the case of women. Inspired by these findings, several authors have classified moral theories in two basic camps, revolving around the injunction to care or the mandate to respect rights. While many concede that the Care and Rights perspectives are not mutually exclusive, it is increasingly common to view ethicists as forced to choose between these two types of theories.     

Convincing Yourself to Care About Others: An Intervention for Enhancing Benevolence Values

To study value change, this research presents an intervention with multiple exercises designed to instigate change through both effortful and automatic routes. Aiming to increase the importance attributed to benevolence values, which reflect the motivation to help and care for others, the intervention combines three mechanisms for value change (self‐persuasion, consistency‐maintenance, and priming). In three experiments, 142 undergraduates (67% male, ages 19–26) participated in an intervention emphasizing the importance of either helping others (benevolence condition) or recognizing flexibility in personality (control condition). We measured the importance of benevolence values before and after the task. In Experiment 1, the intervention increased U.S. participants' benevolence values. In Experiment 2, we replicated these effects in a different culture (Israel) and also showed that by enhancing benevolence values, the intervention increased participants' willingness to volunteer to help others. Experiment 3 showed that the increases in the importance of benevolence values lasted at least 4 weeks. Our results provide evidence that value change does not require fictitious feedback or information about social norms, but can occur through a 30‐min intervention that evokes both effortful and automatic processes.     

Rights, Duties and Responsibilities in Health Care

ABSTRACT The value of autonomy is generally stated to be of prime importance in relation to health care. Arising out of this, rights of the patient to and in health care have been extensively discussed and stated, and have found expression in law. There have been minimal statements of the rights of others involved in health care, such as caregivers, and minimal discussion of duties and responsibilities in relation to rights claimed and conferred. The author suggests that no claim to rights in health care should now be accepted without consideration of related duties and responsibilities.     

Conducting a Pragmatic Trial in Integrated Primary Care: Key Decision Points and Considerations

Pragmatic trials testing the effectiveness of interventions under “real world” conditions help bridge the research-to-practice gap. Such trial designs are optimal for studying the impact of implementation efforts, such as the effectiveness of integrated behavioral health clinicians in primary care settings. Formal pragmatic trials conducted in integrated primary care settings are uncommon, making it difficult for researchers to anticipate the potential pitfalls associated with balancing scientific rigor with the demands of routine clinical practice. This paper is based on our experience conducting the first phase of a large, multisite, pragmatic clinical trial evaluating the implementation and effectiveness of behavioral health consultants treating patients with chronic pain using a manualized intervention, brief cognitive behavioral therapy for chronic pain (BCBT-CP). The paper highlights key choice points using the PRagmatic-Explanatory Continuum Indicator Summary (PRECIS-2) tool. We discuss the dilemmas of pragmatic research that we faced and offer recommendations for aspiring integrated primary care pragmatic trialists.

     

公益诉讼:制度、话语及实践

公益诉讼虽然肇始于古罗马时期 ,但真正被激活并迅速发展却是进入现代资本主义社会之后。西方诸国公益诉讼的勃兴与经济发展、立法观念和司法理念等各种社会背景因素密切相关。可见 ,公益诉讼不仅是一套制度更是一种实践。我国社会的发展现状 ,客观上具备了公益诉讼得以生长的社会经济条件 ,但在立法制度、司法理念与司法机制等方面尚不具备运作公益诉讼的条件和环境 ,要将纸面上权利转换为伸手可及现实利益 ,便需要对立法制度、司法理念等因素进行一番彻底的改造和革新     

青少年患者自主权的伦理合理性及其限度

青少年患者是否享有自主权,这在当代无论是理论还是实践上都是一个广为争议的话题.文章从伦理的视角时青少年患者自主权存在的伦理合理性进行了论证,作者认为,青少年患者自主权的存在不仅具有契约论、目的论和道义论的基础,而且也是尊重青少年身心发展规律的要求.当然,任何权利都有其限度,青少年患者自主权不得超越病人福利原则、不伤害原则和公正原则的限制.     

Self-Enhancement and Social Responsibility: On Caring More, but Doing Less, Than Others

Self-enhancement biases have been found in a variety of self-rated skills, traits, and abilities, yet past research has not examined whether people show such biases in ratings of their social concern and activism. In the present paper, we report the results of two surveys on this question. In the first survey, 549 adults rated their level of concern and activism on one of six different issues (e.g., homelessness). The results showed a general pattern of self-enhancement in professed concern but self-deprecation in activism. In the second survey, a random-digit dialing method was used to contact a representative sample of the general public. A total of 817 respondents rated their level of concern and activism on the issues of environmental protection, animal welfare, and world hunger. The second survey also explored two techniques for debiasing self-enhancement in concern: one based on a cognitive consistency model, and one based on the salience of others' actions. Findings from the second survey replicated those of the first, and both debiasing techniques failed to reduce self-ratings of concern. Moreover, a sizable number of respondents said that they would do more if others showed more concern. These results are consistent with a social dilemma in which citizens feel a personal sense of concern, but are reluctant to act until others show greater concern.     

On Being Exposed to Superior Others: Consequences of Self-Threatening Upward Social Comparisons

Being inferior to someone else can be hurtful. But what exactly happens when we found ourselves in such situations? We first address why and when upward comparison can be self-threatening and later review the effects of such threatening social comparison. We argue that two main kinds of disturbances can ensue: affective disturbances and attentional disturbances. Second, three ways to deal with self-threatening social comparison are reviewed: proactive regulation, defensive regulation, and regulation by avoidance. For each of these disturbances and regulation modes, we review empirical findings and later discuss the impact of upward comparison on performance. We conclude by going back to the very need behind the need for a positive evaluation.     

Child As Metaphor: Colonialism,Psy-Governance,and Epistemicide

This paper mobilizes transdisciplinary inquiry to explore and deconstruct the often-used comparison of racialized/colonized people, intellectually disabled people and mad people as being like children. To be childlike is a metaphor that is used to denigrate, to classify as irrational and incompetent, to dismiss as not being knowledge holders, to justify governance and action on others’ behalf, to deem as being animistic, as undeveloped, underdeveloped or wrongly developed, and, hence, to subjugate. We explore the political work done by the metaphorical appeal to childhood, and particularly the centrality of the metaphor of childhood to legitimizing colonialism and white supremacy. The article attends to the ways in which this metaphor contributes to the shaping of the material and discursive realities of racialized and colonized others, as well as those who have been psychiatrized and deemed “intellectually disabled”. Further, we explore specific metaphors of child-colony, and child-mad-“crip”. We then detail the developmental logic underlying the historical and continued use of the metaphorics of childhood, and explore how this makes possible an infantilization of colonized peoples and the global South more widely. The material and discursive impact of this metaphor on children’s lives, and particularly children who are racialized, colonized, and/or deemed mad or “crip”, is then considered. We argue that complex adult-child relations, sane-mad relations and Western-majority world relations within global psychiatry, are situated firmly within pejorative notions of what it means to be childlike, and reproduce multi-systemic forms of oppression that, ostensibly in their “best interests”, govern children and all those deemed childlike.     

CBT and Behavioural Medicine: On Definitions,Applications and Practical Considerations

Abstract

In the late seventies, behavioural medicine was conceptualized as a promising area for the application of cognitive-behaviour therapy (CBT) to medical problems. Although many studies have been published in which CBT has been applied to somatic conditions, they do not always call it behavioural medicine. It is uncertain if the term “behavioural medicine” is the most appropriate to use in the future; its impact on medicine and psychology can be questioned. However, in this paper it is concluded that CBT has great potential in the treatment of somatic conditions. In addition, practical considerations when applying CBT in multidisciplinary somatic team situations are discussed. A combined “scientist-practitioner” role is seen as especially promising for the introduction of CBT in a context wider than isolated research studies.     

A Psycho-linguistic Study on Adult Playfulness: Its Hierarchical Structure and Theoretical Considerations

By means of a linguistic corpus analysis, statements were derived that reflect trait-like characteristics of playful adults. These were given to a sample of 240 adults who also completed two measures of adult playfulness. Using Goldberg’s (J Res Pers 40:347–358, 2006) top-down approach, the hierarchical factor structure of playfulness in this data set was examined. A solution with seven factors fits the data well and could be clearly interpreted. The retrieved factors were (1) cheerful-engaged; (2) whimsical; (3) impulsive; (4) intellectual-charming; (5) imaginative; (6) lighthearted; and (7) kind-loving. The two playfulness measures did not cover all of these dimensions. The intellectual-charming and the kind-loving variants of playfulness were less well represented in these instruments. The study contributes to the basic question of what factors underlie playfulness and suggests that there are aspects of adult playfulness that were hitherto less well described.