Induced delivery of anencephalic fetuses: a response to James L. Walsh and Moira M. McQueen

James Walsh and Moira McQueen accurately conclude that the early delivery of anencephalic fetuses is morally acceptable, but the reasoning they use to reach that conclusion is flawed. First, the principle of double effect does not require a weighing of good and evil, but rather seeks a sufficient reason for tolerating the physical evil indirectly intended. Second, the principle of double effect requires a clear distinction between physical and moral causality. Third, the Catholic moral tradition will not admit direct and intended killing of the innocent. Rather, early delivery of anencephalic fetuses is permissible because of the pathology associated with delivery of anencephalic fetuses at full term. Thus, the early delivery of an anencephalic infant is acceptable if the purpose of the moral act is avoiding a pathological condition on the part of the mother.     

Anencephalics as organ sources

In recent years, the need for infant organs for transplantation has increased. There is a growing recognition of the potential use of anencephalics as sources of organs. Prevalent arguments defending the use of live anencephalics for organ sources are identified and criticized. I argue that attempts to deny the applicability of the “dead-donor rule” are either question-begging or based on false premises and that attempts to skirt the Kantian dictum against treating others as a means only are not successful. I contend that the apparent utilitarian justification for live anencephalics as organ sources is unsatisfactory for two reasons: first, because it ignores the undermining effect the policy would have on parental values and sentiments central to social welfare; and second, because attempts to respond adequately to the slippery slope argument against live anencephalic use are unconvincing.     

The anencephalic as organ donor: Whose baby is it anyway?

Should an anencephalic newborn, lacking cerebral hemispheres but possessing a functional brain stem, be eligible for organ donation? The dialectical method is used here to envision how a protagonist and an antagonist might debate the ethics of the issue.     

难治性抑郁症成因与优化治疗的思考

抑郁症是一种高患病率、高致残率及高自杀率的严重精神疾患。在过去10年中,抗抑郁药物研究取得了突飞猛进的进展,然而,在临床上仍约有30％～50％的抑郁症患者最终成为难治性抑郁症病例。目前针对难治性抑郁症尚无较好的治疗策略。本文运用系统论方法学分析生物、心理、社会各个要素在病因中所起作用,探讨最佳治疗策略。     

The morality of induced delivery of the anencephalic fetus prior to viability

In situations where anencephaly is diagnosed and where the mother's life or health is threatened Roman Catholic hospitals are faced with the dilemma of waiting until viability before inducing the fetus, thus potentially putting the mother at further risk. According to most Roman Catholic ethicists, induced delivery before viability is contrary to the Church's prohibition of direct killing of the innocent. The authors propose for discussion a reconsideration of this position in the case of the anencephalic fetus and conclude that taking the life of such a fetus does not constitute an attack on its personal dignity and therefore is morally permissible.     

Pharmacotherapy of delusional disorders in the context of offending and the potential for compulsory treatment

Delusional disorder is an uncommon mental illness with an estimated prevalence of 0.03%. Its low prevalence has likely contributed to the paucity of research interest in this area, leading to substantial gaps in knowledge concerning its treatment and management. In the absence of a robust literature, most clinicians rely on their experience and guidelines for treating schizophrenia when treating patients with delusional disorder. This article reviews the available literature that is specific to the treatment of delusional disorder. In addition, it focuses on specific forensic and medicolegal aspects of managing patients with delusional disorder.     

Treating Depression in Older Medical Patients with Psychotherapy

This purpose of this paper is to discuss the effectiveness of psychotherapy for treating depression in older, primary care patients. This paper highlights the feasibility of implementing psychotherapy in primary care settings, patient preference for psychotherapy, and the utility of primary care versions of therapy in treating depression in older adults. The discussion is supported with examples from three ongoing research projects, specifically the San Francisco General Hospital Depression in Late Life Study, the Hartford Foundation/California Healthcare Foundation IMPACT study, and the NIMH PROSPECT study. The findings presented here support the value of offering psychotherapy as a treatment alternative in primary care medicine.     

Distanced Perspectives: Aids,Anencephaly, and Ahp

US court decisions guaranteeing life-sustaining care to anencephalic infants have been viewed with disfavor, and sometimes disbelief, by some ethicists who do not believe in the necessity of life-sustaining support for those without cognitive abilities or an independently sustainable future. The distance between these two views – one legal and inclusive, the other medical and specific – seems unbridgeable. This paper reports on a program using multicriterion decision making to define and describe persons in a way which both acknowledges the differences perceived by many as well as those commonalities insisted on in U.S. court decisions. It does this through application of the Analytic Hierarchy Process to a hierarchy of humanness criteria, and secondarily through reference to that concept's subset, personhood.     

Relating ethnic identity, acculturation, and attitudes toward treating minority clients

This study assessed the relationship among the ethnic identity, acculturation, and self-concepts of minority health care professionals and their attitudes toward treating minority clients and using alternative therapies. The sample consisted of 150 medical students of Indian descent. Strong ethnic identity and acculturation related to high self-esteem, self-clarity, the likelihood of treating more minority patients, and the use of alternative therapies. The more "Westernized" participants expressed less of a preference for serving minority patients and believed themselves to be less effective in serving minorities. Gender differences in some aspects of ethnic identity and attitudes were found. The results imply that a focus on acculturation and ethnicity in all client-clinician psychological research is critical, and especially in cases of cultural matching.     

Suicidal Asian patients: recommendations for treatment

I was given an opportunity to learn how suicide prevention programs are administered in the United States. Not surprisingly, treatment for suicidal patients is conducted in terms of the basic tenets of Western culture. When American therapists are seeing Asian patients, especially suicidal individuals who are regressed and show cultural characteristics, the therapists should be aware of the importance of cultural differences. This report discusses recommendations for treating suicidal Asian patients.     

Gender Matters: Working with Adult Male Survivors of Trauma

There has been a great deal of attention given to the application of feminist therapy in treating women, but there is little written about feminist therapy and its applications in treating men. Gender role analysis has proven to be effective in developing hope, resilience, and transcendence–3 primary sources in times of emotional distress. This article conceptualizes the treatment of men survivors of trauma at 2 levels: redefining masculinity and its legacies and confronting trauma and its legacies.     

Euthanasia and John Paul II's "silent language of profound sharing of affection:" why Christians should care about Peter Singer.

Peter Singer's recent appointment to Princeton University created considerable controversy, most of it focused on his proposal for active euthanasia of disabled infants. Singer articulates utilitarian ideas that often appear in public discussions of euthanasia. Drawing on Pope John Paul II's work on ethics and suffering, I argue that Singer's utilitarian theory of value is impoverished. After introducing the Pope's ethic based on the imago dei, I discuss love as self-gift. I show how this concept supports a theory of value in which spiritual goods are preeminent over material goods. I then describe how suffering reveals spiritual goods, discussing how participation in Christ's suffering can alter our perception of value. I also consider how communal responses to suffering provide opportunities for self-giving. Third, I consider Singer's proposal for killing infants with hemophilia, arguing that it arbitrarily ignores spiritual goods. I then discuss proposals to kill anencephalic infants, discussing how parental responses to their suffering can demonstrate an extraordinary love in seemingly hopeless circumstances. I conclude by calling for a more sustained social response to euthanasia initiatives.     

Converted patients and clinic patients as control cases: a comparison with implications for psychoanalytic training

All twenty-eight respondents to a recent poll of the thirty institutes affiliated with the American Psychoanalytic Association reported that they now accept cases converted from psychotherapy to psychoanalysis as control cases. This study was designed to compare converted cases to clinic cases systematically with respect to patient characteristics, treatment, and the educational experience of the treating candidate. The study followed twenty-four candidates entering analytic training between 1992 and 1995, who treated thirty-four clinic cases and forty-three converted cases between February 1993 and July 2000. Clinic and converted patients were comparable with regard to demographics, prior treatment histories, structural diagnoses, and Axis I diagnoses. In addition, the two groups of cases were indistinguishable with respect to the rate at which candidates received credit toward graduation requirements. Candidates treating converted cases earned approximately dollars 7,600 per patient per year, compared to candidates treating clinic cases, who earned nothing. Eighty-four percent of converted patients diagnosed with a mood disorder by the treating candidate were on medication, in contrast to only 20% of clinic patients with the same diagnosis. Similar differences were seen in the case of anxiety disorders. Given the prevalence of affective and anxiety disorders in control cases and the availability of a variety of medications and psychotherapies with documented efficacy in treating these disorders, candidates should be trained to discuss treatment options with patients who present with Axis I disorders.     

Configurational approach to manifest dream analysis: Possible acceleration of the patient's communication in psychoanalytic psychotherapy

This paper presents an approach to dream analysis utilizing the manifest content of a number of consecutive dreams from the same patient. Following a review of the literature, it is noted that in once-a-week psychotherapy there is often very little time for exhaustive dream analysis to unravel the buried meanings within the latent dream content. Twenty categories have been established for the configurational analysis, which is applied to the analysis of the first eleven dreams of a patient in psychoanalytic psychotherapy. The authors independently analyzed the patient's dreams using each of the 20 categories with high reliability, then combined their contributions. This data was then compared with the treating analyst's independent clinical observations about the twenty categories.     

On the Ordinary Concept of Death

What is death? The question is of wide‐ranging practical importance because we need to be able to distinguish the living from the dead in order to treat both appropriately; specifically, the permissibility of retrieving vital organs for transplantation depends upon the potential donor's ontological status. There is a well‐established and influential biological definition of death as irreversible breakdown in the functioning of the organism as a whole, but it continues to elicit disquiet and rejoinders. The central claims of this paper are that the best way to address the question as to what death is, is to attend closely to our ordinary concept of death; doing so reveals that, whilst our ordinary understanding accommodates the biological definition, it also includes the thought that, for someone who has died, there will never again be anything it is like to be that person. Support for these claims is provided, and their academic and practical implications traced. The important practical implication is that we are left in quandary as to whether certain potential organ donors — for example, anencephalic babies and the permanently vegetative — are dead, a quandary that has serious implications for the relevance of the dead donor rule in transplant ethics.     

Legal issues raised in treating sex offenders

For the past 50 years the criminal justice system has distinguished sex offenders from other criminals. This has resulted in their differential treatment, with the goal being to eliminate their inappropriate behavior. This article discusses the history and status of mentally disordered sex offender (MDSO) statutes. A review of the legal issues which arise when treating a sex offender without statutory authorization is provided. A discussion of problems raised in treating the offender on both an inpatient and outpatient setting is presented. The article concludes with an analysis of the legal problems confronting the treatment provider in working with this group of individuals.     

Group psychotherapy for adolescents comorbid for substance abuse and psychiatric problems: a relational constructionist approach

The group psychotherapy of adolescents comorbid for psychiatric and substance abuse problems is fraught with inconsistent attendance, frequent verbal and physical disruptions by the adolescents, and intense countertransference toward patients and their parents on the part of treating staff. A relational constructionist approach assists staff and patients in overcoming these obstacles and in focusing on the adolescents' search for personal meaning. Multiple group psychotherapy conducted in a combined day treatment and high school program is described and illustrated by case examples during the course of a year of treatment. These examples illustrate the importance of a relational non-hierarchical approach to adolescent patients by treating staff.     

Validation of a Chinese Version of the Obsessive Beliefs Questionnaire

Cognitive models of obsessive-compulsive disorder (OCD) assign a central role to maladaptive beliefs. Evaluation of these OCD beliefs in Western countries is commonly accomplished using the Obsessive Beliefs Questionnaire (OBQ) and is important for conceptualizing and treating OCD. It remains unclear if Western models of OCD beliefs are appropriate for sufferers in some non-Western regions, such as China, which represents nearly 20 % of the world population. Thus, the aim of present study is to examine the psychometric properties of a Chinese translation of the OBQ in three samples: 1,322 undergraduates, 139 patients with OCD, and 79 patients with other anxiety disorders. Confirmatory factor analysis revealed poor fit for multiple English-based models of the OBQ. However, an exploratory factor analysis supported an OBQ model that differs slightly from the English version: (1) Perfectionism/Certainty (P/C), (2) Over-Estimation of Threat (T), (3) Importance of Thoughts/Responsibility for Harm (I/R). This Chinese version of the OBQ (C-OBQ) contains 30 items and shows adequate internal consistency, test-retest reliability, construct validity, and criterion-related validity. In China, the C-OBQ may be a useful instrument for delineating cognitive patterns associated with OCD to inform research and treatment.     

慢性疼痛与抑郁的心身医学整合观

生物医疗观对慢性疼痛患者的诊疗作用较差。慢性疼痛常因为心理应激、个性、行为和疾病状况而复杂化,增加了患者诊疗的难度。患者常因情感症状、生活压力,而失去信心,陷入无助地痛苦选择冲突中。应用一种系统的跨学科方法重建和保持医生的共情和患者的积极心理,采用疾病状态、生活经历、个性特征和行为模式的四种心身整合观点,综合评估抑郁和慢性疼痛患者。设计综合诊疗方案评定的痛苦作用,在方案制定的过程中认识到这四个观点彼此不同,相互补充,全面阐释影响患者痛苦的生物、心理和社会的多种原因。心身整合观点为设计合理的治疗方案提供了方法,提高了医生成功治疗慢性疼痛患者的可行性。