手术戒毒:"非常规"医疗探索下的社会视阈

"手术戒毒"是以一种"非常规"的方式毁损一部分人脑记忆和意识,来探索戒断毒瘾的有效途径."非常规"的手术戒毒挑战了长久以来公众对毒品的"常规"认识以及现行的戒毒政策和方法,从技术、伦理以及观念、权益、法律规制和政策支持等社会层面考量了这一项"非常规"手术.     

颅脑手术戒毒的临床研究及伦理思考

经过近2年的病例追踪与资料整理,最新的阶段性报告结果显示:手术戒毒与已往传统的戒毒疗法相比,确实有明显的治疗效果,但同时也存在较多并发症,这项调查结果又将公众的注意力重新集中到手术戒毒上来.本文就手术戒毒的相关伦理问题进行了讨论.     

我们对于用颅脑手术治疗毒瘾的意见

对颅脑手术治疗毒瘾的伦理评估首先要考虑手术的风险-受益比.这就要求我们鉴定风险的性质、估计风险的大小,评价风险对受试者的可能影响,与可能的受益加以对照以确定风险-受益比是否可以接受.如果风险或伤害大而且不可逆,风险超过可能的受益,这样的风险-受益比就不能接受.继续这种疗法就是不合伦理的.     

关于手术戒毒规范化开展的思考

吸毒成瘾是严重的医学和社会学问题.国内、外对吸毒成瘾采取的治疗方案由脱毒、防复吸和回归社会三个相互关联的方法构成.但收效甚微,复吸率居高不下.西安第四军医大学唐都医院神经外科在动物实验和借鉴以往经验的基础上,将立体定向技术用于毁损脑内与毒品心理依赖密切相关的关键位点的异常部分,对其异常功能进行调整,从而达到彻底戒毒的目的,取得了良好的疗效.本文介绍了手术戒毒在我国的发展历史,提出了规范化开展手术戒毒的建议.     

医务人员言语偏误的伦理评介

通过具体临床言语资料的分析,发现医惠交际中存在着言语信息失量、言语态度失衡、言语策略失慎和言伴信息失却等问题.医务人员对患者缺乏必要的人文关怀和伦理照应是问题产生的关键.加强医务人员的言语伦理修养,是对传统医学伦理的尊重,也是新形势下促进医惠关系和谐发展的一项重要举措.     

神经导航在颅脑手术的最优化选择

评价神经导航系统在颅脑手术的应用价值.充分利用神经导航系统定位精确和实时导航功能,达到颅脑手术疗效的最优化.对神经导航在颅脑手术最优化方面的几点误区进行分析,对颅脑手术"适度医疗"的问题提出一些建议.     

医疗知情同意的法伦理思考

医疗知情同意是一项伦理原则,也是一项法律原则.虽然不同视角下的医疗知情同意具有相对不同的要求,但两者在本质上是一致的.尊重患者的知情同意权是患者和社会对医方所提出的要求,也是医方应尽的法律和伦理义务.因此,从法伦理视角审视知情同意原则,以凸显其丰富的内涵及其情、理、法的融合与统一.     

亚临床型血友病A合并颅脑外伤的围手术期处理2例分析

为了探讨亚临床型血友病A患者合并颅脑外伤行手术治疗时的围手术期处理方法,2例亚临床型血友病A合并颅脑外伤患者术后确诊,在围手术期通过动态的监测血Ⅷ因子活性（FⅧ：C）水平,调整FⅧ输入并维持FⅧ：C在止血水平（30％～50％）,至伤口愈合。结果显示,2例亚临床型血友病A合并颅脑外伤手术患者,术后都得到了及时的恢复。提示亚临床型血友病A合并颅脑外伤患者关键是准确诊断,围手术期要求保持血中凝血因子FⅧ的促凝活性维持在止血水平,直到伤口愈合为止。     

临床均势原则辨析——对临床科研方法的伦理思考

随机对照试验作为一种评价新疗法的可靠设计方法,开始逐渐被世界范围内的临床医生所广泛接受和采用,成为目前最重要的试验方法之一.RCT的运用应该遵循一定的伦理准则,即临床均势原则.围绕临床均势原则这一主题,对随机时照试验的方法论进行较为深入的伦理学思考.并对临床均势的内涵、伦理意义,以及这一伦理要求在实践中所引发的各种伦理争论加以探讨.     

"开颅戒毒"的伦理困境

卫生部叫停"开颅戒毒"手术后,最紧要的工作应是:切实做好对人们健康权的保护工作,改变医患之间信息极不对称的现状,改善医学伦理委员会人员结构,依法规范专家资质,制定统一审查程序,明确审查行为的法律责任,以保障医疗工作更加安全.     

Raising Fees in Group Therapy: Some Ethical and Clinical Implications

Of all money matters in group psychotherapy, one of the most neglected in the literature is the issue of raising the fees. The premise of this paper is that there are ethical and clinical considerations to group fee increases. One consequence of the lack of attention to the subject of raising of fees is that many neophyte group leaders do not learn about its complexity. It will be argued that the raising of fees is not merely a straightforward matter of informing groups about an impending change in the amount of money that they will pay but rather, it is a knotty, emotionally charged issue with both realistic and subjective components for members and leaders alike. Further, it will be argued that the issue of raising fees in group therapy is dissimilar, in significant ways, from raising fees in individual treatment. When leaders use subjective criterion to decide an increase, then the group process may be disrupted. Suggestions for reform will be offered.     

Negotiated nonmonogamy and male couples

One issue that has the potential to confound family or couples therapists working with male couples is the issue of nonmonogamy. For many therapists, sexual nonexclusivity challenges fundamental clinical assumptions that "affairs," or extra-relationship sex or romantic involvements, are symptoms of troubled relationships and are always a form of "sexual acting out." This article explores the issue of sexual exclusivity and nonexclusivity within male couples. In order to achieve both clinical and cultural competency in work with male couples, therapists need to challenge their cultural biases regarding monogamy.     

Fatigue and Quality of Life in Hepatitis C: Fact or Fiction?

The chronic hepatitis C virus (HCV) has traditionally been impossible to treat. Recently there has been increased attention in the treatment of HCV due to the development of drug treatments (i.e., Interferon and Ribavirin). As clinical attention to the assessment and treatment of HCV has increased, the issue of fatigue has become a central concern. Fatigue is one of the major symptoms reported by those suffering from HCV but it is not clear whether fatigue should be treated as a major symptom that is an important focus on attention or if it is a minor and irrelevant concern. In this paper, we examine the issues of fatigue in HCV in light of the importance of health-related quality of life in HCV. We present evidence to suggest that fatigue is a major issue that warrants clinical attention. We also propose that fatigue be reconceptualized as lassitude and provide an operationalized definition of dysfunctional lassitude, a new clinical construct that may have value as a psychological diagnosis. The purpose of this paper is to provide those interested in psychological issues in HCV, and chronic illnesses for which fatigue is a major symptom, guidelines for future clinical and research efforts.     

Encountering diversity: Medical ethics and pluralism

An emerging issue in medical ethics is how to respond to the growing religious and ethnic diversity seen in American hospitals. This fictionalized account of a clinical case uses narrative ethics to explore decisions at the end of life in a pluralistic society. The author maintains that it is the rights secured for patients and their families by secular bioethics and its inherent respect for pluralism that allow for cultural and religious differences.     

Social class tensions within families

Abstract

The upward or downward social class mobility of an individual family member can result in tensions between the individual and the rest of the family, tension which is heightened because it rarely is identified and named as a class issue. This article explores the issue of class, identifies common situations in which class tensions occur within families, and discusses clinical considerations.     

Sexual Compulsivity in Gay Men: Controversy and Treatment

Compulsive sex among some gay men has been made a more significant issue by the AIDS epidemic. There is controversy as to whether or not compulsive sex is a disorder or if it should be thought of as addiction. The clinical usefulness of the addictive model is discussed, along with the commonalities between the two most prevalent and successful approaches used to treat this disorder: namely, group treatment and the self-help Twelve Step addictive model.     

Group therapist countertransference to trauma and traumatogenic situations

In this introduction to the special issue on "Group Therapist Countertransference to Trauma and Traumatogenic Situations," the author notes that for many therapists it is not only group member disclosures and re-enactments, but also the co-occurring, sociopolitical contexts in which they live that may involve traumatic challenges. He considers three historically evolving views of countertransference: (1) the "classical"position, (2) the "totalistic" view, and (3) the "intersubjective/relational" view. He views the therapist's intense emotionality (as opposed to clinical detachment) in response to trauma as inevitable, and considers the particular roles of "bystander," "perpetrator," and "victim" induced in the therapist by traumatic re-enactments in the group. He concludes with a synopsis of some of the key points made in each of the contributions to the special issue.     

The Dream Sense,Emergent Clinical Process,and the Question of Symmetry: Reply to Brown and Colombo

In recent years I have become interested in Bion and neo-Bionian field theory, but the origin of my interest in dreaming does not lie in scholarly or clinical sources. The source of the idea of the dream sense is my own experience. After addressing that point, I reject what appears to be Colombo’s impression (this issue) that detailed inquiry is necessarily the basis of interpersonal and relational clinical practice, and then take issue with Brown’s understanding of expressive participation in relational thinking (this issue). Responding to Brown’s wish that I offer more detail about my own clinical process, I present an overview of my understanding of the way I work. I conclude by addressing the understandings offered by the discussants of symmetry in the analytic relationship, and offering more details of my own.     

关于临床实践教学中患者隐私权的调查与分析

临床实践教学中患者隐私权的界定与保护一直是舆论界和学术界争论的问题之一.通过发放调查问卷,综合分析患者、医学生及带教医生对这一问题的观点,为解决这一争议进行了理性的思考,并给出了合理的建议.     

Problematic Identity Processes: The Role of Identity Distress

This special issue of Identity: An International Journal of Theory and Research explores some of the anxiety, distress, and difficulties that may be encountered in the identity development process. Despite findings documenting the presence of identity distress in samples from a variety of settings and cultures, it has been slowly moving out of direct attention within the world of clinical psychology and psychiatry. This special issue expands on our understanding of identity distress in a number of ways. It adds to our knowledge of prevalence and severity, as well as its psychological correlates. It examines identity distress under the contexts of traumatic exposure and the refugee experience, and it offers some cross-national comparisons. Also offered is a developmental psychopathology perspective as a way to lay the groundwork for increased prevention and intervention work, and an example of such an intervention program for emerging adults. It is hoped that this special issue on identity distress will shine more light on this important, and possibly growing, yet understudied phenomenon, and will contribute toward expanding and enhancing efforts to foster positive youth development.