Considerations for ethical practice in managed care

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.     

The ethical practice of Web C ounseling

The emergence of on-line counselling services for addressing problems ranging from poor self-esteem, stressful relationships and addictions raises serious ethical concerns in this new electronic venue. A number of ethical considerations are discussed. The evolution of the National Board of Certified Counselors' Standards for the Ethical Practice of WebCounseling is described.     

The perception of ethical dilemmas in clinical practice

The empirical diagnosis presented in this paper is based on interviews with nurse practitioners and physicians designed to elicit their perceptions on the nature and role of ethical dilemmas in clinical practice. Having selected five of these perceptions or views which were common and significant, the philosophical therapy offered consists in, first, a general discussion of ethical dilemmas and, second, a critical analysis of each of the five views with the aim of pointing out confusions and errors, the recognition of which can be of applied and practical help in the clinical setting.     

临床医生医护合作态度及影响因素的研究

良好的医护合作态度是医生开展医疗活动的基础,同时对建立和谐的医护关系有重要意义.通过对辽宁省6所三级甲等医院的933名临床医生进行问卷调查,了解临床医生医护合作态度的现状,揭示职称、工作年限、是否参加过医护合作有关课程的学习以及对目前工作环境的满意度是影响临床医生对医护合作态度的主要因素.     

The lawyer and the forensic expert: Boundaries of ethical practice

The role of attorneys in relationship to mental health experts is examined. Issues which are discussed include the necessity of expert testimony, selection of the expert, and the data underlying the expert opinion. In addition, the attorneys' responsibilities in presenting the mental health expert in court is discussed with reference to different elements of the trial process.     

常人疾病观及其对医患关系的影响

常人疾病观是普通人对于某一疾病的认知、解释和态度的集合。与专业医务人员相比, 普通人更关注心理、家庭和社会因素而非生物学因素的致病作用, 就医选择多元而并不遵循标准化的就医模式, 同时更愿意将疾病体验视为个人生活的特殊问题加以建构性理解。常人疾病观与科学医学观之间的不一致性可能降低患者的就医满意、对医信任和医嘱依从性, 从而影响治疗效果。立足中国社会的医学文化与医疗制度, 研究中国人的常人疾病观, 并探讨其对医患关系的影响作用与社会心理机制, 可为改善当下中国医患关系紧张现状提供有益建议。     

How adolescents perceive their relationships

In order to determine how adolescents perceive their relationships, a set of eight drawings representing one, two or three characters, whose sex and relationships where not clearly defined, were shown to 403 Parisian adolescents (227 girls and 176 boys) aged 15 to 19. The majority of data converge for all subjects, regardless of the sex, curriculum or socioeconomic factors. The subjects consistently identify more mixed-sex dyads and triads than same-sex in all pictures. This predominance does not imply that the adolescents perceived all relationships as having a romantic connotation. Some data seem consistent with the traditional sex role stereotypes. The subjects' responses do not seem to reflect the reality of their own peer relationships.     

The effect of leader moral development on ethical climate and employee attitudes

This study examines the effect of leader moral development on the organization’s ethical climate and employee attitudes. Results indicate that the relationship between leader moral development and ethical climate is moderated by two factors: the extent to which the leader utilizes his or her cognitive moral development (i.e., capacity for ethical reasoning), and the age of the organization. Specifically, the influence of the leader’s moral development was stronger for high utilizing leaders, those whose moral actions were consistent with their moral reasoning. Additionally, the influence of the leader’s moral development was stronger in younger organizations. Finally, as predicted, congruence between the leader’s moral development and the employee’s moral development was positively associated with job satisfaction and organizational commitment and negatively associated with turnover intentions.     

Human dignity and vulnerable agency: An ethical framework for forensic practice

In this paper, we present an integrated ethical framework that covers the different levels of ethical tasks inherent in forensic and correctional work. First, we briefly give an overview of the ethical framework and its component notion of human dignity. Second we analyze in depth the concept of dignity and its relationship to normative theories and ethical concepts that are particularly relevant for forensic practitioners. Third, we explore the capacity of the conceptions of human dignity and vulnerable agency to integrate principles typically contained in ethical codes and practice, such as beneficence, autonomy, and justice. Fourth, we discuss how conflict between ethical codes or duties of station adhered to by practitioners can be effectively addressed in light of the model of dignity and agency outlined earlier. Fifth, we explain how individuals' specific ethical judgments and actions should proceed in light of our framework model.     

Family decision-making for nursing home residents: Legal mechanisms and ethical underpinnings

Families frequently act as substitute decisionmakers for their older members who suffer from diminished mental capacity to make and express their own medical choices. Substitute decisionmaking takes on particular ethical and legal urgency within the nursing home environment, especially when choices concern potential medical treatment near the end of the nursing home resident's life. This article examines current legal mechanisms in the United States that enable a family to make substitute medical decisions, the ethical underpinnings of those mechanisms, and specific ethical and legal considerations implicated by their application to the nursing home setting. The article offers advice to nursing home professionals, including physicians, in working with families as substitute decisionmakers.     

Color-luminance relationships and the McCollough effect

The McCollough effect is an orientation-specific color aftereffect induced by adapting to colored gratings. We examined how the McCollough effect depends on the relationships between color and luminance within the inducing and test gratings and compared the aftereffects to the color changes predicted from selective adaptation to different color-luminance combinations. Our results suggest that the important contingency underlying the McCollough effect is between orientation and color-luminance direction and are consistent with sensitivity changes within mechanisms tuned to specific color-luminance directions. Aftereffects are similar in magnitude for adapting color pairs that differ only in S cone excitation or L and M cone excitation, and they have a similar dependence on spatial frequency. In particular, orientation-specific aftereffects are induced for S cone colors even when the grating frequencies are above the S cone resolution limit. Thus, the McCollough effect persists even when different cone classes encode the orientation and color of the gratings.     

Family therapy beyond postmodernism: some considerations on the ethical orientation of contemporary practice

Ethics is a subject that is self-evidently important for systemic therapy, as for therapy generally, yet arguably it is one that has not received nearly as much attention in the literature as it warrants. This paper looks at the historical context for the marginalization of ethical discourse and suggests that the contemporary influence of postmodernist and hermeneutic thinking reinforces this tendency. Flaskas' (2002) recent argument for the reclamation of an idea of truth and reality as a social and emotional process is considered, and it is suggested that this needs supplementing with a perspective on truth and reality as an ethical process. Consideration is given to the enduring influence within postmodernist approaches of the modernist Kantian conception of ethics as centred in individual consciousness. I argue that important elements of contemporary systemic practice (for example, the reflecting team approach) are also pointing towards a different formulation of ethics that is focused more specifically on processes of communication. In elaborating this theme the paper draws on the work of the German social theorist Jürgen Habermas who writes on the ethics of communication.