Rethinking Professional Ethics in the Cost-Sharing Era

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions—an “aspirational ethic” that exhorts physicians to treat all patients the same regardless of their ability to pay, and an “agency ethic” that calls on physicians to be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay.     

医患关系中医务人员的伦理学思考

医患关系是一种特殊的人际关系,医务人员应从伦理学角度深入思考医患关系。了解熟悉并懂得患者,运用医患沟通技巧缩短医患间的心理距离。加强自身修养,提高思想道德水平和专业技能。充分发挥健康宣传教育在促进和谐医患关系中的作用。让我们共同努力构建和谐医患关系     

‘Familiar friends’: Catholic mother–daughter narratives

The main theoretical and practical focus of this paper is on the Catholic mother–daughter relationship, and how connections between women shape, and are shaped in, and through this nexus. It is contended that it is imperative that we begin to understand different representations of connections among, and between women, including that of mothers and daughters, as they compose part of the changing yet continual dialect of our (religious) feminine identities. The intent is to embrace the contradictions and polarities, which are apparent in these inter-generational relations. This article is set in middle class suburban Melbourne Australia, and spans the period from the early to late twentieth century. Conversations between an Anglo-Saxon Catholic mother and daughter act as a catalyst to discuss the matrilineal pedagogical dimensions that mark female relations within social and religious discourses.     

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.     

Talking about Spirituality in the Clinical Setting: Can Being Professional Require Being Personal?

Spirituality or religion often presents as a foreign element to the clinical environment, and its language and reasoning can be a source of conflict there. As a result, the use of spirituality or religion by patients and families seems to be a solicitation that is destined to be unanswered and seems to open a distance between those who speak this language and those who do not. I argue that there are two promising approaches for engaging such language and helping patients and their families to productively engage in the decision-making process. First, patient-centered interviewing techniques can be employed to explore the patient's religious or spiritual beliefs and successfully translate them into choices. Second, and more radically, I suggest that in some more recalcitrant conflicts regarding treatment plans, resolution may require that clinicians become more involved, personally engaging in discussion and disclosure of religious and spiritual worldviews. I believe that both these approaches are supported by rich models of informed consent such as the transparency model and identify considerations and circumstances that can justify such personal disclosures. I conclude by offering some considerations for curbing potential unprofessional excesses or abuses in discussing spirituality and religion with patients.     

The Sexual and Theological Ethics of Gay Marriage in France: A Dialectic between Autonomy and Universalism

Abstract

The debate on gay marriage has gathered pace globally and particularly in France. Here, the secularization of marriage as an ‘acte laïque’ has furthered progress towards a political and juridic recognition of gay marriage. The Catholic church (Vatican) has opposed this development in its re-enforcement of Catholic sexual ethics and the distinction it draws between secular and religious definitions of marriage. Complicating this distinction is the perception of a trend towards post-secularism in France where religion is making a return to democratic debates on citizenship and gender, and raising concerns over the status of the civility of the marriage act. The focus of this article is to look at gay marriage from the perspective of contemporary ethical and theological thinking. Specifically, I aim to examine alternative discourses that open up new ways of configuring gay marriage through an examination of concepts of integrity, responsibility and asceticism, and critically the ethical relationship between autonomy and norms.     

Women,Depression and the Global Folie

No abstract available for this article.     

Acceptability in France of Induced Abortion for Adolescents

Background: This study investigated the factors affecting the acceptability in France of abortions. Method: 80 study participants from Toulouse and 124 from Metz judged the acceptability of abortion in 64 vignettes composed of five factors: 1) the adolescent's age (15 or 17.5 years), 2) the adolescent's plans to continue schooling or not, 3) the fetus' age (1, 2, 3, or 4 months), 4) the adolescent's parents' agreement or not, and 5) the agreement or not of baby's father. Results: Three clusters were noted: 1) abortion is never acceptable (8% of participants), 2) abortion is always acceptable (23%), and 3) acceptability of abortion depends on the circumstances (63%). In the majority cluster (3), all five factors had significant effects, but the fetus's age accounted for most of the variance (78%). Conclusion: Most subjects in this study judged, in accordance with French law, that the acceptability of induced abortion in minors depends on the circumstances and, in particular, on the fetus' age.     

关怀伦理的介入：医患关系重构的新视角

梳理有关学者的关怀伦理理论观点,并基于关怀伦理的相关思想对疾病状态下患者的特性（脆弱性、自主性和依赖性）进行分析,在此基础上,讨论目前医疗机构中主流医患关系模式理论（包括律法关系、家长制关系和自主决策关系）的局限性与不足,并将这类主流医患关系说纳入到基于关怀的医患关系之中,以重构适用于当前医疗行为模式和医疗行业现状、体现己他两利关怀思想的医患关系模式,最后阐述了基于关怀的医患关系中的“关怀”实践路径,包括引导性双向叙事、同情与移情以及关怀美德。