Lessons Learned: Providing Supportive Accountability in an Online Anxiety Intervention

Technology-delivered interventions have the potential to help address the treatment gap in mental health care but are plagued by high attrition. Adding coaching, or minimal contact with a nonspecialist provider, may encourage engagement and decrease dropout, while remaining scalable. Coaching has been studied in interventions for various mental health conditions but has not yet been tested with anxious samples. This study describes the development of and reactions to a low-intensity coaching protocol administered to N = 282 anxious adults identified as high risk to drop out of a web-based cognitive bias modification for interpretation intervention. Undergraduate research assistants were trained as coaches and communicated with participants via phone calls and synchronous text messaging. About half of the sample never responded to coaches’ attempts to schedule an initial phone call or did not answer the call, though about 30% completed the full intervention with their coach. Some anxious adults may choose technology-delivered interventions specifically for their lack of human contact and may fear talking to strangers on the phone; future recommendations include taking a more intensive user-centered design approach to creating and implementing a coaching protocol, allowing coaching support to be optional, and providing users with more information about how and why the intervention works.     

If You Want to Do Something About Your Own Craziness, Have Your Own Experiential Sessions

If a person is troubled by worries or fears about being crazy, out of one's mind, psychotic, the person can learn to have one's own experiential sessions aimed at two goals. One is to undergo a deep-seated, qualitative change toward becoming the person one is capable of becoming. The related other goal is to be free of the worrisome, fearful scenes or situations of being crazy, out of one's mind, psychotic. An illustration is given of how to achieve these goals by having one's own experiential session.     

Surviving a Lawsuit Against a Counseling Program: Lessons Learned From Ward v. Wilbanks

This article features information about a lawsuit brought by a former student against Eastern Michigan University and its counseling program. In addition to describing the major elements of the lawsuit, the authors reflect on lessons learned and offer recommendations for other counseling programs.     

On Not Seeing What You Do Not Want to See: Meloen, van der Linden and de Witte on Authoritarianism

Meloen, van der Linden, and de Witte (1996) were puzzled by their finding that their various scales of authoritarian attitudes all correlated at similar low levels with approval for a racist political party. They also reported that the "Directiveness" behavior inventory correlated not at all with political variables. If the validity characteristics of the various scales used are taken into account, however, the implications of their results are clear: The alleged scales of authoritarian attitudes were simply functioning as alternative scales of conservatism and people who preferred leftist political parties were just as likely to be authoritarian as those who preferred racist political parties.     

A Preface to Ethics:

This essay outlines a new preface for ethics demanded by the massive developments of the global age. It does so in and through the comparative use of “myths” to explicate the lived structure of experience. The essay begins by isolating main features of global dynamics, including proximity, the compression of the world and the expansion of consciousness, and also global, cultural reflexivity. In the second step of the “preface,” it is argued that globality itself is a moral space in which peoples must orient their lives. It is a moral space defined by the massive extension of human power in the modern world. In light of the challenge that global dynamics and the extension of human power now pose, the essay then isolates, methodologically, options for developing a global ethics, and advocates a distinctly hermeneutical approach. This approach is practiced in the last section of the “preface” by engaging ethically the biblical “myth” of creation and its reinterpretation in an epitome of Jesus's Torah teaching. The intention is to show how current religious thought can speak to massive challenges in a distinctive way. It is, again, to offer a preface to ethics.     

The Lessons of the Development of the First APA Ethics Code: Blending Science,Practice, and Politics

The Ethics Code of the American Psychological Association (APA) is a bedrock of the profession. The contextual factors of society affect the Ethics Code of the APA, resulting in an ever-changing document. The context of the reorganization of the APA after World War II created an initial impetus toward a formalized code. A key contextual feature of the Code's development was the use of the Critical Incident Technique, which was based in the empirical aspirations of the psychological field. This article explores the historical context around the APA's decision to draft an ethics code, reviews its development, and discusses its role for psychologists today.     

技术、虚无与责任:汉斯·约纳斯的伦理思想研究

现代技术远非古代技术所能比拟,其导致的危害也是前所未有的.约纳斯认为,现代技术本质上是一种现代虚无主义.以往本质上是人类中心主义的传统伦理学无法应对现代技术在道德上挑战.他提出了一种“责任伦理”观,主张医学和医术有一种特殊的责任,当今人类应该对自然及未来的人类负责.     

Medical Humanities and Cultural Studies: Lessons Learned from an NEH Institute

In this essay, the directors of an NEH Institute on Medicine, Literature, and Culture consider the lessons they learned by bringing humanities scholars to a teaching hospital for a month-long institute that mingled seminar discussions, outside speakers and clinical observations. In an exchange of letters, they discuss the productive tensions inherent in approaching medicine from multiple perspectives, and they argue the case for a broader conception of medical humanities that incorporates the methodologies of cultural studies.     

To Know You is (Not) to Want You: Mediators Between Sociosexual Orientation and Romantic Commitment

Past studies have indicated that individuals with an unrestricted sociosexual orientation (SO; ‘unrestricted’ reflects comfort with sex outside the confines of a committed relationship) emphasize attractiveness and desirability when pursuing romantic partners. Additionally, SO is related to decreased commitment, and ultimately increased infidelity, in a current romantic relationship. Thus, the current study investigates potential mediators between sociosexual orientation (SO) and romantic commitment. Perceptions of a romantic partner’s characteristics such as physical attractiveness, various personality traits, and perceived similarities were examined as mediators. The findings indicate perceived social skills, intellect, and perceived similarities with the partner were all significant mediators between SO and commitment. Additionally, physical attractiveness was a marginally significant mediator. The final mediation model suggests that individuals with unrestricted SOs may have lower commit in their current relationships because participants with an unrestricted SO, compared to participants with a restricted SO, rated their partners as having fewer social skills, less intellect, and also fewer similarities between themselves and their partners.     

Christian Ethics,Religious Ethics,and Secular Ethics: A Contemporary Reappraisal

In this essay, I argue that Christian ethicists should not think of themselves as religious ethicists. I defend this claim by arguing that the concept of religious ethics, as it has come to be understood as a discipline that is distinct from secular ethics, is incoherent. In part one, I describe the fraught attempts by theologians in the 20th century to identify the distinctiveness of Christian ethics. In part two, I argue that certain accounts of natural law unwittingly reinforce a problematic conception of secular ethics. Part three examines some trends in religious studies and comparative religious ethics to highlight problematic conceptions of religion. Drawing together these strands of inquiry, I contend that that the secular-religious dichotomy in contemporary ethics should be rejected, but by the same token, I suggest that comparative ethics remains a worthwhile enterprise.     

Jonathan Edwards's Virtue: Diverse Sources, Multiple Meanings, and the Lessons of History for Ethics

The incompleteness of the task of integrating the influences made upon Jonathan Edwards by Calvinism and the moral sense leaves open a great many questions central to identifying his ethical position with any detail. This should worry ethicists, theologians, and church historians alike. For the puzzle of what Edwards meant by virtue is at the heart not only of his ethics but of a great many strands of his thought. It must be pieced together from diverse sources; and there are multiple meanings to be sifted through. But it is nevertheless possible to bring the concepts made available by the diverse moral traditions upon which Edwards drew into a generally coherent counterpoise. Such a counterpoise is not merely of antiquarian interest. Lacking a precise account of Edwards's ethical position, it is awkward to talk about applying it to the problems of the twenty-first, or any, century.     

A Code of Ethics for Health Care Ethics Consultants: Journey to the Present and Implications for the Field

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here.     

“医学伦理学再启程”亟待破解的医学伦理课题

面临新境遇的医学伦理学,亟待破解的医学伦理课题有：医疗资本和医疗利益集团追求利润最大化的行为对公立医疗机构公益性造成持续性损害;医学高新技术僭越伦理底线,无限制地对身体进行技术干预;医学技术权力与医学高新技术、医疗资本结盟形成挑战医学伦理的异化力量;确立利益伦理是医学伦理学研究的重要内容;确认患者利益置于首位是现代医学伦理学的首要原则;促进美德伦理与规范伦理结合,推进制度伦理建设与机构伦理建设是医学伦理学落地生根的关键环节。

     

案例教学与医学伦理学教育

案例教学已经成为普遍的方法在我国各医学院校的医学伦理学教学中广泛使用,案例教学作为一种方法,如何客观地看待它,需结合医学伦理学教育的目的和内容。案例教学具有增加互动、加深理解和提高分析能力等优点,但如果驾驭不好,也会暴露一些弱点,而起到反作用。试图还案例教学法于医学伦理学教育的本来位置。     

From Environmental to Ecological Ethics: Toward a Practical Ethics for Ecologists and Conservationists

Ecological research and conservation practice frequently raise difficult and varied ethical questions for scientific investigators and managers, including duties to public welfare, nonhuman individuals (i.e., animals and plants), populations, and ecosystems. The field of environmental ethics has contributed much to the understanding of general duties and values to nature, but it has not developed the resources to address the diverse and often unique practical concerns of ecological researchers and managers in the field, lab, and conservation facility. The emerging field of “ecological ethics” is a practical or scientific ethics that offers a superior approach to the ethical dilemmas of the ecologist and conservation manager. Even though ecological ethics necessarily draws from the principles and commitments of mainstream environmental ethics, it is normatively pluralistic, including as well the frameworks of animal, research, and professional ethics. It is also methodologically pragmatic, focused on the practical problems of researchers and managers and informed by these problems in turn. The ecological ethics model offers environmental scientists and practitioners a useful analytical tool for identifying, clarifying, and harmonizing values and positions in challenging ecological research and management situations. Just as bioethics provides a critical intellectual and problem-solving service to the biomedical community, ecological ethics can help inform and improve ethical decision making in the ecology and conservation communities.

Beyond Positivist Ecology: Toward an Integrated Ecological Ethics

A post-positivist understanding of ecological science and the call for an “ecological ethic” indicate the need for a radically new approach to evaluating environmental change. The positivist view of science cannot capture the essence of environmental sciences because the recent work of “reflexive” ecological modelers shows that this requires a reconceptualization of the way in which values and ecological models interact in scientific process. Reflexive modelers are ecological modelers who believe it is appropriate for ecologists to examine the motives for their choices in developing models; this self-reflexive approach opens the door to a new way of integrating values into public discourse and to a more comprehensive approach to evaluating ecological change. This reflexive building of ecological models is introduced through the transformative simile of Aldo Leopold, which shows that learning to “think like a mountain” involves a shift in both ecological modeling and in values and responsibility. An adequate, interdisciplinary approach to ecological valuation, requires a re-framing of the evaluation questions in entirely new ways, i.e., a review of the current status of interdisciplinary value theory with respect to ecological values reveals that neither of the widely accepted theories of environmental value—neither economic utilitarianism nor intrinsic value theory (environmental ethics)—provides a foundation for an ecologically sensitive evaluation process. Thus, a new, ecologically sensitive, and more comprehensive approach to evaluating ecological change would include an examination of the metaphors that motivate the models used to describe environmental change.

Counseling to End an Epidemic: Revisiting the Ethics of HIV/AIDS

In the decades since HIV/AIDS was first identified, medical discoveries have advanced prevention and treatment, and shifting demographics have changed the face of the illness. Despite these changes, the counseling literature on HIV/AIDS and its ethical implications for counselors have remained limited and stagnant. Whereas past discussions have focused primarily on issues of confidentiality, this article addresses multiple ethical implications of HIV/AIDS to reflect current knowledge about the illness and its effects on clients.     

Ethics Remediation,Rehabilitation, and Recommitment to Medical Professionalism: A Programmatic Approach

This article recounts the development of the Professional/Problem-Based Ethics (ProBE) Program, the original physicians’ professional ethics remediation course. Since 1992, more than 1,200 healthcare professionals of many disciplines have been mandated to attend ProBE by licensing boards and other oversight entities. Using a small-group, interprofessional setting, the ProBE Program assists participants to discover and articulate ethical underpinnings violated by their misconduct; appreciate professional responsibilities that are societal, regulatory, and ethical; and recommit to professional ideals. The authors describe the rationale for developing ProBE, its curriculum, participant demographics, and infractions and reconsider medical professionalism in light of two decades of ProBE.     

Behavioral Health Consultation and Primary Care: Lessons Learned

This article provides an overview of 20 years of professional experiences with developing and implementing a model for integrating behavioral health services into primary care. The Primary Care Behavioral Health (PCBH) model is designed to provide immediate access to behavioral care for a large number of primary care patients by positioning a behavioral health consultant in the exam room area to function as a core member of the primary care team. In an initial era of discovery, the authors were directly involved in developing and testing a variety of new approaches to providing behavioral health services in general medicine. In a second era focused on feasibility, the authors worked with Kaiser Permanente, the United States Air Force and Navy, the Veteran’s Administration, and the Bureau of Primary Care to system test this innovative model of integrated care. Now in an era devoted to dissemination, the authors review the various roles formal research, system level quality improvement initiatives and stakeholder analysis play in promoting integrated care. The authors also describe current efforts to (1) create a tool that helps systems develop integration targets and (2) use the PCBH model as a platform for teaching medical residents and behavioral health providers to work together in a redesigned primary care team model.