What Spirituality Means for Patients and Families in Health Care

This research focuses on the spiritual care experiences of patients and families at a hospital in Australia. Twenty-four patients and 10 family members were interviewed. Results indicate the importance of relatedness: being treated as a person, reminded of your capabilities and conversations about what matters. Maintaining contact with friends and family, sustaining religious and spiritual practices, music therapy and pet therapy were also significant and contact with the natural world and shared activities. The results indicate the importance of spirituality offered through pastoral care, and that all those involved in health care can contribute to the spiritually nurturing environment that reinforces healing.

     

晚期癌症患者宁养疗护与伦理

晚期癌症患者宁养疗护强调人的生活质量与生命价值,其在实践中得到了长足的发展,正成为姑息医学中的重要部分。随着医学向生物心理社会医学模式转变和姑息医学快速发展,宁养疗护伦理问题日益凸显。宁养疗护伦理在医疗方面强调适度治疗与合理用药,护理方面强调患者生理、心理、灵性、社会和宗教等层面的整体性照顾。梳理宁养疗护伦理有利于在宁养疗护服务中做出最优伦理选择,这种选择需遵循不伤害原则,注重生命质量原则、适度治疗和舒适生存原则、尊重患者意愿原则以及公平正义的原则。     

Engaging Narratives and the Limits of Lay Ethics: Introduction

How can one discover the ethical issues associated with nanotechnologies? One heuristic is to tend closely to the ethical reflections of lay publics and the ways in which these are informed by experience with technological innovation, technology governance, and the (broken) promises of visionary science and technology. A close collaboration between social scientists and philosophers took this heuristic to its limits: On the one hand, it achieved remarkably fine–grained insights into public reflection about nanotechnologies. On the other hand, a philosophical analysis of these reflections makes apparent that there is a profound disconnect between the lay ethics rooted in public talk and the ethical and normative commitments that are embedded in nanotechnological research programs and practices. Accordingly, critical engagement with the ways in which ordinary people try to make sense of nanotechnologies constitutes a novel heuristic for the discovery of ethical issues. This introduction and the subsequent four papers show this heuristic at work.     

Understanding Respite Care Use by Families of Children Receiving Short-Term, In-Home Psychiatric Emergency Services

Respite care is widely believed to be an important support service for families raising a child with a disability. We report the findings of a respite care utilization study conducted within the context of a larger research and demonstration project examining three models of intensive, in-home services for children experiencing psychiatric crises. Respite care, both in-home and out-of-home, was a support service available to families in two of the three study conditions. Overall, 34% of 146 eligible families used in-home and or out-of-home respite care. Utilization was lower than the estimates developed prior to implementation, prompting an inquiry at the end of the first project year designed to maximize use and to gather more information on caregiver and service provider attitudes toward respite care. The inquiry included caregiver and provider focus groups, surveys, and enhanced data collection and analysis. Caregiver interviews indicated that many families did not fully understand what it meant to receive respite care or even that it was available to them. A comparative analysis of respite care users and non-users revealed that respite care users were more likely to have younger children, children who had a greater number of assessed functional impairments, and fewer social supports. Respite care users also reported greater difficulty managing their children's difficult behaviors.     

Commitment and Partialism in the Ethics of Care

It is plausible to think that practices of caring are partly constituted by a caregiver's commitment to a cared‐for. However, discussions of caring often contain no explicit discussion of such commitments, and do not attempt to draw any philosophical conclusions from the nature of caring relations as committed. A discussion of caring practices that emphasizes the importance of commitment therefore has the potential to generate important new insights for our understanding of caring. This essay begins that project by arguing that a commitment‐centric conception of caring entails the truth of moral partialism. Although many care‐ethicists are sympathetic to partialism, the arguments in its defense remain controversial. As I show in this article, however, partialism is necessarily true given the committed nature of caring. This is because the concept of commitment is itself a necessarily partial one: to say that we are equally committed to everyone or everything is equivalent to saying that we are not committed to anything. Thus, when viewed as a species of commitment, it is part of the concept of caring that it requires us to put the needs of those we care for before the needs of those unknown to us.     

Engaging Clients,Families, and Communities as Partners in Mental Health

Counselors are being called on to reach beyond the office and clinic to partner with clients, their families, and communities to address mental health and social problems. Counselors need models of collaboration that guide them in building transformative client‐family‐community partnerships. W. J. Doherty and T. J. Mendenhall (2006) presented a model of community‐based collaboration in their article Citizen Health Care: A Model for Engaging Patients, Families, and Communities as Co‐Producers of Health. After reviewing their article, an analysis of a university‐community partnership is used to frame the discussion of the model's implications for counselors and counselor education programs.     

疏离与关怀:传染病患者的社会交往伦理探析

现代社会围绕传染病涉及医学、伦理、社会文化等多因素相互影响和作用,整个社会呈现出不同的道德认识、评价、情感选择方式,构成了传染病患者与医生、与社会其他人之间的复杂道德关系和张力互动。关注传染病患者伴随生活世界转换而与社会的疏离及自我放逐,在社会人道关怀和个体社会责任强化中,完善社会控制,重建公共交往伦理,对于保持社会和谐和公正意义重大。     

Reweighing the Ethical Tradeoffs in the Involuntary Hospitalization of Suicidal Patients

Suicide is the 10th leading cause of death in the United States and the second cause of death among those ages 15–24 years. The current standard of care for suicidality management often involves an involuntary hospitalization deemed necessary by the attending psychiatrist. The purpose of this article is to reexamine the ethical tradeoffs inherent in the current practice of involuntary psychiatric hospitalization for suicidal patients, calling attention to the often-neglected harms inherent in this practice and proposing a path for future research. With accumulating evidence of the harms inherent in civil commitment, we propose that the relative value of this intervention needs to be reevaluated and more efficacious alternatives researched. Three arguments are presented: (1) that inadequate attention has been given to the harms resulting from the use of coercion and the loss of autonomy, (2) that inadequate evidence exists that involuntary hospitalization is an effective method to reduce deaths by suicide, and (3) that some suicidal patients may benefit more from therapeutic interventions that maximize and support autonomy and personal responsibility. Considering this evidence, we argue for a policy that limits the coercive hospitalization of suicidal individuals to those who lack decision-making capacity.     

The Unhappy Marriage of Care Ethics and Virtue Ethics

The proposal that care ethic(s) (CE) be subsumed under the framework of virtue ethic(s) (VE) is both promising and problematic for feminists. Although some attempts to construe care as a virtue are more commendable than others, they cannot duplicate a freestanding feminist CE. Sander‐Staudt recommends a model of theoretical collaboration between VE and CE that retains their comprehensiveness, allows CE to enhance VE as well as be enhanced by it, and leaves CE open to other collaborations.     

Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

Supererogation in an Ethics of Care

Most philosophers who advance an ethics of care do not claim that their theories are meant to account for all of morality, or that they can, or should, replace the traditional Western philosophical approaches to moral theory. However, one care ethicist, Michael Slote, holds that his theory can be used to understand all of individual and political morality. Moreover, while Kantianism, utilitarianism, and both ancient and contemporary Aristotelian ethics are all uncomfortable with supererogation and are typically committed to assumptions that rule out the possibility of someone acting beyond the call of duty, Slote claims that the way in which his theory accommodates supererogation constitutes a real advantage over other approaches to ethics. My aim in this paper is to cast doubt on the truth of this claim by showing that Slote’s theory has considerable difficulty accommodating supererogation.     

Ethics and Culture in Mental Health Care

This article examines the complex relationship between culture, values, and ethics in mental health care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range of ethical issues faced by mental health clinicians working in a multicultural environment, including issues of therapeutic boundaries, diagnosis, treatment choice, confidentiality and informed consent, and the just distribution of limited health care resources.     

关爱受教育者:柯尔柏格道德教育思想的核心

关爱受教育者是柯尔柏格道德教育思想的基点。本文从道德教育的目的、方法、教育者在道德教育中的作用等方面对作为我国当代道德教育理念的“关爱受教育者”思想进行了理论探讨