Billing and Record-Keeping for Familial Cancer Risk Counseling: A National Survey

We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.     

DTC基因检测的伦理思考

直接面向消费者提供基因检测服务称为Direct-to-Consumer (DTC)基因检测.随着人类基因组计划测序工作的完成,DTC基因检测服务行业逐渐发展起来,它的出现与人们日益提高的健康需要相适应.但与此同时,一些社会伦理和法律问题也随之产生.对DTC基因检测的现状以及各国对其认可度进行阐述,剖析DTC基因检测存在的伦理问题,如隐私问题,有限的预测价值,检测信息的准确性,检测结果对受试者造成的负面心理影响,以及由此产生的基因歧视和卫生保健资源的浪费等.     

伦理学视野中的企业社会责任理由解读

企业社会责任是指企业在突破仅对股东负责的传统理念限制后,以社会本位为着眼点,对非股东的利害关系人之权益承担的一定责任。企业社会责任具有特定的内涵与种类。企业应当承担社会责任,这不仅仅是社会正义的要求,同时,社会责任的承担对企业而言,并非只是负担。利税不能成为企业回避社会责任的借口。     

Naturalizing Ethics: the Biology and Psychology of Moral Agency

Moral agency is a central feature of both religious and secular conceptions of human beings. In this paper I outline a scientific naturalistic model of moral agency making use of current findings and theories in sociobiology,developmental psychology, and social cognitive theory. The model provides answers to four central questions about moral agency: (1) what it is, (2) how it is acquired, (3) how it is put to work, and (4) how it is justified. I suggest that this model can provide religious and secular moral theories with a basis for a common understanding of moral agency.     

论医学伦理学的自主性原则

医学伦理学的自主性原则是对个人的自主和自由的尊重,其核心是对人权的尊重,包含有知情同意、保密、隐私等具体规则。自主性原则是根源于西方强调个性自由和选择的自由主义道德传统,我国古代哲人也提出过相近乃至相同的看法。     

The Concept of Abnormality in Medical Genetics

This paper explores usage of the concept ofabnormality in medical genetics and proposesdirectives for more careful usage of this concept.The conceptual difficulties are first explored, thena model is developed to assess actual usage, followedby analysis of a sample of genetic textbooks andgenetics literature. It appears that fact andvaluation are often intermingled, that referencestandards used to define 'genetic abnormalities' areoften not clear and that the concept of abnormality isoften used independent of the degree of certainty withwhich the altered genetype develops into a (seriously)harmful phenotype. On the basis of these findings itis argued that more restraint and more careful use ofthe concept of genetic abnormality of medical geneticsis appropriate as well as more agreement on the use ofreference standards.     

儒家伦理思想与当代中国道德体系建设

儒家伦理思想作为中华民族道德传统的主干,一直深深地、普遍地影响着人们的思想观念和行为选择,对中华民族的道德追求、行为方式和人格塑造都产生了重大影响。儒家“仁爱”的道德原则及其道德规范体系,以及关于职业道德、家庭道德和社会公德的思想和要求,都是社会主义道德建设的宝贵资源。我们应当坚持批判继承其原则和方法,摒弃其消极因素,吸取、弘扬其积极因素,这对于当今中国道德体系的建设是十分重要的。     

The Role of the Child in Adult Development

This paper provides theoretical and empirical support for the view that children play a large and often underappreciated role in adult development. Fifty parents and teachers were asked to discuss occasions when they learned something valuable from a child or when a child changed them in some significant way. Adults reported that children can cause them to (a) shift their values or priorities, (b) integrate memories or experiences previously disowned or repressed, (c) become more creative and cognitively flexible, or (d) look at the world with more wonder, awe, or curiosity. Werner's concept of genetic stratification (H. Werner, 1957) and Labouvie-Vief, Chiodo, Goguen, Diehl, and Orwoll's concept of dynamic intersubjectivity (G. Labouvie-Vief, L. M. Chiodo, L. A. Goquen, M. Diehl, & L. Orwoll, 1995) are used to explain the results.     

Civil Ethics and the Validity of Law

This paper aims to clarify the nature and contents of 'civil ethics' and the source of the binding force of its obligations. This ethics should provide the criteria for evaluating the moral validity of social, legal and morally valid law. The article starts with observing that in morally pluralist Western societies civil ethics already exists, and has gradually started to play the role of guiding the law. It is argued that civil ethics should not be conceived as 'civic morals' which is in fact rather 'state ethics', nor as 'public ethics' which is said to reach its perfection when it becomes law, nor as ethics applicable primarily to the basic structure of a society (political liberalism), but instead as a citizens' ethics. Subsequently the paper attempts to show what the contents of this ethics are, and which ethical theory would be able to ground its obligations.     

Ethical Issues in Cancer Genetics: 1) Whose Information Is It?

This article presents and discusses four clinical cases that exemplify the complexity of ethical dilemmas concerning the provider's obligation to disclose or withhold genetic information from patients. Case 1: What is the responsibility of the cancer genetics provider to ensure that a positive test results is shared with distant relatives? Case 2: To ensure that results go to at-risk relatives, do we have the right to ignore the wishes of the designated next-of-kin? Case 3: Do we have the right to reveal a familial BRCA1 mutation to a patient's relative, who is at 50% risk? Case 4: Do we have an obligation to reveal that a patient is not a blood relative and therefore, not at risk to have inherited a familial mutation? These cases form the basis for discussing the provider's dual obligations to keeping patient confidentiality and informing patients and families about risk (i.e. duty to warn). We also provide a summary of consensus points and additional discussion questions for each case.     

Virtue Ethics, Theory, and Warrant

Are there good grounds for thinking that the moral values of action are to be derived from those of character? This ‘virtue ethical’ claim is sometimes thought of as a kind of normative ethical theory; sometimes as form of opposition to any such theory. However, the best case to be made for it supports neither of these claims. Rather, it leads us to a distinctive view in moral epistemology: the view that my warrant for a particular moral judgement derives from my warrant for believing that I am a good moral judge. This view seems to confront a regress-problem. For the belief that I am a good moral judge is itself a particular moral judgement. So it seems that, on this view, I need to derive my warrant for believing that I am a good moral judge from my warrant for believing that I am a good judge of moral judges; and so on. I show how this worry can be met, and trace the implications of the resulting view for warranted moral judgement.     

Knowledge of Breast Cancer Genetics Among Breast Cancer Patients and First-Degree Relatives of Affected Individuals

The cloning of BRCA1, a susceptibility gene for inherited breast cancer, has made genetic screening possible for individuals and families whose medical histories are suggestive of an inherited predisposition to breast cancer. To date, few systematic attempts have been made to determine the level of knowledge about breast cancer genetics among women who are likely to seek BRCA1 screening when it becomes widely available. The present study attempted to assess the general knowledge about BRCA1 mutations in two groups: (1) first-degree relatives (FDRs) of breast cancer patients; and (2) women with a previous diagnosis of breast cancer. A self-administered, thirty-item questionnaire was developed through a pilot study. Ten of the items were objective, factual questions about breast cancer genetics. Responses to these questions were used to generate an overall knowledge score for each respondent. The study population was moderately knowledgeable about breast cancer genetics, with an average score of 5.35 out of 10. Counselors should not underestimate the importance of evaluating each counselee's existing knowledge about breast cancer, which can affect the provision and reception of genetic information. In particular, specific areas of knowledge that may be confusing or misunderstood were identified and these topics are discussed in detail.     

Huntington disease: A case study describing the complexities and nuances of predictive testing of monozygotic twins

When a candidate for predictive testing for the Huntington disease gene is a monozygotic twin, confidentiality of the co-twin's diagnosis and autonomy of participation are among the critical genetic counseling issues. Predictive testing can proceed when twins voluntarily and simultaneously request counseling and evaluation in an HD testing program. This case describes a young man referred for predictive testing to an HD testing site on the East Coast of the United States. Family history revealed a twin brother of unknown zygosity who resided on the West Coast of the United States. The genetic counselors on opposite coasts collaborated to provide genetic counseling and evaluation for voluntary, informed predictive testing of the twins, protecting their rights while observing national protocol guidelines.     

Intimacy and confidentiality in psychotherapeutic relationships

This article explores the relations among and between intimacy, psychotherapeutic relationships and moral advice. The article concludes that a psychotherapeutic relationship is not usefully explained in terms of intimacy. Instead, a psychiatric relationship is a form of moral advice, and it is this dimension of a psychotherapeutic relationship as a form of moral advice that poses a natural limit to the confidentiality necessary for engaging in psychotherapy.     

市场经济、道德权利与产权伦理

产权伦理是现代市场经济的一个根本性的精神基础,是建立有效的产权制度及其运行机制的重要条件;同时,它是人类道德体系的核心价值理念之一,是基于权利,义务与道德的内在逻辑构建起来的。产权伦理的研究具有重要的理论价值和现实意义,可以构成一门具有特殊的学科特质,研究方法和理论内容的伦理学学科。     

The Religion of Genetics in Epistemology and Ethics

In the dialog between genetics and religion, the genetics of religion has received thoughtful attention from the possibility of free will to the evolution of human religious behavior. In this article, the author focuses on the reverse, the religion of genetics – specifically, two aspects of how religion shapes our understanding and use of genetics. If religion is (as often argued) whatever our ultimate concern or worldview is, it gives context and direction for the study and application of genetics. Some of the implications are traced through two examples of interaction with one religion, the varied Christian tradition.     

解析现代生育伦理问题的思维路向

人类生育选择有以“善”为核心和以“正当”为核心的两类价值定位 ,因而 ,对现代生育伦理问题的理论解释 ,不能只是其中的任何一种思维路向 ,而应当是两种思维路向的合理整合。     

No more than Conjectures: Popper and the Ethics of Scientific Enterprise

Karl Popper dealt with both problems Yurevich (Integrative Psychological and Behavioral Science, 43(2), 2009, doi: 10.1007/s12124-008-9082-7) deals: the crisis in Psychology and in the discourse about the nature of science. Although he failed to provide a complete response for both problems, his proposals can yet be fruitful to the reflection on these matters in the context of the present discussion. He offers some tentative answers to what could be considered a healthy epistemic activity, something Yurevich does not provide. More interestingly, some of the Popper proposals seem to fit, and in some extent correct, the quest for “collaborative work” proposed by Zittoun et al. (Integrative Psychological and Behavioral Science, 43(2), 2009, doi: 10.1007/s12124-008-9082-7) as a way of transforming crisis in development.     

Ethics and the Science of Animal Minds

Ethicists have commonly appealed to science to bolster their arguments for elevating the moral status of nonhuman animals. I describe a framework within which I take many ethicists to be making such appeals. I focus on an apparent gap in this framework between those properties of animals that are part of the scientific consensus, and those to which ethicists typically appeal in their arguments. I will describe two different ways of diminishing the appearance of the gap, and argue that both of them present challenges to ethicists seeking a firm scientific basis for their claims about the moral status of animals. I argue that more clarity about the role of appeals to science by applied ethicists leads to questions about the effectiveness of such appeals, and that these questions might best be pursued empirically.