医务人员在医疗活动中的利益边界与道德责任分析

当今是一个以利益为轴心的时代,利益伦理是医学伦理学不可忽视的课题。欲望是无穷的,利益是有限的,任何利益都有其边界和限度,我们必须设置利益的道德界限。医患双方未能遵守利益限度和利益边界原则,使矛盾转化为冲突。利益冲突不仅影响医生的专业判断,而且影响了其医疗决定。医生既是医疗职业者,也是社会的一员,社会公众利益最大化是医疗服务的基本目标,为病人最大利益着想是医护专业最根本的道德规范与责任。     

A draft model aggregated code of ethics for bioethicists

Bioethicists function in an environment in which their peers--healthcare executives, lawyers, nurses, physicians--assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists.     

Ethics Consultation and Autonomy

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist.     

A Draft Model Aggregated Code of Ethics for Bioethicists

Bioethicists function in an environment in which their peers—healthcare executives, lawyers, nurses, physicians—assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists.     

Dual-relationship prohibitions: A concept whose time never should have come

The concept of dual-relationship prohibitions has limited value in that it creates confusion and leads to unfair results in ethics and licensing actions. It serves little purpose because it does not assist psychologists in analyzing situations. Neither does it provide much help in assisting psychologists in deciding how to act in a particular situation, such that the client's best interest is considered. This article addresses the problems with dual-relationship prohibitions. It also focuses on the constitutional problems of dual-relationship restrictions. Finally, a new standard is offered, that of substantial conflict of interest. In addition, an analytical model is proposed to guide psychologists in making decisions regarding whether a substantial conflict of interest exists where multiple-role relationships are involved. Finally, several suggestions are presented to make the entire process connected with ethics complaints fairer and more constitutionally sound.     

Conflicts Between Ethics and Law in Counseling and Psychotherapy

Codes of ethics are designed to guide and govern the behavior of the professional for whom they are written. In such fields as counseling, psychology, and social work, ethical standards are necessary to protect clients, guide professionals, safeguard the autonomy of professional workers, and enhance the status of the profession. Sometimes, however, the professional worker finds that the ethical standards of the profession seem to be in conflict with the law. These conflicts may arise in such areas as advertising, confidentiality, and clients' rights of access to their own files. The authors discuss the nature, ramifications, and implications of ethical-legal conflicts in the helping professions.     

英国心理咨询的专业化发展及其问题

由于英国咨询与治疗协会及其前身英国咨询协会的不懈努力,英国心理咨询业的专业化发展取得长足进步。表现在：在培训方面,统一课程要求;注重受训者的业务发展;培训对象、时间及费用上有灵活性。在督导方面,实施终身督导;尊重各种流派;坚持授权式和发展式督导,保证督导人员独立行使职责。在资格鉴定或注册方面,严格控制条件和标准。在伦理和投诉方面,出台了内容丰富、独具特色的关于咨询和治疗的伦理规范框架。英国心理咨询所面临的主要问题在于：学校心理咨询的不景气;咨询专业化要求与咨询实际不相吻合;在经济上面临挑战;资格鉴定注册及投诉上存有争议。了解他山之石,对于促进我国心理咨询专业化的健康发展不无裨益。     

Kitchener's Principle Ethics: Implications for Counseling Practice and Research

This extensive literature review examining the influence of K. S. Kitchener's (1984) introduction of principle ethics on counseling and psychology ethics notes the ultimate practicality of principle ethics. The authors maintain that although a strong influence of principle ethics in the area of counselor education emerges through the review, there is little clear evidence of influence in the areas of counseling research or practice. A primary reliance in the counseling professional literature on K. S. Kitchener's original work has likely resulted in a static understanding of the concepts and a concomitant theory–to–application knowledge gap. Implications include a more thorough and ongoing bridging between counseling ethics, philosophical ethics and practice, and a more overt presence of principle ethics.     

工程中利益冲突问题研究

首先在详细分析工程中利益冲突已有定义的基础上,本文从不同角度提出了一种不同的定义。然后,分析了利益冲突的构成,并列举了利益冲突的情形。接着,分析了利益冲突的伦理问题,并提出解决方法。最后介绍了美国工程社团以及大型企业有关利益冲突的伦理章程和行为规范。     

Student Attitudinal Changes in a Counseling Ethics Course

The purpose of this study was to investigate ethical attitude changes in counselors in training related to specific topics during a 16-week, two-credit counseling ethics course. This study indicated that significant attitudinal changes occurred related to professional ethics and self-awareness, dual relationships, impairment, and multiculturalism.     

Ethical Aspects of Spirituality in Counseling

The authors review the professional literature related to spirituality and ethics in counseling. The American Counseling Association's (1995, 2005) code of ethics was used as a basis for exploring the possibilities and limits/boundaries appropriate for discussion of spirituality in counseling. Implications for practice and research are discussed.     

浅议生物医学研究中不同主体的利益冲突

作为医学伦理学研究的重要内容,生物医学研究中的利益冲突问题日益受到公众、研究机构和管理部门的关注。探讨生物医学活动中研究者、研究机构、学术期刊三种不同主体利益冲突的表现、危害及其特点,以期有针对性地促进人们对该领域利益冲突问题的认识。     

“So wat do u want to wrk on 2day?”: The Ethical Implications of Online Counseling

Internet counseling is an area of rapid expansion in the field of applied psychology. Internet counseling or psychotherapy involves a variety of activities such as psychoeducation, individual therapy, and automated self-help interventions delivered via the Internet. Although other professional societies such as the National Association of Social Workers, the American Counseling Association, and the National Board of Certified Counselors have tackled the issues of Internet counseling ethics head on, the American Psychological Association has been conspicuously absent from this debate. Yet online therapy clinics are operating, and intervention efficacy is being studied. This discussion provides an overview of online counseling modalities, details the ethical concerns associated with each, and offers suggestions for the ethical practice of online counseling.     

Conflit d’intérêts et déontologies : l’échec des déontologies existantes et l’improbable (?) succès de la loi

The increasing frequency with which health scandals have come to light since the 1980s has uncovered a great deal of unlawful behavior, both in the pharmaceutical industry and the medical profession, as well as in the world of “experts” (or researchers), along with journalists and specialist media companies. These types of behavior have accumulated and combined to inhibit any reaction from government, thus preventing health policy from playing its role. The State has its share of responsibility in this failure, for having been unable to conserve the impartiality and effectiveness of its administrative actions: it must acknowledge this, which is a whole other problem. However, in the case in point, it is obvious that those texts which must have been breached to allow these health scandals to occur are almost exclusively the result of professional self-regulation, with a wide range of diverse legal values: ethics for the health professions, journalistic ethics, charters between the pharmaceutical industry and media companies, alongside scientific ethical charters. These texts are the result of regulations generated by the professions themselves, drafted to counteract conflicts of interest. The sheer number of cases highlights the failure of these self-regulatory measures, leading to legislation targeting the problem, in particular that of December 29, 2011, which strengthened monitoring in terms of conflicts of interest and penalties against those placing themselves in a conflict of interest situation. Will this legislation, in direct response to the so-called Mediator^® case, be able to succeed where self-regulation failed, swept away as it was by financial considerations? The arbitrations that characterized the drafting of this legislation and the resulting complexity, which affects the decrees, seem to promise many difficulties, particularly due to the scarcity of resources the authorities have to enforce it.     

Ethical Analysis in Counseling: A Case for Narrative Ethics,Moral Visions,and Virtue Ethics

The author presents an overview of the current content of ethics education in counseling, grouping that content into 3 areas: decision‐making models, principle ethics, and the standard of care. It is argued that as the field of ethics education has grown, so has the need for additional content models, especially ones that enhance moral sensitivity and reduce objectification of client circumstances. The author presents 3 possible approaches to revising the conceptualization of professional ethics that meet the need for new models: moral visions, narrative ethics, and virtue ethics.     

Professional Virtue and Professional Self-Awareness: A Case Study in Engineering Ethics

This paper articulates an Aristotelian theory of professional virtue and provides an application of that theory to the subject of engineering ethics. The leading idea is that Aristotle’s analysis of the definitive function of human beings, and of the virtues humans require to fulfill that function, can serve as a model for an analysis of the definitive function or social role of a profession and thus of the virtues professionals must exhibit to fulfill that role. Special attention is given to a virtue of professional self-awareness, an analogue to Aristotle’s phronesis or practical wisdom. In the course of laying out my account I argue that the virtuous professional is the successful professional, just as the virtuous life is the happy life for Aristotle. I close by suggesting that a virtue ethics approach toward professional ethics can enrich the pedagogy of professional ethics courses and help foster a sense of pride and responsibility in young professionals.     

A team-taught interdisciplinary approach to engineering ethics

This paper outlines the development and implementation of a new course in Engineering Ethics at the University of Tennessee. This is a three-semester-hour course and is jointly taught by an engineering professor and a philosophy professor. While traditional pedagogical techniques such as case studies, position papers, and classroom discussions are used, additional activities such as developing a code of ethics and student-developed scenarios are employed to encourage critical thinking. Among the topics addressed in the course are engineering as a profession and its role in society; ethical successes and failures; risk, safety, and the environment; professional responsibilities; credit and intellectual property; and international concerns. The most significant aspect of the course is that it brings both engineering and non-engineering points of view to the topics at hand. This is accomplished in two ways. First, as mentioned previously, it is team-taught by engineering faculty with an interest in ethical and societal issues, and by philosophy faculty with expertise in the field of professional ethics and an interest in science and technology. Second, the course is offered to both engineers and non-engineers. This mix of students requires that all students must be able to explain their technical and ethical decisions in a non-technical manner. Work teams are structured to maximize interdisciplinary interaction and to foster insights by each student into the professional commitments and attitudes of others. An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.     

Infusing Professional Ethics Into Counselor Education Programs: A Multicultural/Social Justice Perspective

Multiculturalism and social justice counseling issues influence counselors' ethical thinking and behavior. Counselor educators are responsible for facilitating students' understanding of the relevance of multicultural/social justice counseling issues and ethical standards for professional practices. Added insights in these areas aid students to work within a culturally diverse society. This article focuses on the importance of addressing these complex issues by outlining strategies to infuse ethics into counselor education programs from a multicultural/social justice counseling perspective.     

Ethical Challenges for Military Psychologists: When Worlds Collide

Despite the mental health needs in the military and improved access to military psychologists, many in need do not seek psychological services. The military policies, culture, and environment pose considerable barriers to help seeking. In turn, military practices often conflict with the psychologist’s professional ethics, leading to a range of ethical dilemmas including multiple relationships, multiple agencies, and limited confidentiality. To address ethical concerns and encourage service members to seek mental health services, this article proposes maintaining an understanding of military rules, law, and professional ethics; identifying multiple relationships and establishing boundaries up front; and collaborating with the patient in disclosures of information.