What is conscience and why is respect for it so important?

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed.

When Supervising Physicians See Patients Strategies Used in Difficult Situations

As part of training in an internal medicine ambulatory clinic, a supervising physician may see a patient who has already been seen by a trainee. The authors conducted qualitative analyses of videotapes of medical interactions and of the participants commentaries regarding the interactions. They found that physicians and trainees showed concerns regarding the emerging definitions of their relationship to each other and to the patient in opening the interaction and in taking history from the patient. The concerns experienced by supervising physicians and by trainees are described arid the strategies used in opening the interaction and in interviewing the patient are analyzed. The article concludes with an evaluation of the strategies used to manage interactional difficulties.     

The relationship between medicine's internal morality and religion.

In the face of managed care and market economies infringing on the practice of medicine, reducing its autonomy and determining the moral guidelines for medical practice, many physicians are calling out for a return to what is perceived as a traditional medical ethic. Many religiously motivated critics of certain modern developments in medicine have made similar appeals. These calls are best understood as an attempt to define medicine as a practice that is necessarily ethical in nature, a practice the moral basis of which is internal to that practice. This article examines and assesses this definition of medicine in reference to Aristotle's division of human undertakings into three distinct categories: theory, poieisis (i.e., production), and praxis. It is concluded that medicine can be understood as a praxis (as opposed to a theory or production, both of which are morally neutral), because the practice of medicine, and all of its constitutive acts, can only be explained and assessed in reference to health, which is itself a final good and hence of moral value. Such an understanding would immunize medicine against usurpation by the free market. However, by the same token it would also dissociate medicine from all other moralities external to it, including those grounded in faith and religion.     

Does young adults’ preferred role in decision making about health,money, and career depend on their advisors’ leadership skills?

Few empirical data exist on how decision making about health differs from that in other crucial life domains with less threatening consequences. To shed light on this issue we conducted a study with 175 young adults (average age 19 years). We presented the participants with scenarios involving advisors who provided assistance in making decisions about health, money, and career. For each scenario, participants were asked to what extent they wanted the advisor to exhibit several leadership styles and competencies and what role (active, collaborative, or passive) they preferred to play when making decisions. Results show that decision making about health is distinct from that in the other domains in three ways. First, most of the participants preferred to delegate decision making about their health to their physician, whereas they were willing to collaborate or play an active role in decision making about their career or money. Second, the competencies and leadership style preferred for the physician differed substantially from those desired for advisors in the other two domains: Participants expected physicians to show more transformational leadership—the style that is most effective in a wide range of environments—than those who provide advice about financial investments or career. Finally, participants’ willingness to share medical decision making with their physician was tied to how strongly they preferred that the physician shows an effective leadership style. In contrast, motivation to participate in decision making in the other domains was not related to preferences regarding advisors’ leadership style or competencies. Our results have implications for medical practice as they suggest that physicians are expected to have superior leadership skills compared to those who provide assistance in other important areas of life.     

Psychosocial Genetic Counseling in the Post-Nondirective Era: A Point of View

For three decades nondirectiveness has served as the central ethos for genetic counseling. It has evolved from narrow definitions defining what should not be done to broad definitions that promote active counseling skills in support of client autonomy and informed decision making. As broad definitions have been formulated, the term nondirective has become largely irrelevant to their content; it persists primarily as a historic relic. It has thus become an impediment to creative theory and clinical practice. I propose that nondirectiveness be replaced as the central ethos, while relevant components (providing balanced information, not imposing the counselor's values) are retained as elements of practice and ethics. This raises the question of what principle(s) should be adopted as a new guiding ethos. To promote a discussion of that issue I propose that the central ethos of genetic counseling should be to bring the psychosocial component into every aspect of the work.     

A metaphilosophical dialogue

Three philosophical attitudes in dialogue are suggested in answering the question posed by the Journal. An inviting, First Inner Voice undeerstands philosophy as a shareable theoretical task that can be explained and understood even across distant philosophical paradigms. A Second Inner Voice, sometimes termed in the dialogue as sceptic, distrusts any metaphilosophical definition of what philosophy is and what it should do, but would, nevertheless, aspire to retain a certain universalistic understanding of its own work, though it cannot be strongly and conceptualy rendered. A Third Inner Voice, regarded in the text as somewhat Hegelian, insists in the unavoidability of strong philosophical definitions both in historical and in conceptual terms. No proposal or conclusion is forwarded regarding what should be done in contemporary philosophy, though an analysis of harm experiences is taken as an example of philosophical work     

患者的药物颜色偏好

本研究比较了患者的一般颜色与药物颜色偏好的不同,探究患者对药物颜色的态度及服药时间对二者的影响。通过对699名患者的调查发现,其一般颜色偏好仍是蓝、红、绿、紫、黄,但药物颜色偏好紫色。与深色相比,患者更偏好浅色药物。患者认为药物颜色的作用主要是区分药物种类,而且服药时间越久,对这种功能的需求越强。这些结果支持了生态效价理论,并有很重要的实用价值。药物颜色偏好的其它影响因素和心理效应是未来研究的方向。     

Conscience in childhood: old questions, new answers

Although conscience has been the focus of reflection for centuries, fundamental questions regarding its organization have not been fully answered. To address those questions, the authors applied structural equation modeling techniques to longitudinal data comprising multiple behavioral measures of children's conscience, obtained in parallel fashion at 33 and 45 months. The measures encompassed moral emotion (guilt and empathic distress) and rule-compatible conduct (internalization of maternal prohibitions and requests and of another adult's rules). Confirmatory factor analyses supported a differentiated view of conscience with 2 latent factors at both ages: Moral Emotion and Rule-Compatible Conduct. The structure of conscience was remarkably stable over time. The coherence between Moral Emotion and Rule-Compatible Conduct factors increased as children grew older.     

CONSCIENCE, MORAL TRUTH, AND MORAL ERRORS: SOME RESPONSES TO EDMUND LEITES

Edmund Leites's lucid article on conscience, casuistry, and moral decision in the Church of England in the late 17th and early 18th centuries has amply demonstrated how the idea of conscience developed and changed from a background assumption of moral autonomy to that of self-reliance in addition to the belief in moral autonomy. In this shift the art of moral casuistry has gradually lost its original relevance and even become a forgotten idea. It may be wondered why this happened and what significance may be adduced from this. It may also be wondered what philosophical evaluation can be rendered of casuistry independent of the historical nexus of its transformation. From a comparative perspective in connection with the Chinese heritage, Leites's paper provides excellent evidence for the surprising existence of similar strains of thought on conscience in Chinese and Western traditions even though the metaphysical and religious contexts and backgrounds of these strains of thought are radically different. This difference in metaphysical and religious contexts and backgrounds raises some profound philosophical questions which are indicated in Leites's comments on my original article. In this response, I shall first discuss similar strains of thought on conscience in Chinese and English sources, and then explore briefly the different metaphiscal structures underlying these thoughts. I shall finally consider what theoretical conclusions are warranted in light of both the article and the comments of Edmund Leites.     

Problem-solving in general practice

Objective: To identify problem solving strategies in general practice. Basic procedures: Three styles of scientific reasoning were defined and modelled on the medical environment. These models were tested in a simulated doctor-patient encounter. Main findings: According to the definitions contained in the models a deductive or hypotheticodeductive strategy could not be discovered. All participants used exclusively the inductive method and, more specifically, the speculative variant. This variant may be best described as a process of iterative pattern recognition. Conclusions: The manifest utilization of the inductive method carries many implications among which are the irretraceability and irreproducibility of the process. The speculative form approaches the conception of art rather than science. This is exactly what most doctors try to tell: medicine is an art. The strategy allows for flexibility and quick response to the patient's needs.     

Cognitive, Linguistic, and Social Aspects of Adults' Noun Definitions

Low-income, rural adults and middle-income, urban adults provided oral definitions for eight common nouns. Two general issues were addressed: (1) whether the rural adults' definitions would conform to the well-documented Aristotelian form typically found among middle-class, well-educated adults; and (2) whether different definitional types would emerge for two different noun classes, social vs. object nouns. Participants' definitions were examined for conceptual content and linguistic form. Among rural participants, the mean proportion of definitions conforming to the Aristotelian model was .13, contrasted with .69 for the urban participants. Also, rural adults were significantly less likely to cast definitions in the conventional linguistic form than were urban adults. On other measures of definitional skill as well, rural participants demonstrated less mastery. There were no significant differences in definitional form between social and object nouns. Various explanations for the findings are considered.     

Telemedicine in Primary Health: The Virtual Doctor Project Zambia

Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth "model" that is independent from these three categories. These models frame the expectations placed upon physician-researchers by colleagues, regulators, patients and research participants. This paper examines the extent to which the data from semi-structured interviews with 30 physician-researchers at three major pediatric hospitals in Canada reflect these traditional models. It seeks to determine the extent to which existing models align with the described lived experience of the pediatric physician-researchers interviewed. Ultimately, we find that although some physician-researchers make references to something like the weak version of the similarity position, the pediatric-researchers interviewed in this study did not describe their dual roles in a way that tightly mirrors any of the existing theoretical frameworks. We thus conclude that either physician-researchers are in need of better training regarding the nature of the accountability relationships that flow from their dual roles or that models setting out these roles and relationships must be altered to better reflect what we can reasonably expect of physician-researchers in a real-world environment.     

Integrating complementary and alternative therapies into psychological practice: A qualitative analysis

Although complementary and alternative therapies (CATs) are utilised widely for treating psychological disorders, little research has examined psychologists' beliefs about integrating CAT into psychological practice. Six practicing psychologists and six psychology students were interviewed about their CAT integration beliefs, in particular integrating CAT into clinical practice via recommending CATs, offering referrals to CAT practitioners, or undertaking training to utilise CATs within psychological practice. Guided broadly from a theory of planned behaviour perspective, participants raised a number of costs and benefits, discussed referent groups who would influence their decisions, and suggested motivators and barriers for integration. A number of additional themes were raised, including risks, such as the possibility of litigation and the need for clear Society guidelines, as most participants were unclear about what constitutes appropriate practice. Identifying these themes serves as an important initial step to informing discussion and policy for this emerging practice issue within psychology.     

Differentiating visual and kinesthetic imagery in mental practice.

Through two experiments, the study sought to emphasize the usefulness of the visual and kinesthetic imagery in mental practice. In Experiment 1, it was hypothesized that when the task to be learned through mental practice necessitates the reproduction of a form by drawing, the visual image, which provides a wide span of apprehension, is more suitable than the kinesthetic image. On the other hand, the kinesthetic image that supplies inputs from the muscles' positions and movements should be more appropriate for the acquisition of the duration of the drawing. In Experiment 2, it was hypothesized that the task, transformed into a motor task necessitating minute coordination of the two hands, would benefit more from kinesthetic imagery. To have optimal control over what was actually experienced during mental practice, the participants' imagery skills were measured. The participants also benefited from prior imagery training. The results demonstrate that when using mental practice to initially acquire a task, visual imagery is better for tasks that emphasize form while kinesthetic imagery is better for those tasks that emphasize timing or minute coordination of the two hands.     

Implementing the Scientist–Practitioner Model in the Hospital Setting

Psychologists who work in hospital settings confront assorted challenges in implementing the scientist–practitioner model. Clinical psychologists must deal with the tension between an evidence-based model and the realities of clinical practice. Psychologists can gain a better understanding of what it means to function as a scientist–practitioner by understanding current debates in both psychology and medicine on the relationship between research and practice. Psychologists are not unique in the slow pace of implementing research into practice. Psychologists in hospitals can make a contribution to the treatment of medical patients by emphasizing the role of the treatment relationship in health-care outcomes. Medicine’s use of practice-based research networks provides a valuable structure for psychologists to emulate in order to function as active participants in the collection of practice-based evidence rather than passively accommodating to the evidence-based clinical practice guidelines.     

对希波克拉底警句的深层解读--审美修养是从医之必需

试图透过医学与艺术的联系,深入到医学与美学关系的层面,进而发掘希波克拉底关于"医学的艺术乃是一切艺术之中最为卓越的艺术"这一论断的深刻内涵,指出希波克拉底警句蕴涵着:医学是美的职业,它具有崇高地位和独特的重要性;医学所追求的是健康而美好的人生,医学所创造的是健康之美、生命之美、至善之美、仁爱之美.既然医学是最为卓越的艺术,医务工作者就应该重视美学修养,并让医学审美意识牢牢植根于自己的医学实践之中.换句话说,审美修养是从医之必需.     

Is Self-Disclosure Part of the Genetic Counselor's Clinical Role?

The role of genetic counselor self-disclosure in clinical practice is unclear as there are few published investigations of this issue. In the present study, 11 genetic counselors who previously received genetic services were interviewed about their opinions and use of disclosure. Several themes were extracted from their responses. All participants reportedly disclosed to patients; however, not all disclosed their receipt of genetic services. Patient requests for self-disclosure influenced many participants’ disclosure decisions. Opinions regarding potential benefits of disclosure varied. Nearly all participants stressed the importance of self-disclosing judiciously, stating that it may be counterproductive to client goal attainment. Four individuals with expertise in genetic counseling and psychotherapy were invited to react to these themes and to provide their opinions of self-disclosure. Their views are compared to those of the present sample, and practice and research recommendations are given.     

Higher education, democracy and citizenship – the democratic potential of the university?

From a historical point of view, theuniversity as an institution has had the roleof educating an elite, rather than any obvioustask of enforcing democracy. But what kind ofexpectations regarding citizenship anddemocracy can we justifiably have when it comesto the role of higher education and ouruniversities today when higher education isundergoing a process of massification. Couldthe university eventually become a place fordeliberative communication, developingdeliberative qualities among its many students?According to the contributions presented here –stemming from a conference on the theme``Higher education, democracy and citizenship'',held at Örebro university, Sweden 2000 –the answer is yes, to some extent, if there isroom for pluralism in different dimensions,opportunities to challenge one's own tradition,and tolerance and respect for the concreteother.     

Judgments About Sexism: A Policy Capturing Approach

Different definitions of sexism have been usedby different experimenters and little attention has beengiven to the possibility that participants' definitionsof sexism might vary across individuals and across situations, just as the definitions ofinvestigators vary. Judgments about sexism areinextricably based on individual perceptions, values,and beliefs. It would seem reasonable, therefore toexamine individual conceptions of what constitutessexism. A total of 95 primarily middle-class Caucasianparticipants (68 females, 27 males) participated inthree studies investigating what information people use in deciding whether or not a male actor issexist. Six specific categories of information (or cues)were examined: (1) comments (or lack thereof) by theactor on a female target's physical appearance, (2) unwanted or inappropriate physical contact(or lack thereof), (3) assumptions (or lack thereof)about the target's work, personality, etc., based on hergender, (4) the target being interrupted (or not) by the actor, (5) an apparent powerdifferential (or lack thereof) between the actor and thetarget, and (6) assumptions by the actor aboutappropriate gender role behaviors. A policy capturingmethodology was employed in which three different sets ofscenarios, each describing a number of interactions(called profiles) between a target and an actor, werepresented to male and female participants who rated the degree of sexism exhibited by the actor ineach scenario. Policy capturing represents anideographic approach to research in which the primaryfocus is on establishing statistical parameter estimates that describe each individual's behavior in avariety of environmental situations. Only when that isaccomplished does the researcher examine the possiblenomothetic aggregations across participants. Thus many fewer participants are required than intraditional nomothetic approaches. Each profile set useda different subset of the cues which contained eithersubtle (Study 1), overt (Study 2), or very overt (Study 3)levels of the cues. Multipleregression analysis revealed that when relatively overtacts of sexism were described, most participants hadreliable policies; that is, their judgments werepredictable from the cues. However, when relatively subtleacts of sexism were described, most participants did nothave reliable policies; that is, their judgments werenot very predictable from the cues. There were large individual differences in howparticipants weighted the importance of various cues,especially with subtle cue levels, and in participants'mean sexism ratings.     

Negotiating the Cultural Steps in Developing an Online Intervention for Korean American Intimate Partner Violence

Korean American (KA) immigrants experiencing intimate partner violence (IPV) underutilize existing services, but instead rely on KA clergy for assistance. However, there had not yet been an intervention curriculum developed for KA clergy to help them address IPV in their congregations. There was a lack of understanding regarding what needed to be included in an intervention curriculum for KA clergy, as well as the most effective form of curriculum design and delivery for such an intervention. This article discusses the process of developing an online IPV intervention curriculum for KA clergy to increase their capacity for IPV prevention and intervention within their congregations. Researchers developed Korean Clergy for Healthy Families by incorporating feedback from expert consultants and engaging study participants. The result is an IPV curriculum that speaks to participants’ cultural values and religious beliefs, and identifies barriers KA clergy experience when confronted with IPV. Specific steps to assist those who would want to develop culturally appropriate interventions are provided.