Selecting people randomly

This article considers what justification can be found for selecting randomly and in what circumstances it applies, including that of selecting patients to be treated by a scarce medical procedure. The author demonstrates that balancing the merits of fairness, common good, equal rights, and equal chance as they apply in various situations frequently leads to the conclusion that random selection may not be the most appropriate mode of selection. Broome acknowledges that, in the end, we may be forced to conclude that the only merit of random selection is the political one of guarding against partiality and oppression.     

人文课程建设与医学生人文素质培养

人文课程在医学教育中担负着培养医学生思想品德的重要任务。优秀的医学人才不仅需要较高的专业技术水平,更需要有饱含人文情感的人文素质,否则,就很难适应医学的发展及社会对医学人才的要求。因此,加强人文课程的建设,培养医学生的人文素质,使他们成为高素质的医学人才,是医学教育发展的必然和需要。     

“病人选医生”是推动医院改革的重大突破

随着卫生部《关于实行病人选医生促进医疗机构内部改革的意见》文件的下发,病人选医生已经成为加快医疗卫生机构改革的一个重大突破;具体分析它在深化医疗卫生机构改革过程中实现了几个方面的重大突破：一是病人选医生是建立新型的医患关系的重大突破;二是确立“以病人为中心”的服务模式的重大突破;三是建立一种新型的评价体系的重大突破;四是建立新型医疗劳动个人收入分配制度的重大突破。     

7. The Hero's Return

ABSTRACT Chapter 7 discusses the synthesis of the five-factor and life-story models into an integrative model that is applied to the case study of Dodge Morgan. Such integration allows new ways of thinking, considers multiple levels of analysis, and solves problems that cannot be approached by either model individually. Through the combined lenses of these trait and phenomenological models, one can not only view an individual personality at a higher level of abstraction, but also achieve a different understanding of the models themselves. We discuss the impact of the voyage on Morgan's psychological development; we also analyze post-voyage assessments and personal documents with reference to consistency and change, personal meaning, and the balancing of agentic and communal motivations.     

Seeking Balance: Decision Support Needs of Women Without Cancer and a Deleterious BRCA1 or BRCA2 Mutation

Recommendations for women with a deleterious BRCA1 or BRCA2 gene mutation include complex medical approaches related to cancer risk reduction and detection. Current science has not yet fully elucidated decision support needs that women face when living with medical consequences associated with known hereditary cancer risk. The purpose of this study was to describe health communication and decision support needs in healthy women with BRCA1/2 gene mutations. The original researchers completed an interpretive secondary qualitative data analysis of 23 phenomenological narratives collected between 2008 and 2010. The Ottawa Decision Support and Patient Centered Communication frameworks guided the study design and analysis. Women described a pattern wherein breast and ovarian cancer risk, health related recommendations and decisions, and personal values were prioritized over time based on life contexts. Knowing versus acting on cancer risk was not a static process but an ongoing balancing act of considering current and future personal and medical values, further compounded by the complexity of recommendations. Women shared stories of anticipatory, physical and psychosocial consequences of the decision making experience. The findings have potential to generate future research questions and guide intervention development. Importantly, findings indicate a need for ongoing, long-term, support from genetics professionals and decision support interventions, which challenges the current practice paradigm.     

Shadow and Spirituality

When we confront the meaning of spirituality in education confusion and conflict can arise as they arise from the confrontation with spirituality in ourselves. This occurs both at the personal and at the collective level, according to writers such as C.G. Jung. Failure to understand that human spirituality includes a shadow side of this kind is precisely what leads many forms of human spiritual expression, including organized religion, into deep splits and schisms. It is unsurprising, therefore, that the willing, but perhaps, nä L ve attempts of contemporary educationalists to understand spirituality within education in a wholly positive light have themselves run into trouble. This paper will attempt to argue that without balancing contemporary educational debate about spirituality against some writers', including C.G. Jung's, deepest insights into the place of shadow in spirituality, children will yet again be sold a misfaction [1] about the nature of that aspect of human being and becoming. This, in turn will merely deepen the chaos, confusion and conflict arising from the earnest and well-intentioned, but perhaps nä L ve, attempt to make spirituality part of the cross-curricular experience of all children in all common schools.[2]     

Pragmatism, Pluralism, and Psychotherapy Relationships: An Interview with John C. Norcross, Ph.D.

John C. Norcross has made significant contributions in the areas of the transtheoretical model of change, psychotherapy integration, and empirically supported psychotherapy relationships. This interview explores the contributions of pragmatic philosophy and his personal upbringing to his work as a psychotherapy researcher and practitioner. Dr. Norcross discusses the status of the psychotherapy integration movement, the work of the Task Force on Empirically Supported Psychotherapy Relationships, and future trends in psychotherapy over the next 25 years. He emphasizes the importance of a methodological rigor that recognizes the unique characteristics of the psychotherapy relationship. He describes his current interest in the psychotherapy of psychotherapists, illustrating it with his personal challenges in balancing work and home.     

LAW AND ETHICS IN ISLAMIC BIOETHICS: NONMALEFICENCE IN ISLAMIC PATERNITY REGULATIONS

In Islamic law paternity is treated as a consequence of a licit sexual relationship. Since DNA testing makes a clear distinction between legal and biological paternity possible, it challenges the continued correlation between paternity and marriage. This article explores the foundations of paternity regulations in the Islamic ethico‐legal tradition, with a particular focus on what is termed here “the licit sex principle,” and investigates the extent to which a harm‐based argument can be made either by appeal to or against Islamic paternity regulations. It argues that in Islamic bioethics the definition of harm and its boundaries is a function of both: (1) identification of legal and religious rights and the extent to which these rights are violated; and (2) balancing and reconciling perceived harm against both specific principles in relation to a given issue and also the overarching objectives of Islamic law. The article is divided into three main sections addressing the Islamic legal, ethical, and bioethical dimensions of paternity.     

Infertility,epistemic risk,and disease definitions

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices.

     

BOOK REVIEWS

This paper explores R. Jacob Emden's surprising quest for the knowledge of alchemy. This important eighteenth-century rabbinic leader searched for ancient books in the library of Göttingen University, sought living experts and read original alchemical works in German. His sustained interest in alchemy reflects an historical phenomenon far deeper than his personal curiosity. By delving into his forgotten 1736 Igeret bikoret, comparing it to his other writings, and then contextualizing it within contemporary European medical discourse, I wish to use the quarrel between competing medical world views, so typical of the early modern era, to understand R. Jacob Emden's alternative, esoteric path to modernity and the specific ties it reveals between theology, law and medical practice.     

Medical Students’ Efforts to Integrate and/or Reclaim Authentic Identity: Insights from a Mask-Making Exercise

Medical students’ mask-making can provide valuable insights into personal and professional identity formation and wellness. A subset of first- and second-year medical students attending a medical school wellness retreat participated in a mask-making workshop. Faculty-student teams examined student masks and explanatory narratives using visual and textual analysis techniques. A quantitative survey assessed student perceptions of the experience. We identified an overarching theme: “Reconciliation/reclamation of authentic identity.” The combination of nonverbal mask-making and narrative offers rich insights into medical students’ experience and thinking. This activity promoted reflection and self-care, while providing insight regarding personal and professional development.     

Ethical Considerations for Psychologists Taking a Public Stance on Controversial Issues: The Balance Between Personal and Professional Life

Previous literature has documented the general issues psychologists often face while balancing their personal and professional lives. The struggle stems from attempting to satisfy the need to maintain a life outside of work while having the professional obligation to follow the American Psychological Association’s (APA’s) Ethical Principles of Psychologists and Code of Conduct (Ethics Code) to prevent their personal lives from interfering with their professional roles and relationships. The present article analyzes the subject of psychologists taking a public position on controversial public issues. Although the APA Ethics Code does not restrict how psychologists conduct themselves during their personal time, taking a public stance on a controversial issue could potentially strain professional relationships and inadvertently reflect negatively on the profession. The present article examines ethical issues that (a) should be taken into account before psychologists take a public position on a controversial issue and (b) are in conflict with APA’s Ethics Code or current research.     

Medical ethics in Poland

The work related to medical ethics written by Polish authors are reviewed and some topics concerning teaching and various other activities in this field are presented. The attention is centered on the opinions and attitudes concerning the essence of medical profession and the personal model of the physician, doctor-patient relationship (including duties of the doctor), medical research on humans, abortion and other problems. The role of medico-ethical tradition in Poland is described. Main trends in polish ethical thought in relation to medicine are taken into consideration. General aspects of medical ethics in present-day Poland are tentatively characterized.     

Identity Transformation in Medical Students

This paper reviews the literature on the impact of medical school on personal development and consolidation of core identity. The limited literature relies on reports from medical students’ journaling exercises, discussion groups, post-graduation surveys, and repeated personality testing. We review forces acting on medical students, with potential transforming effects. These forces include high external expectations and internal fear of superficial knowledge and skills, entry into the culture of medicine with its insider jargon and hierarchy, high academic workload, and the emotional burdens of confronting cadavers and death as well as bearing witness to patients’ suffering. Potential developmental delay, emergence of substance abuse and hedonic acting out, cynicism, and loss of individual core values are possible consequences. Protections against these adverse outcomes include identification of strong mentors and role models, developing post-conventional morality and relativistic thinking, finding healthy coping strategies such as peer support, and remaining intellectually creative and personally reflective.     

When personal history repeats itself: Decomposing memories for recurring events

Retrospective reports of personal events constitute the principal data source for much applied social science research. Such reports are known to be subject to biases and errors of inference. In health surveys, for example, events associated with chronic conditions are particularly likely to be under-reported (Jabine, 1987). In this series of studies we apply perspectives and tools from psychological studies of memory to the problem of understanding and improving reports of past untilization of health care. In two studies we found that subjects report using different strategies to answer questions about how often they have seen a doctor over the past 12 months, depending on the type of doctor's visit and its frequency. A third study, in which subjects' recall was checked against medical records, provided evidence that individual health events within a group of recurring, similar events are much less likely than non-recurring events to be recalled. In Experiment 4 we tested the efficacy of cognitively oriented intervention techniques designed to (1) help subjects decompose their molar memories of groups of similar events into individual events and (2) place all remembered health events into a personal timeline. The intervention more than doubled the proportion of recurring events on the medical record that was recalled. In addition, the proportion of events that could be dated, and the accuracy of dates provided, both rose.     

Do health beliefs about COVID-19 predict morbidity? A longitudinal study

In a highly powered (N ≈ 5000), six-months longitudinal study (December 2020-May 2021), we tested the assumption that beliefs concerning COVID-19 and the precautions against it predicted morbidity. Six months after having filled out a survey measuring beliefs about the disease and the precautions against it, participants reported if they were or had been ill with COVID-19. A lower likelihood of being or having been ill with COVID-19 was predicted by personal optimism concerning infection, perceived personal control over infection, perceived effectiveness of precautions, and self-reported personal or better-than-average adherence to the precautions. A higher likelihood of being or having been ill with COVID-19 was predicted by perceived personal control over a good outcome of an infection, egocentric impact perception concerning the impact of the disease, perceived difficulty of adherence to the precautions, and both personal and egocentric impact perception concerning the impact of the precautions. Comparative optimism did not predict morbidity, nor did personal optimism concerning severe disease or a good outcome, perceived personal control over severe disease, and moralization of the precautions. We discuss implications for public health communication.     

Let's exist again (like we did last summer)

ABSTRACT

This paper is a defence of a psychological view of personal identity against the attack Peter Unger launches against it in his Identity, Consciousness and Value. Unger attempts to undermine the traditional support which a psychological criterion of identity has drawn from thought-experiments, and to show that such a criterion has totally unacceptable implications—in particular, that it allows that persons can go out of and come back into existence. I respond to both aspects of this criticism, arguing that the relevant thought- experiments (and the support they appear to offer) survive Unger's attack intact, and that he does not establish his case against intermittent existence.     

When do women respond against discrimination? Exploring factors of subtlety,form, and focus

We examined the personal‐group discrimination discrepancy (PGDD), the tendency for women to recognize that others encounter sexism while simultaneously minimizing their own personal experiences with sexism, and the degree to which it (a) applies to all manifestations of discrimination, and (b) extends beyond perceptions of discrimination to taking action against it. Our findings replicated the PGDD when it comes to perceptions of discrimination, but this effect was reversed for behavioral action such that women were more likely to take action against discrimination when it was directed at them personally. We also disentangled the factors of subtlety (subtle vs. overt) and form (formal vs. interpersonal) by showing that women can reliably distinguish between these factors when determining their reactions to discrimination.     

The ethics of biometrics: the risk of social exclusion from the widespread use of electronic identification

Discussions about biotechnology tend to assume that it is something to do with genetics or manipulating biological processes in some way. However, the field of biometrics-the measurement of physical characteristics-is also biotechnology and is likely to affect the lives of more people more quickly than any other form. The possibility of social exclusion resulting from the use of biometrics data for such uses as identity cards has not yet been fully explored. Social exclusion is unethical, as it unfairly discriminates against individuals or classes of people. Social exclusion is unethical, as it unfairly discriminates against individuals or classes of people. This article looks at some of the ways in which social exclusion might arise from the use of biometric data, and introduces a model of balancing individual interests with which to analyse whether it is justified to run the risk of excluding some members of society for the benefit of others.     

What is the Role of the Arts in Medical Education and Patient Care? A Survey-based Qualitative Study

To inform medical education reform efforts, we systematically collected information on the level of arts and humanities engagement in our medical school community. Attitudes regarding incorporating arts and humanities-based teaching methods into medical education and patient care were also assessed. An IRB-approved survey was electronically distributed to all faculty, residents, fellows, and students at our medical school. Questions focused on personal practice of the arts and/or humanities, as well as perceptions of, and experience with formally incorporating these into medical teaching. Of 13,512 community members surveyed, 2,775 responded (21% overall response rate). A majority of respondents agreed or strongly agreed that medical education and patient care could be "enhanced" by the integration of the arts (67% and 74% respectively). There was enthusiastic support for the creation of a formal program in the arts at our medical school (72 %). Integration of the arts into medical education may have a role in improving the quality of medical training and would likely be well received by teachers and learners.