ICU临终病人治疗的社会,伦理和法律问题（下）

ＩＣＵ临终病人治疗的社会、伦理和法律问题（下）北京医科大学第一医院（１０００３４）刘秀文,李莉,冷强北京医科大学医学伦理学教研室（１０００８３）李本富上述抢救组病人在死亡前４８小时所接受的各种治疗,大部分对病人当时已无意义,如ＣＰＲ应是诊断意外发生心...     

两岸临终伦理研究述评

临终伦理是两岸学界关注的共同话题之一.从治疗原则、医护理念、宗教信仰、殡葬礼俗等不同层面和视角,台湾学界揭示了临终伦理的多重面向;从临终关怀所面临的多重伦理困境的角度,内地学界探索了临终关怀的一般模式和构建临终伦理体系的基本原则.两岸临终伦理研究具有相辅相成、可达致相得益彰的研究前景.     

临终患者ICU使用的相关问题

随着危重病医学的发展,越来越多的患者接受ICU治疗,而其中许多患者在临终前接受了他们所不愿接受的积极治疗。伦理学上并没有要求我们不惜一切代价挽救生命而不顾及患者及其家属的需要。让临终患者能够选择有尊严的、无痛苦的死亡,成为当前ICU治疗与护理的出发点和目标。在美国及欧洲ICU临终患者,限制生命支持治疗是主要的治疗模式,但差异显著。为真正理解“好死”的定义和判定患者生命质量、判定积极治疗的参考因素,国外已进行了大量研究。目前各国由于经济、文化、宗教等各方面的差异,直接影响临终患者的临终决策,综述了各国近年来有关ICU临终患者研究结果。     

临终患者ICU使用的相关问题

随着危重病医学的发展,越来越多的患者接受ICU治疗,而其中许多患者在临终前接受了他们所不愿接受的积极治疗.伦理学上并没有要求我们不惜一切代价挽救生命而不顾及患者及其家属的需要.让临终患者能够选择有尊严的、无痛苦的死亡,成为当前ICU治疗与护理的出发点和目标.在美国及欧洲ICU临终患者,限制生命支持治疗是主要的治疗模式,但差异显著.为真正理解"好死"的定义和判定患者生命质量、判定积极治疗的参考因素,国外已进行了大量研究.目前各国由于经济、文化、宗教等各方面的差异,直接影响临终患者的临终决策,综述了各国近年来有关ICU临终患者研究结果.     

大学生对临终者的内隐与外显态度

目的:考查大学生对临终污名者的内隐、外显态度。方法:使用内隐联想测验(IAT)和相应的外显测验,对安徽师大在校本科生、研究生共60名进行实验研究。结果:大学生在临终者内隐态度上,不相容任务反应时(1185.53±278.95)ms长于相容任务反应时(765.62±199.10)ms;大学生对临终者外显态度均表现出消极态度,但对于临终关怀的态度表现出积极(1.54±0.52);被试的性别以及被试是否接触过临终者并不能改变内隐以及外显态度。结论:大学生对临终者具有负面刻板印象以及污名效应,临终关怀以及对临终者的偏见应该引起重视。     

《阿弥陀佛临终要》与临终迁旨研究

本文从文本和修法二个角度,对明代汉译藏传密教短篇仪轨《阿弥陀佛临终要》做了汉藏比较研究。《阿弥陀佛临终要》依《大方广佛华严经普贤行愿品》所说普贤十大行愿,述拔济众生脱离烦恼苦海,往生阿弥陀佛净土的思想。而其修法是典型的藏传密教无上瑜伽部本尊禅定的究竟定,故它是一部显密圆融的本尊修法。所谓“临终要”,则指它是一部指导行者临终修习“坡斡”,亦名“迁识”法的要门。笔者先对《阿弥陀佛临终要》与其相应的藏文本《无量光佛修习义》作细致的文本对勘,然后勾勒这个文本于西番传承的历史,进而对它所传的“临终瑜珈”修法,以及它与汉藏佛教中的阿弥陀佛和观音菩萨信仰的关系做一些基础性研究和解释。     

将帮助临终患者活的更好的问题谈透

美国内科年鉴Meltem博士指出,尽管临终状态是人的一生之中不可避免的一部分,但是针对患者临终生活状况的照护已经有相当广泛的政治辩论。参加患者临终生活状况的照护的交谈,可能在情绪上会对每个人是一个非常棘手的挑战。关于严重的疾病或者疾病的终末期的信息,     

ICU临终病人治疗的社会,伦理和法律问题（上）

通过对本院外科重症监护治疗室（ＳＩＣＵ）９年内死亡病人回顾性调查分析,试图找出本ＳＩＣＵ对临终病人治疗的现状、存在的问题及同国外的差距。在被调查的１０２例死亡病历中,有９０例全力抢救到底;１２例不同程度地放弃抢救。有２６例临床诊断为脑死亡,其中２１例得到了全力抢救到底的治疗 。     

临终护理中“人性情怀”的伦理回归与释放

伴随着临终处境的衍变,临终病人生理功能、心理需求和社会关系等方面也随之发生变化,由于不同的"身体"处境,临终者与健康者在相互对等的关系上出现断裂,从而导致两者在不同境遇下具体道德现象与传统伦理道德产生冲突。从医护伦理角度看,通过"触摸式护理"或者"无声护理"方式可以深入临终病人内心世界,继而启发医护人员等回归并释放更多的"人性情怀",这或许可以为临终伦理难题提供一种消解的路向,帮助道德主体重塑并践行"敬畏生命"的伦理思想。     

临终关怀与安乐死医学社会学探讨

临终关怀与安乐死医学社会学探讨山西焦化工业总公司职工医院（０３１６０６）李红霞，王萍兰，卫崇理一、临终关怀是被动的安乐死临终意味着走向死亡，临终关怀是指对临终病人的生理、病理、心理行为作出客观评价，从而有针对性地关心、体贴、照顾病人，以提高病人的生命...     

Psychological science treatment

New discoveries in psychological science have changed our understanding of some basic psychological processes. The new science, however, has not of yet been properly incorporated into the practice of psychotherapy. This has created a confusing state of affairs, lacking clear distinctions between therapy interventions rooted in lore and personal insight and those based on systematic scientific inquiry. In this paper, I discuss the problems caused by the current situation and propose a new distinction by which the psychological (science) treatment of psychological disorders is differentiated from psychotherapy. The implications of the proposed distinction for clinical research and training are discussed.     

Psychological distress and quality of life of people living with HIV/AIDS in a Nigerian teaching hospital

Presence of psychological distress and poor quality of life (QoL) may affect the outcome of HIV/AIDS. One hundred and seventeen consecutive and consenting participants were interviewed using a Socio-demographic questionnaire, Kessler Psychological Distress Scale (K10) and World Health Organization Quality of Life-HIV Bref. Fifty-six (47.9%) participants scored 20 and above on K10 Scale. QoL was significantly higher in married participants, those who perceived their state of health as being good, asymptomatic participants and those who scored well–mild on K10. The older age group scored higher on QoL Scale than the younger age group in the physical health domain while the married participants scored higher in the domains of physical health, psychological health, environment and spiritual/religion. The participants who perceived their state of health as being good scored higher than those who perceived their health as poor in all domains. There is a high level of psychological distress and poor QoL in people living with HIV/AIDS.     

The emotional geographies of the ‘livingdying’

This paper engages with Madge's (2016; 2018) notion of the ‘livingdying’ through an analysis of three recent autobiographies of death and dying. Dying: A Memoir by Australian author, Cory Taylor (2016), In Gratitude by British writer, Jenny Diski (2016), and The Bright Hour by American memoirist, Nina Riggs (2017), provide insight into the sometimes contradictory emotional responses to the different spaces traversed by the ‘livingdying’. We identify how the emotions of fear and anxiety, sadness and grief, anger and frustration, and isolation and loneliness infuse the liminal spaces that the ‘livingdying’ occupy. In doing so we highlight how the normative dualism of ‘the living’ and ‘the dying’ shapes emotional vulnerabilities. Finally, hoping to further advance Madge's (2016; 2018) provocation to acknowledge, account for and honour the intrinsic entanglement of living and dying and life and death, we propose a reframing of her notion of ‘livingdying’ that includes the ‘ordinary’ living, that is, those not dealing with a terminal illness.     

The Pain of Dying

SUMMARY

Dying can be a painful and difficult business. Fears, hopes, losses, questions, and uncertainty result in a form of pain that lies beyond the therapeutic reach of science and pharmacology. Efforts to preserve and prolong life or to make things better can sometimes result in this pain being overlooked or remaining unheard. To search the deepest part of oneself is the journey that beckons us all as we are dying. Within this space resides the source of our own suffering but also the seeds for healing. This exploration has a momentum of its own but requires conditions not often found within the biomedical paradigm. If this model of care remains the only source of hope for those with a life-threatening illness, ‘the pain of dying’ may not be addressed.     

测量大学生的心理问题:GHQ-20的结构及其信度和效度

本研究对GHQ-20进行了结构分析并检验其对中国大学生被试的可信性和有效性。被试取自北京市两所高校的一至三年级大学生,共1142人。包括两个分研究,研究一(354名被试 )和研究二(788名被试)。研究一的因素分析提取出三个因子,它们被分别命名为三个不同的分量表:GHQ-自我肯定,GHQ-忧郁和GHQ-焦虑。两个研究结果均发现,GHQ-20的内部一致性满意,其三个分量表的内部一致性或者满意或者可接受。效度检验结果表明,GHQ-20及三个分量表均具有良好效度。基于上述结果,GHQ-20可以作为测量中国大学生心理问题的一个较为满意的工具,其分量表亦可作为测量中国大学生不同心理问题的较满意或至少是可用工具。     

A meta-analysis of studies on psychological preparation of children facing medical procedures

Abstract

The results of a meta-analysis of 75 controlled intervention studies between 1953 and 1985 concerning psychological preparation of children facing medical procedures are analyzed. Both the subject matter and methodological characteristics of the studies were subjected to multiple coding procedures. 125 controlled comparisons were carried out in the 75 studies. and 916 individual effect sue scores were calculated. The overall effect size was found to be 0.44. The effectiveness of modeling techniques, which were wed most frequently. was below average. With regard to coping-modeling films, systematic desensitization and cognitive-behavioral packages, the effect of psychological preparation is dependent in large pan on the methodological quality of the control strategy. Very few evaluations have been made of interventions with children considered to be at risk for psychological stress. Preparation r measures can attain higher effect rue scores when they are undertaken in conjunction with major medical operations. series of treatments or children in poor health. With regard to the validity of the studies analyzed, no relationship could be found with the effect size scores. In general, the poor level of documentation of the reported research findings is criticized.     

The role of passion for work and need satisfaction in psychological adjustment to retirement

Two studies tested a model in which passion for work predicts psychological adjustment to retirement through the satisfaction of basic psychological needs. With a sample of 103 French-Canadian retirees from a variety of occupations, the first study used a retrospective cross-sectional design. The second study followed 73 French-Canadian teachers over a 6-year period and examined the relationship between passion for work, assessed when participants were still working, and psychological adjustment to retirement, measured when participants were retired. All participants completed questionnaires on demographics, passion for work, basic psychological needs and psychological adjustment to retirement. Results from structural equation modeling confirmed the hypothesized model, such that both studies confirmed the mediating role of basic psychological need satisfaction in the passion–psychological adjustment to retirement relationship. Need satisfaction significantly mediated the relationship between harmonious passion for work and psychological adjustment to retirement in Studies 1 and 2. The mediation was also confirmed between obsessive passion and psychological adjustment to retirement in Study 1, but not in Study 2. These findings suggest that passion for work matters in psychological adjustment to retirement. Being passionate about work can thus lead to positive or negative outcomes in retirement, depending on whether the passion is harmonious or obsessive, respectively.     

心理弹性如何影响员工创造力：心理安全感与创造力自我效能感的作用

摘 要 通过对350名知识型员工及其领导的配对问卷调查,探讨心理弹性对知识型员工创造力的作用机制。结果表明,心理弹性对心理安全感有显著的正向影响;心理安全感完全中介了心理弹性对创造力的影响;创造力自我效能感调节了心理安全感对创造力的正向作用;创造力自我效能感调节了心理安全感在心理弹性与创造力之间的中介作用。     

Dispositional mindfulness as a positive predictor of psychological well-being and the role of the private self-consciousness insight factor

The current study explored relationships among dispositional mindfulness, the private self-consciousness (PrSC) insight factor, and psychological well-being. Several mindfulness studies indicate that dispositional mindfulness is a positive predictor of psychological well-being. In a distinctly different area of consciousness research, Grant, Franklin, and Langford’s (2002) PrSC insight factor shows similar predictive results. Here it is hypothesized that these two seemingly independent dispositional consciousness constructs have overlapping variance and that insight can serve as a partial mediator for dispositional mindfulness when it predicts psychological well-being. Participants were 184 university students who were administered a self-report measure of dispositional mindfulness, insight, and psychological well-being. Correlational analyses revealed that mindfulness and insight were significantly and positively correlated with each other and with psychological well-being. Bootstrap regression analyses supported the model of insight as a partial mediator of the mindfulness–psychological well-being predictive relationship.     

生命意义感对大学新生日常烦心事和心理适应的影响

为验证日常烦心事对个体心理适应的作用过程,并探讨生命意义感是否在烦心事知觉与心理适应之间起调节作用。研究采用纵向追踪方式对153名大学新生进行新近生活经历问卷、压力知觉量表、生命意义感量表和心理适应的测量。结果显示压力知觉在日常烦心事与心理适应之间起完全中介作用;拥有意义在烦心事知觉与心理适应之间起调节作用,但追求意义的调节作用不显著。这说明日常烦心事会通过压力知觉影响个体心理适应,拥有意义对个体心理适应具有调节作用。