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。     

Self-Disclosure as an Approach to Teaching Ethical Decision-Making

This article presents arguments for and against weight loss counseling in feminist therapy. Conflicts between feminist therapy and weight loss counseling are explored and the implications of counseling and not counseling on women's empowerment are considered. Although each case requires an individual ethical decision, the author, a feminist therapist who has done weight loss counseling in the past, concludes that the answer to the title question should, in general, be "no."     

Ethical principles and cultural integrity in health care delivery: Asian ethnocultural perspectives in genetic services

The tradition of Western thought is not always ubiquitous when working within the context of different ethnocultural populations, particularly that of Asian culture, and often poses ethical quandaries for health care professionals engaged in genetic services. For example, understanding the Asian ethnocultural perspective of patient autonomy, informed consent, and nondirective counseling from the Western perspective may be inappropriate and compromise cultural integrity and the delivery of effective genetic services because: (1) A distinction exists between the role of Asian (collective) autonomy vs. Western (individual) autonomy in the decision-making process. (2) The medical model is complementary to Asian expectations and respect of authority and may result in an uninformed consent to genetic professional's recommendations. (3) Misinterpretations of the normative decision-making process, misconceptions of normalcy, and the limits of tolerance of nondirective counseling may result in less effective treatment and compliance. Therefore, we suggest that acknowledging the impact of ethnicity and culture on ethical principles as applied in genetic services is essential in the assessment and delivery of ethically and culturally appropriate health care.     

Ethical principles in the counseling of gay and lesbian adolescents: issues of autonomy, competence, and confidentiality

Ethical dilemmas in counseling gay and lesbian adolescents are analyzed according to underlying ethical principles. Developmental issues and their relevance to therapy are emphasized. Conflicts among client autonomy, claims of paternalism, and limits of confidentiality are examined. Competence to enter therapy for issues of sexual identity is assessed. The author concludes that adolescents are generally competent to explore issues of sexual identity.     

Ethical Issues in Consultation,Associate Professor and Director

Consulting relationships differ from traditional counseling and psychotherapeutic relationships in several fundamental ways. These differences require special consideration in evaluating ethical questions and conflicts, identifying ethical parameters within any given situation, and using existing ethical guidelines in determining appropriate courses of action. Currently, formal guidelines specific to the practice of consultation are not available, and existing codes of ethics for the helping professions provide only limited guidance for consultation practice. Consequently, consultants bear a heavy personal responsibility for the consequences of their professional decisions and actions. In this article the author reviews several important ethical issues relevant to consultation and examines their implications for consultation practice.     

Ethical Implications in Cross-Cultural Counseling and Training

The nonspecificity of the ethical guidelines forces counselors to develop personal philosophies in regard to serving culturally unique clients. The resulting variability in the quality and availability of services threatens the growth and dilutes the integrity of the counseling profession. The worldview of the counselor is discussed as it affects client welfare, self-determination, and cultural autonomy in the counseling alliance. Ethical issues surrounding the development and implementation of cross-cultural training programs are reviewed and discussed.     

Forging the Link Between Multicultural Competence and Ethical Counseling Practice: A Historical Perspective

Recognition of multicultural competence as an essential component of ethical counseling practice is a growing trend. This article presents a historical perspective of salient events that have contributed to forging a link between multicultural competence and ethical behavior. Multicultural counseling is traced from its beginnings to its emergence at a position of prominence in the profession, along with the development of ethical guidelines over time. This time line depicts the infusion of multicultural considerations into ethical standards and provides a perspective for examining the current status of multicultural competence as an ethical mandate. Implications for the counseling profession are offered.     

A Systems Approach to Ethical Problems

Codes of professional ethics and cases designed to teach ethical decision making are written for individual professionals and ignore the systems level of analysis. They typically employ a lineal view of causality and overvalue placement of blame as a component of ethical problem solving. This article takes a systems approach to ethical problems and identifies aspects of systems that promote or impede ethical decision making. Psychological abuse of children is used as an example of a problem requiring a coordinated, systemic response to ethical issues such as autonomy, privacy, and confidentiality.     

诊疗最优化原则的伦理学探析

讨论了诊疗最优化原则的伦理学意义:它充分体现了医学的宗旨、医学职业道德理想和对患者的无私关爱,有利于纠正医疗卫生行业的时弊,昭示着医疗卫生改革发展的方向.针对实践中遇到的阻力和困惑,作者提出了促进最优化原则实施的五点建议.     

Critical Race Theory as a Decisional Framework for the Ethical Counseling of African American Clients

The authors introduce critical race theory as a decisional framework for ethical counseling, with a focus on racial disparities when working particularly with African American clients. The authors provide a fictional case example that explains how this framework can be implemented when conducting cross‐cultural counseling with African American clients. Implications for counselors are provided.     

“Family Matters”: A Conceptual Framework for Genetic Testing in Children

Genetic testing in minor children presents a complex ethical and social problem. Current guidelines state that genetic testing of children is recommended only under circumstances where a clear medical or psychosocial benefit to the child can be demonstrated. Because of the difficulty in determining a psychosocial benefit, the discussion about genetic testing of minors ultimately tends to focus on who has the right to make the decision and whose right to autonomy is jeopardized, the parent's or the child's, when there is no identified medical benefit. Historically, a western bioethics paradigm, Principlism, has been used to guide genetic counseling sessions and genetic-testing guidelines for minors. This bioethics paradigm is guided by the principles: respect for autonomy, beneficence, nonmaleficence, and justice. Genetic testing in children, when viewed through a traditional bioethics filter is limited by its focus on the individual because children are not only individuals, they are also integral parts of a larger social context, that of their family. Because this bioethics paradigm places a strong emphasis on individual autonomy, the family's beliefs and values and the parents' concern for their children may be overshadowed by the medical community's attempt to preserve the child's "right" to an autonomous decision about genetic testing. The purpose of this paper is to present a theoretical and ethics-based conceptual framework that may be useful in the development of genetic counseling interventions.     

Ethical Issues in Gerocounseling

Recently, there has been a tremendous increase in the attention paid to counseling older adults and the importance of maintaining sound ethical practices in professional counseling. Unfortunately, to date there has been little movement to combine the two areas and examine the unique ethical issues faced in gerocounseling practice. To address this void, the authors enumerate some ethical dilemmas they have encountered in gerocounseling, examine the American Association for Counseling and Development (formerly American Personnel and Guidance Association) Ethical Standards (1981) that are pertinent, and suggest options for handling the conflicts raised.     

Counseling Minors: Ethical and Legal Issues

This article discusses the ethical and legal dilemmas facing counselors who work with minors in the school system. From an ethical perspective, minors should be able to expect confidentiality; however, parents and guardians have certain legal rights that limit the rights of minors. The author uses a hypothetical case to address these concerns and offers intervention strategies used for empowering minor clients in counseling.     

Ethical considerations and training recommendations for philosophical counseling

Philosophical counseling is a diverse and burgeoning type of mental health service delivery. Despite competing approaches to theory and practice, the field has largely strayed from an ethical critique of its methodology and counselor training requirements. This article outlines several ethical considerations and training recommendations that are proposed to bolster the quality and effectiveness of philosophical practice. As philosophical counseling gains increasing recognition in North America, recently established national organizations in philosophical practice may profit from revisiting their interim codes for professional conduct. Proposed training suggestions for counselor preparation my further assist institutions and board-regulated agencies in establishing competent and acceptable standards of client care.     

Moral Orientation as a Component of Ethical Decision Making

Morals are foundational to professional and ethical counseling practice. Moral orientation may play an integral role in ethical decision making. The authors review the literature regarding moral orientation and discuss the connection to ethical decision making. Implications for counselor preparation and practice are addressed.     

Accidental communities: race, emergency medicine, and the problem of polyheme

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a "community" within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between "autonomy" and "community." The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. Part II examines a clinical trial for the blood substitute PolyHeme (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of "community." The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment.     

Spirituality: Implications for Professional School Counselors' Ethical Practice

The separation between church and state (e.g., public education) is contentious. Furthermore, schools and many professional school counselors (PSCs) may choose to disregard and/or discount spirituality. This article (a) presents the importance of spirituality in counseling, (b) explores legal statutes and ethical standards relating to spirituality as a component of multiculturalism and professional school counseling, and (c) offers steps and strategies to support the ethical practice of PSCs. A case example and implications are discussed.     

The Relationship Between a Counselor's Ethical Orientation and the Stress Experienced in Ethical Dilemmas

The interaction of a counselor's ethical orientation, the ethical dilemmas within the counseling profession, and the stress experienced in resolving ethical dilemmas is examined in this research. A significant relationship was found between a societal orientation of ethical reasoning and the perception of stress associated with ethical dilemmas. The demographic variables of setting and gender also were significantly related to the stress associated with making ethical choices. Implications of the findings and future research on the relationship between ethical orientation and the stress involved in the ethical dilemmas of counseling are discussed.