Philip Roth'sPatrimony: Narrative and ethics in a case study

I assess the ethical content of Philip Roth's account of his father's final years with, and death from, a tumor. I apply this to criticisms of the nature and content of case reports in medicine. I also draw some implications about modernism, postmodernism and narrative understandings.A version of the first two sections of this paper was presented at the annual meeting of the Society for Health and Human Values November 6, 1993, Washington, D.C.     

Method and methodology in medical ethics: Inaugurating another new section

This essay announces the inauguration of a section ofTheoretical Medicine and invites submissions on the topic “Method and Methodology in Medical Ethics.” It offers some sketches of plausible meanings of “method” and of “methodology” and their relationships as these might apply to work in biomedical ethics. It suggests a broad range of issues, dilemmas or conflicts that may be addressed for help via method and/or methodology.     

Effects of counsellor interpretations and client reactance on social influence and the working alliance

These two studies investigated the main and interaction effects of client reactance and counsellor interpretation discrepancy and style on counsellor social influence and the working alliance. Undergraduate students who were divided into high and low reactant pups listened to low, moderate, or high discrepancy interpretations given by counsellors who used a tentative or absolute interpretation. Contrary to the hypotheses, results showed only one interaction effect for reactance, interpretation discrepancy, and interpretation style. Low reactant participants rated the working alliance higher with tentative interpretations while high reactant participants rated it higher with absolute. High reactant participants consistently tended to perceive the counsellor less positively than low reactant participants. There were unexpected gender differences, suggesting that females saw the counselling more positively in the low discrepancy condition while males did in the moderate. The results were not supportive of an interaction among reactance, discrepancy, and style, but are in line with macro-results in the counselling and psychotherapy literature indicating the primary importance of client variables.     

Confidentiality in the military

This article presents and analyzes options military physicians face regarding whether or not to respect gay servicepersons' confidentiality. This situation is considered to be generic to others that involve similar conflicts. Dilemmas arising before and after the emergence of HIV-related diseases are discussed. Recommendations regarding psychiatrists' ethical obligations when conducting forensic exams are compared with military physicians' obligations to respect servicepersons' confidentiality. It is suggested that military psychiatrists should violate servicepersons' confidentiality under some circumstances, but generally should warn them in advance that they will do so. Possible exceptions exist when warning servicepersons would increase the likelihood that justice would be violated or substantial harm would occur.     

Toward a reconstruction of medical morality

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.     

临床伦理学的未来方向

1　既往史序言本文是描述临床伦理学领域系列文章中的最后一篇。我们在本文中预测临床伦理学若干可能的方向。我们选定为今后 2 0年作些推测———这是一个大致上相等于美国现代生命医学伦理学运动整个历史的时期。在以往 2 0年中 ,生命医学伦理学是跟生物学与医学的革命性发展同步的。其结果是 ,生命医学伦理学在这个时期比它在整个既往历史中变化得更为深刻。今日 ,生命医学伦理学不仅使伦理学家们高度感兴趣 ,而且使我们社会全体都高度感兴趣 ,包括卫生界、公众、法院、媒体及政策制订者。在一个 2 5 0 0年中甚少变化 ,几乎只把它眼光限…     

Anxiety Sensitivity and Negative Interpretation Biases: Their Shared and Unique Associations with Anxiety Symptoms

Anxiety sensitivity (AS) is a psychological risk factor for anxiety disorders. Negative interpretation biases are a maladaptive form of information-processing also associated with anxiety disorders. The present study explored whether AS and negative interpretation biases make independent contributions to variance in panic and generalized anxiety symptoms and whether particular interpretation bias domains (e.g., of ambiguous arousal sensations) have specific associations with panic and/or generalized anxiety symptoms. Eighty-nine female undergraduates (44 low AS; 45 high AS) completed measures of AS, interpretation biases, and panic and generalized anxiety symptoms. Findings showed that AS and negative interpretation biases both significantly added to the prediction of anxiety symptoms. Negative interpretations of ambiguous arousal sensations were uniquely associated with panic symptoms, while negative interpretations of ambiguous general and social events were uniquely associated with generalized anxiety symptoms. Findings support the conceptual validity of AS and negative interpretation biases and their unique and shared contributions to anxiety symptoms.