论艾滋病人及艾滋病毒感染者权利与义务的平衡

《艾滋病防治条例》,对于艾滋病病毒感染者和艾滋病人的权利和义务进行了精巧的设计。本着保护人权和预防疾病的需要,对艾滋病病毒感染者和艾滋病人在医疗活动、人身权益和社会经济各方面的权利与义务都进行了很好的平衡。     

提倡“理性医疗”

“理性医疗”是对疾病进行科学、客观地综合分析,由此筛选出一个理性的处置方案的医疗过程。“理性医疗”不但有利于社会,有利于医患双方,更符合自然科学的规律,同时,对传统的伦理学观念也是一种补充与完善。“理性医疗”的实现需要医患双方的共同协作。     

Bullying among mentally‐ill patients detained in a high‐secure hospital: an exploratory study of the perceptions of staff and patients into how bullying is defined

The present study is the first to explore patient‐to‐patient bullying within a secure psychiatric hospital housing mentally‐ill patients. Its main aim was to provide an outline of the perceptions held by both patients and staff with regards to patient‐to‐patient bullying as opposed to providing an objective study of bullying. The total sample comprised 104 participants, 44 patients and 60 staff. These were sampled from wards housing male patients and wards housing female patients. All participants took part in a semi‐structured interview based on that developed by Ireland and Ireland [2003] and Ireland [2005, 2004]. One quarter of participants stated they had seen a patient being bullied in the previous week, with staff perceiving a higher extent of bullying than patients. Differences between wards were minimal. It was predicted that theft‐related bullying would be reported most frequently, that staff would identify a wider range of bullying behaviours than patients and that direct forms of aggression would be identified more readily as bullying than indirect forms. All predictions were supported. Problems in attempting to obtain a definition of bullying were also identified, with participants operating broader definitions than those found in the school‐based literature. For example, bullying was not generally considered a repeated form of aggression, the severity of the aggression or provocative behaviour of the victim were not defining features, and it was felt bullying could be accidental. In summary, the current study highlights how patient‐to‐patient bullying does occur in services housing mentally‐ill patients and that researching the behaviour may require the adoption of broader hospital‐specific definitions of bullying. Aggr. Behav. 32:1–13, 2006. © 2006 Wiley‐Liss, Inc.     

TERMINATION OF A FE/MALE TRANSSEXUAL PATIENT'S ANALYSIS: AN EXAMPLE OF GENERAL VALIDITY

The author describes the termination of an analysis, which, while relating to the particular case of a male-to-female transsexual patient, may be relevant to all analysts, particularly those whose patients need to integrate disavowed and split-off parts of themselves. The patient had undergone sex-change surgery at the age of 20. Having lived as a woman thereafter, she had asked for analysis some twenty years later. The author, who discussed the first three years of that analysis in an earlier paper, as well as her hesitation about undertaking it, considers that its termination after seven years illustrates not only the specific problems posed by transsexuals but also the general ones presented by 'heterogeneous patients'. To the best of her knowledge, this is the first published case history of a transsexual patient who has undergone surgery. In the author's view, the patient has acquired a new sense of internal unity based on a notion of sex differentiation in which mutual respect between the sexes has replaced confusion and mutual hate, and her quality of life has improved. On the general level, this termination shows how the reduction of paranoid-schizoid anxieties and the reintegration of split-off parts of the personality lead, as the depressive position is worked through, to a better toleration of internal contradictions, a new sense of cohesion of the self and a diminution of the fear of madness.     

代理行使知情同意权的有关问题探讨

代理行使知情同意权在医疗实践中广泛存在,也面临一些争议。对代理权设置的法律意义、代理行使知情同意权在医疗实践中的种类以及不同情况下的问题与对策作出分析,为这个领域的代理实践提供一些思路。     

是否告知重症患者病情的调查

本调查认为:目前多数人仍主张不将病情如实告知重症患者.我们应当清楚实情告知重症患者病情所面临的困难和患者知情同意权行使时的障碍,从而缩短社会承认医生告知的过程.     

Managing Hypochondriasis in Elderly Clients

The present paper provides a diagnostic and treatment overview of geriatric hypochondriasis. It is suggested that our current definition of hypochondriasis may be inadequate in describing the complexity of the disorder and its varied manifestations in the general population and especially in our geriatric population. Attempts by researchers to provide greater diagnostic clarity are reviewed, including the concepts of hypochondriasis as a discrete disorder (primary hypochondriasis) and hypochondriasis as part of a comorbid mix of disorders (secondary hypochondriasis). Diagnostic features of geriatric hypochondriasis are discussed, including comorbidity, prevalence, the relationship of medical illness to hypochondriacal symptomatology, and etiology. Treatment considerations which are reviewed include: the importance of respect for the defenses of the client, the importance of venting and expressions of feeling by the client, the creation of a psychological atmosphere of professional and interpersonal support, and reattribution training. It is suggested that hypochondriasis is a social “communication” and that comorbidity itself may be the key to unlocking the unspoken “messages” of hypochondriacal older adults.     

An Investigation of Genetic Counselors' Discussions of Genetic Discrimination with Cancer Risk Patients

Twenty-five genetic counselors who see familial cancer risk patients were interviewed about their definitions of genetic discrimination, perceptions of patient risk for discrimination, frequency and type of discrimination experienced by their patients, sources of information about discrimination, and what they tell patients about genetic discrimination. There was variability in participant definitions and content of discussions of genetic discrimination. Although 82% regarded risk to be low to theoretical, 40% reported possible instances of genetic discrimination, including insurance companies requiring results to cover procedures, denial of life/health insurance, social discrimination, and employment discrimination. Ninety-six percent of the sample reported always or almost always discussing genetic discrimination, and one or more of the following: insurance discrimination risks, protective legislation, no known cases positively documenting discrimination, strategies to avoid discrimination, and uncertainty of protective measures. The majority use current literature and research as information sources. Practice, policy, and research implications are discussed.     

Psychotherapists' dreams about their patients

Abstract This study examines therapists’ dreams about their patients from the Jungian and the relational perspectives. Few clinical and empirical references to this subject are to be found in the literature. In the present study 31 dreams were collected from 22 therapists. Dreams were collected using anonymous self‐report inventory. The research focused on three theoretical research questions: 1. What themes appear in the manifest content of therapists’ dreams about their patients? 2. What contributions are made by Jungian interpretation of therapists’ dreams about their patients? 3. To what extent are masochistic contents present in the manifest content of therapists’ dreams about their patients? The first question was addressed using categorical content analysis of a) themes common to different dreams and b) pre‐determined themes for all dreams. The third research question was addressed using Beck's (1967) ‘Masochistic Dream’ measure. Results: Among the themes common to different dreams were: therapist‐patient role reversal; therapist and/or patient attends and remains in meeting, departs/doesn’t depart; cancellation of therapy session; sexuality between therapist and patient; aggression; presence vs. absence; non‐verbal relationship and communication; time; driving vs. stopping. With regard to pre‐determined themes it was found that in 20 of the 31 dreams, the therapist had a negative experience and was characterized as vulnerable. Likewise it was found that 26 out of 31 dreams took place in either a) a street, a road, a route, a corridor; b) en route to somewhere; c) a therapy room and/or building; d) a house. With regard to the contribution of Jungian interpretations of the dreams it was found that 17 of the dreams had diagnostic and prognostic elements, 4 of which were initial dreams, 9 of them were compensatory dreams and in 14 it was found that the patient represents the shadow of the therapist. With regard to the third question it was found that 18 of the 31 dreams met Beck's (1967) criteria for masochistic dreams. The theoretical discussion examines the findings from a Jungian perspective, with an emphasis on also understanding the dream in terms of its expression of relational aspects of the therapist‐patient relationship. The findings affirm the presence of the ‘wounded healer’ archetypes in therapists’ dreams about their patients. The results of the study indicate that therapists’ dreams about their patients can be a valuable tool for deepening understanding of the therapeutic relationship and process.