Adolescents,Risk Behaviour and Confidentiality: When Would Australian Psychologists Breach Confidentiality to Disclose Information to Parents?

The protection of confidentiality in psychological practice is vital. However, confidentiality is not absolute and psychologists are permitted to breach confidentiality under particular circumstances. Ethical challenges surrounding confidentiality are complex with adolescent clients, as assessments often consider the risk that adolescents pose to themselves in addition to the risk posed to others. The current study documented situations in which Australian psychologists would breach adolescents' confidentiality to disclose information about risk behaviour to parents, with a focus on situations where adolescents posed a risk to themselves as opposed to other people putting adolescents at risk. A total of 264 Australian psychologists were surveyed online. They were each presented with 68 variations of a vignette about a 15‐year‐old boy who was engaged in risk behaviour and were asked whether they would breach confidentiality in each case. The vignettes covered six behavioural domains (smoking, sexual behaviour, drinking, drug use, suicide, stealing) and varied in behaviour intensity, frequency and duration. Consensus was reached about breaching confidentiality in 16% of cases (related to sexual behaviour, drug use, and suicide). Consensus was reached about not breaching confidentiality in 41% of cases (relating to smoking, sexual behaviour, drug use, suicide, and stealing). In the remaining 43% of cases, significant disagreement occurred (relating to all six behavioural domains). The findings suggest a high degree of variation in opinion about confidentiality with adolescents, emphasising the importance of transparent communication and informed consent. The findings also raise questions about how important consistency of psychological practice is across Australia.     

Ethical considerations in the management of military related concussion

Since the year 2000 over 300,000 military service members have been diagnosed with mild traumatic brain injury/concussion. Consequently, this injury has become the subject of increased awareness and study within the military healthcare environment. Although single and/or isolated concussions typically heal in a relatively rapid fashion with limited to no long-term sequelae, there is debate in the field about the impact of repeat concussion. To this end, various ethical challenges arise when managing patients with such injuries. Several papers outlining these issues with regard to athletes have been published in the sports medicine literature. However, because providers caring for military service members must make return-to-duty-decisions, practice within the military setting results in a number of unique ethical considerations. More specifically, management of service members with a history of repeat concussion and increasingly complicated recoveries, as well as the potential for premature return-to-duty are topics of concern for military health care providers. Using the American Psychological Association ethical principles and standards, the current article outlines various ethical challenges to concussion management in the military setting. The ethical principles of Beneficence and Nonmaleficence and Respect for People’s Rights and Dignity, as well as the 3 related ethical standards of Competence, Avoiding Harm, and Conflict of Interest are discussed. Policy changes are highlighted as a proximal solution to these ethical challenges.     

Limits to Confidentiality in U.S. Army Treatment Settings

A number of reports detail ethical concerns of behavioral health providers in the U.S. Military regarding limited confidentiality. This article provides a review of limits to confidentiality in behavioral health settings as outlined by U.S. Army regulations and Department of Defense directives. Specific limits are discussed under seven categories, including: medical treatment and oversight, command notification, threats to safety, public health purposes, judicial or administrative proceedings, law enforcement investigation, and specialized personnel programs. Specific attention is given to war crimes reporting, special duty, and command involvement. Lessons learned for best practice across service branches are provided as a collaborative model for resolving perceived conflict between the APA Ethics Code and military regulations.     

Indian Buddhist concepts of normative and deviant bodies: can ancient sexual mores be reconciled with modern sensibilities?

José Cabezón’s Sexuality in Classical South Asian Buddhism is the most comprehensive study to date of early Indian Buddhist notions of sexuality and gender. This article is a response to Cabezón’s work that critiques some of his ideas and raises further questions for research into this still nascent field.     

HOW SHOULD WE BEHAVE? A REVIEW OF REASONS AND PERSONS BY DEREK PARFIT

In this book Parfit attempts to develop a rational, non-religious ethics. Instead of asking, “What does God tell us to do?” he asks, “What does reason tell us to do?” Given a set of simple assumptions, he considers whether it is possible to be consistently selfish or consistently good. Analyses of personal dilemmas (problems of self-control) and moral dilemmas (problems of social cooperation) show that neither consistent selfishness nor consistent goodness is logically possible. Instead, a fine balance must be maintained between, on the one hand, our immediate versus long-term good and, on the other, our own good versus that of other people. Ultimately Parfit fails to develop a formula by which such a balance may be struck. Parfit''s analysis is consistent with behavioral analysis in its reductionistic view of the self and the parallel it draws between relations with other people and relations with oneself at other times. Parfit''s analysis is inconsistent with behaviorism in its view of the mind as internal, available to introspection, and able to cause behavior. His nonfunctional mentalism leads Parfit to inconsistencies and blocks the path to a consistent ethics. Teleological behaviorism''s view of the mind in terms of patterns of overt behavior is not hampered by these inconsistencies and may lead to a functional rather than purely rational ethics.     

INTRODUCTION: VIRTUE AND VICE

Abstract: This introduction to the collection Virtue and Vice, Moral and Epistemic addresses three main questions: (1) What is a virtue theory in ethics or epistemology? (2) What is a virtue? and (3) What is a vice? (1) It suggests that a virtue theory takes the virtues and vices of agents to be more fundamental than evaluations of acts or beliefs, and defines right acts or justified beliefs in terms of the virtues. (2) It argues that there are two important but different concepts of virtue: virtues are qualities that attain good ends, and virtues are qualities that involve good motives. (3) Accordingly, vices are qualities that either fail to attain good ends or involve bad motives. Finally, the introduction summarizes the eleven essays in the collection, which are divided into four sections: the Structure of Virtue Ethics and Virtue Epistemology; Virtue and Context; Virtue and Emotion; and Virtues and Vices.     

EXPERIENTIAL NARRATIVES OF RAPE AND TORTURE

Many Guatemalan women suffered extreme sexual violence during the latter half of the twentieth century. Learning of this violence can evoke hatred in persons who love and respect women—hatred for the men who perpetrated the violence and also for other men around the world who victimize women in this way. Hatred is a common response to a perceived evil, and it might in some cases be a fitting response, but it is important to subject one's emotions to critical moral reflection. A key task of ethics is to encourage persons to cultivate good habits of being moved. This essay analyzes the way in which two different texts manage, through the skillful presentation of experiential narratives, to help readers acknowledge the hatred they might feel, but also to think twice about the hatred to which they consent.     

产前超声检查的医学伦理学思考

产前超声检查是指在妊娠期间应用超声检查技术检测母体内胎儿是否存在先天性缺陷和遗传性疾病,随着超声技术的迅速普及和发展,产前超声检查已成为产前诊断的不可缺少的有效手段之一。本文从医学与哲学的角度对产前超声检查的必要性、安全性、局限性以及相关医学伦理问题,如知情同意权、隐私权及人工流产等进行综合分析。     

伦理与审美的双重奏——儒家之礼的人类学解析

借鉴人类学关于仪式的研究成果,探讨传统儒家之礼对个体身心进行调节和实现社会整合的内在机制。儒家对礼进行建构的过程中,通过一系列具有审美意味的象征符号,展演了内在的伦理精神和道德理念,释放了个体的感性情感和欲望;通过赋予和强化个体的社会角色与身份,礼为个体生命的价值实现提供了一个构建意义的场域,同时也完成了对于个体的社会调控。