Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.     

Evidence-Based Psychotherapy and Counselling in the UK: Critique and Alternatives

Developments in empirically supported therapy or evidence-based practice in the UK are outlined and critically examined. Perceived advantages and disadvantages are set out, with a commentary. It is asserted that the evidence-based ethos is seriously flawed and that psychotherapy is essentially a faith-based craft, not a thoroughly researchable scientific enterprise. Some alternatives to evidence-based practice are briefly outlined, before turning to an exploration of the wider context of anthropathology in which therapy takes place and against which it must acknowledge its limitations. Broad-brush conclusions are drawn.     

传统儒家、道家哲学生态观比较

儒家、道家哲学生态观既有共同点,又存在差异。在生态存在论上,两者都是一种生成论世界观,强调人与自然万物的内在联系。不过,道家注重自然运化过程的自然性、一体性,儒家则强调自然运化的生命特征,肯定人与万物的差别;在生态价值论上,道家偏重“自然”的价值．强调自然运化的自然目的性和价值性,肯定人和万物的自然本性的价值。儒家则偏重“人文”价值。它强调人与社会的生存价值．肯定主体德性的价值;在生态实践观上,道家强调“自然无为”的实践原则,“自然无为”体现了对自然自组织、自协调智慧的信任。道家实践观体现在个人生活方式上具有消减性特征,强调慈爱利物、俭啬有度、知和不争。儒家强调发挥人的主体能动性,肯定主体对人与社会、人与自然关系的协调作用。在对农业生产实践的治理上。儒家强调顺应天时、因地制宜和“谨其时禁”。     

Genetic Counseling for Fragile X Syndrome: Updated Recommendations of the National Society of Genetic Counselors

These recommendations describe the minimum standard criteria for genetic counseling and testing of individuals and families with fragile X syndrome, as well as carriers and potential carriers of a fragile X mutation. The original guidelines (published in 2000) have been revised, replacing a stratified pre- and full mutation model of fragile X syndrome with one based on a continuum of gene effects across the full spectrum of FMR1 CGG trinucleotide repeat expansion. This document reviews the molecular genetics of fragile X syndrome, clinical phenotype (including the spectrum of premature ovarian failure and fragile X-associated tremor-ataxia syndrome), indications for genetic testing and interpretation of results, risks of transmission, family planning options, psychosocial issues, and references for professional and patient resources. These recommendations are the opinions of a multicenter working group of genetic counselors with expertise in fragile X syndrome genetic counseling, and they are based on clinical experience, review of pertinent English language articles, and reports of expert committees. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the facts and circumstances of a specific case, will always supersede these recommendations.     

情境理论的迁移观及其教育意义

支撑—活动观、社会共享认知观以及实践共同体观是当前情境理论中具有代表性的迁移观点。这些观点分别从不同的角度强调情境特性对迁移的影响,并主张在常规的学校教育中突出情境、尤其是社会文化与社会实践情境的作用。     

“Mind the gaps”: An empirical approach to engineering ethics, 1997–2001

A survey on ethical issues in engineering was administered over a five-year period to Stanford engineering students and practicing engineers. Analysis of its results strongly suggests that important disconnects exist between the education of engineering students regarding ethical issues in engineering on the one hand, and the realities of contemporary engineering practice on the other. Two noteworthy consequences of these gaps are that the views of engineering students differ substantially over what makes an issue an ethical issue, while practicing engineers exhibit significant disagreement over what is the most important non-technical aspect of being a responsible engineering professional in contemporary society. These divergences impede the recognition of ethical issues and of specific moral responsibilities of engineers in concrete professional practice. It is argued that the use of suitably refined and probing surveys of engineering students and practicing engineers about ethical issues in engineering is an important although neglected empirical approach to the study of engineering ethics. Such an approach can enhance the prevailing case study method and combat over-tidy theoretical-analytical approaches to the subject. When a train arrives at a station in the London Underground, a public announcement cautions passengers to “mind the gap”, i.e. heed the space between the station platform and the carriage while entering or exiting. An early draft of this paper was presented at the International Conference on Ethics in Engineering and Computer Science, Case Western Reserve University, Cleveland, Ohio, March 21–23, 1999.     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.     

母亲积极养育行为对儿童顺从行为的早期预测与双向作用:从婴儿到学步儿

顺从是儿童早期重要的社会化成就。传统理论关注父母控制策略对顺从的作用,但实证结果表明其解释率有限;当前理论更加关注积极养育行为在顺从发展中具有发展适宜性的作用机制。本研究采用追踪设计考察了84个家庭从儿童6个月到3岁时母亲的敏感性和鼓励自主两种积极养育行为与学步儿顺从发展的关系。结果表明:(1)1岁前母亲敏感性对学步儿2岁时的合作性顺从有正向预测作用,对2岁到3岁合作性顺从的变化没有预测作用;(2)1岁前母亲敏感性对学步儿2岁时的情境性顺从和2岁到3岁的情境性顺从的变化均有负向预测作用;(3)在2岁到3岁期间,母亲的鼓励自主与学步儿的合作性顺从水平有双向正向预测作用,但与情境性顺从不存在双向预测关系。     

The learning benefits of teaching: A retrieval practice hypothesis

Teaching educational materials to others enhances the teacher's own learning of those to‐be‐taught materials, although the underlying mechanisms remain largely unknown. Here, we show that the learning‐by‐teaching benefit is possibly a retrieval benefit. Learners (a) solved arithmetic problems (i.e., they neither taught nor retrieved; control group), (b) taught without relying on teaching notes (i.e., they had to retrieve the materials while teaching; teaching group), (c) taught with teaching notes (i.e., they did not retrieve the materials while teaching; teaching without retrieval practice [TnRP] group), or (d) retrieved (i.e., they did not teach but only practised retrieving; retrieval practice group). In a final comprehension test 1 week later, learners in the teaching group, as did those in the retrieval practice group, outperformed learners in the TnRP and control groups. Retrieval practice possibly causes the learning benefits of teaching.     

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.