The “Ought-Is” Problem: An Implementation Science Framework for Translating Ethical Norms Into Practice

Abstract

We argue that once a normative claim is developed, there is an imperative to effect changes based on this norm. As such, ethicists should adopt an “implementation mindset” when formulating norms, and collaborate with others who have the expertise needed to implement policies and practices. To guide this translation of norms into practice, we propose a framework that incorporates implementation science into ethics. Implementation science is a discipline dedicated to supporting the sustained enactment of interventions. We further argue that implementation principles should be integrated into the development of specific normative claims as well as the enactment of these norms. Ethicists formulating a specific norm should consider whether that norm can feasibly be enacted because the resultant specific norm will directly affect the types of interventions subsequently developed. To inform this argument, we will describe the fundamental principles of implementation science, using informed consent to research participation as an illustration.     

Examining Relationships Between Physicians and Their Patients: A Psychoanalytic Model

This is a study of a group of physicians' reflections about their communication with patients. Using an applied psychoanalytic framework for self-inquiry in groups, the authors summarize their findings and provide a model for others to use. They describe their method of conducting and studying three physician groups. The authors identify six essential dynamics within groups and illustrate the dynamics with examples of physician reflections. They summarize further their observations about the composition, dominant themes, and phases of development for each group. The intent of the self-inquiry groups—to clarify physicians' habits and thought patterns about patients—is upheld in the report's conclusion, in which the authors report participants' evaluation of their learning experience. Recommendations are made for analysts to apply the model in work with general physicians.     

中国经济伦理学研究中的若干问题——兼论经济伦理学的学科性质

中国经济伦理学的研究虽然成果显著,但还存在着需要进一步澄清的三个相互关联的重要问题,即“理论性”与“应用性”问题、“伦理学”与“经济学”问题、以及“理想性”与“现实性”问题。这三个问题的正确理解有助于关于经济伦理学学科性质的合理界定,也有助于中国经济伦理学研究的继续深入。     

遗忘的药物——呋喃妥因在尿路感染中的应用

随着抗生素的不断发明和应用,目前临床中已经发生很多耐药菌的尿路感染,极大地增加了医疗负担。呋喃妥因虽已使用50多年,但很少耐药菌株,费用低廉,临床仍有广阔的应用前景。本文复习呋喃妥因的相关指南推荐、作用机制、体内代谢、临床抗菌特点和副作用等,希望引起对这个被临床逐渐遗忘的药物重视。