论保密义务与诚信原则

尊重患者隐私,保守执业秘密,是医师的道德义务,也是法律义务,保密义务的理论基础在于诚实信用原则。为此,医疗活动中应引入体现伦理道德要求的诚信理念,从道德和法律两方面规范医师的行为,并且建立以法律规范为主的规制模式。     

Questionable research practices among Brazilian psychological researchers: Results from a replication study and an international comparison

Research on scientific integrity is growing in psychology, and questionable research practices (QRPs) have received more attention due to its harmful effect on science. By replicating the procedures of previous research, the present study aimed at describing the use of QRPs among Brazilian psychological researchers and to make an international comparison with previous studies in other countries—the US and Italy. Two hundred and thirty-two Brazilian researchers in the field of psychology answered questions related to 10 different QRPs. Brazilian researchers indicated a lower tendency to engage in two QRPs (failing to report all of a study's dependent measures; deciding whether to collect more data after looking to see whether the results were significant) when compared to their Italian and North American counterparts, but indicated a higher tendency to engage in two other QRPs (selectively reporting studies that “worked”; not reporting all of a study's conditions). Most of the sample did not admit integrity conflicts in their own research but indicated that others have integrity problems, as observed in previous studies. Those discrepancies could be attributed to contextual and systemic factors regarding different publication demands among the different nations. Further studies should focus on identifying the antecedents of QRPs.     

Translating multiple assessment techniques into an intervention selection model for classrooms

Translating current research to school-based clinical practice highlights issues not often encountered in laboratory settings. With the assistance of a consultant, teachers conducted functional analyses, brief multielement treatment comparisons, and controlled treatment evaluations under naturalistic conditions in the classroom. Teachers also provided input on treatment selection. Treatment integrity data collected throughout the study suggested that teachers implemented analyses and treatments with high integrity. The functional analysis outcomes combined with effectiveness and acceptability data led to the selection of interventions that reduced problem behavior in the classrooms for each of 3 children.     

Roles for scientific societies in promoting integrity in publication ethics

Scientific societies can have a powerful influence on the professional lives of scientists. Using this influence, they have a responsibility to make long-term commitments and investments in promoting integrity in publication, just as in other areas of research ethics. Concepts that can inform the thinking and activities of scientific societies with regard to publication ethics are: the “hidden curriculum” (the message of actions rather than formal statements), a fresh look at the components of acting with integrity, deviancy as a normally occurring phenomenon in human society, and the scientific community as an actual community. A society’s first step is to decide what values it will promote, within the framework of present-day standards of good conduct of science and given the society’s history and traditions. The society then must create educational programs that serve members across their careers. Scientific societies must take seriously the implications of the problem; set policies and standards for publication ethics for their members; educate about and enforce the standards; bring the issues before the members early and often; and maintain continuing dialogue with editors. An earlier version of this paper was presented at the AAAS-Office of Research Integrity (ORI) meeting in Washington DC on the theme: “The Role and Activities of Scientific Societies in Promoting Research Integrity” held on April 10–11, 2000.     

Patients’ health or company profits? The commercialisation of academic research

This paper is a personal account of the events associated with the author's work at the University of Toronto's Hospital for Sick Children on a drug, deferiprone, for the treatment of thalassaemia. Trials of the drug were sponsored by the Canadian Medical Research Council and a drug company which would have been able, had the trials been successful, to seek regulatory approval to market the drug. When evidence emerged that deferiprone might be inadequately effective in a substantial proportion of patients, the drug company issued legal threats when the author proposed informing her patients and the scientific community. Until protests were made by international authorities in her field of research, the hospital and university did not adequately support the author's academic freedom and responsibilities as a medical practitioner. It is argued that underlying cause of this, and of other similar cases, is the political philosophy which is driving the commercialisation of universities and bringing about the deregulation of drug approval procedures. Together these changes constitute a serious threat to the public good.     

The Moral Contours of Empathy

Morally contoured empathy is a form of reasonable partiality essential to the healthy care of dependents. It is critical as an epistemic aid in determining proper moral responsiveness; it is also, within certain richly normative roles and relationships, itself a crucial constitutive mode of moral connection. Yet the achievement of empathy is no easy feat. Patterns of incuriosity imperil connection, impeding empathic engagement; inappropriate empathic engagement, on the other hand, can result in self-effacement. Impartial moral principles and constraints offer at best meager protection against these perils, and hence serve poorly in securing morally contoured empathy. More nuanced and practical guidance should be sought in normatively substantive conceptions of our roles and relationships and their defining moral stakes. These, joined with more abstract moral tools, can facilitate rich, narratively textured interpretations of moralitys demands. While the content of our normative conceptions must be continually debated, engaging in this debate is vital to the achievement of proper empathy, and thus to effective, respectful, morally healthy care of dependents.This paper was originally presented at the conference on Reasonable Partiality at the Vrije Universiteit, Amsterdam, October 22–24, 2003. I wish to thank all those present for stimulating discussion. Special thanks go to Bert Musschenga, who organized the conference, and who has provided insightful feedback on this paper. Warm thanks as well to Brenda Almond and Bernie Rollin for lively exchanges on the issues addressed here and to Nancy Sherman for sharing with me an ongoing fascination with, and her own fantastic work on, empathy. Comments from an anonymous reviewer for the journal were challenging and helpful. Finally, I wish to express gratitude beyond normal bounds to Maggie Little both for her generosity, keen insight, and artful intervention at key points in this essays evolution and for her ground-breaking work on deontic pluralism that deeply influences the position I frame here.     

诚信结构初探

以质性研究的范式, 对中国人的诚信结构进行本土化的探索。遵循质性研究的“目的性抽样”原则, 采取强度抽样的具体策略进行取样, 选择了15名访谈对象。运用扎根理论的一般流程, 以深度访谈的方法收集资料并转换成电子文本。使用Nvivo 8.0质性分析软件对电子文本进行编码, 寻找本土的概念。初步产生292个开放式编码和关联式编码7个：“诚实、信用、信任、责任心、层次性、关联性、相互性”; 形成1个核心式编码：“诚信及其结构”。最后构建了两个理论：1)诚信由诚实、信用、信任和责任心四因素构成; 2)诚信四因素关系特点及其结构。采用原始资料检验法、专家评价法等效度评估和归类一致性指数信度评估对研究结果进行检验, 一致性程度较好, 说明有较好的效度和信度。     

Compounding Vulnerability: Pregnancy and Schizophrenia

The predominant ethical framework for addressing reproductive decisions in the maternal–fetal relationship is respect for the woman's autonomy. However, when a pregnant schizophrenic woman lacks such autonomy, healthcare providers try to both protect her and respect her preferences. By delineating etic (objective) and emic (subjective) perspectives on vulnerability, I argue that options which balance both perspectives are preferable and that acting on etic perspectives to the exclusion of emic considerations is rarely justified. In negotiating perspectives, we balance the etic commitment to protect the vulnerable patient and her fetus from harm with the emic concern to empower a decisionally incapacitated woman. Equilibrium is best achieved by nurturing interdependent relationships that empower and protect the vulnerable woman. The analysis points to the need for better social support for mentally ill patients.     

Enhancing Adherence to a Problem-Solving Model for Middle-School Pre-Referral Teams

Abstract

Performance feedback and checklists were used to improve the degree to which middle-school teams adhered to elements of systematic problem solving as described in the Instructional Consultation literature (Bartels & Mortenson, 2002; Rosenfield, 1987). Direct observations of problem-solving meetings were conducted to determine levels of adherence to a problem-solving methodology. Performance feedback was provided to each participating school psychologist after a period of no feedback and was followed by the provision of a checklist of problem-solving steps to all team members. Visual analysis of the data indicated variable improvements in systematic problem solving following presentation of feedback and checklists. Feedback and prompts, while necessary, may not be sufficient to ensure adequate adherence to problem solving.