社区护理病房中长期慢性病患者的照料服务机制——基于质性研究的方法

现有社区护理病房照料服务存在不能充分满足患者的深层需求、生活质量不佳的问题。访谈材料显示出由于照料者缺乏对“善终”概念的认知,患者、家属以及医护人员的三方关系中,患者处于权力的弱势地位,主体之间在讨论死亡相关问题上存在严重的脱节。患者的意愿从表达、传递、实施等环节中都存在阻碍,患者“善终”的需求无法实现。“以患者为中心”的照料理念应在现有照料服务中加以推广,通过提升社区照料质量来满足医学关系、家庭关系和患者自身利益的既定政策目标。

     

Ronald Dworkin on Abortion and Assisted Suicide

In the first part of this article, I raisequestions about Dworkin's theory of theintrinsic value of life and about the adequacyof his proposal to understand abortion in termsof different ways of valuing life. In thesecond part of the article, I consider hisargument in ``The Philosophers' Brief on AssistedSuicide', which claims that the distinctionbetween killing and letting die is morallyirrelevant, the distinction between intendingand foreseeing death can be morally relevantbut is not always so. I argue that thekilling/letting die distinction can be relevantin the context of assisted suicide, but alsoshow when it is not. Then I consider why theintention/foresight distinction can be morallyirrelevant and conclude by presenting analternative argument for physician-assistedsuicide.     

Claudia Card's Concept of Social Death: A New Way of Looking at Genocide

Scholarship in the multidisciplinary field of genocide studies often emphasizes body counts and the number of biological deaths as a way of measuring and comparing the severity and scope of individual genocides. The prevalence of this way of framing genocide is problematic insofar it risks marginalizing the voices and experiences of victims who may not succumb to biological death but nevertheless suffer the loss of family members and other loved ones, and suffer the destruction of relationships, as well as the foundational institutions that give rise to and sustain those relationships. The concept of social death, which Claudia Card offers as the central evil of genocide, marks a radical shift in conceptualizing genocide and provides space for recovering the marginalized voices of many who suffer the evils of genocide but do not suffer biological death. Here her concept of social death is explored, defended, and criticized.     

“AFTER THE EVENT”: FREUD'S UNCANNY AND THE ANXIETY OF ORIGINS

This essay aims to revise Freud's theory of the uncanny by rereading his own essay of that name along with the key material Freud drew on in formulating his theory: E. T. A. Hoffmann's short story “The Sandman” (1816a) and Ernst Jentsch's essay “On the Psychology of the Uncanny” (1906a). While arguing, initially, both that Jentsch's work is fundamentally misconstrued by Freud and that it offers a better account of what happens in Hoffmann's story, the essay moves beyond Jentsch's account to offer a more philosophically oriented theory of the uncanny, one more in line with Freud's ideas in Beyond the Pleasure Principle (1920a).     

Neurophysiological marker of inhibition distinguishes language groups on a non-linguistic executive function test

Successful interaction with the environment depends on flexible behaviors which require shifting attention, inhibiting primed responses, ignoring distracting information, and withholding motor responses. These abilities, termed executive function (EF), are believed to be mediated by inhibitory processes in the frontal lobes. Superior performance on EF tests (i.e., faster reaction times (RT), and fewer errors) has been shown in bilinguals compared to monolingual speakers. However, findings are inconsistent, and no study has directly linked this bilingual advantage to frontal lobe inhibitory processes. To clarify this uncertainty, we concomitantly tested neural inhibitory processes and behavioral responses on an EF test in bilinguals and monolinguals. Specifically, we compared English monolinguals (N = 15) to Spanish/English bilinguals (N = 13) on event-related brain potentials (ERP) during a non-linguistic, auditory Go/NoGo task, a task linked to non-motor, cognitive inhibition in monolinguals. Participants responded with a button press on trials in which target tone-pairs (Go trials) were presented and withheld their responses on non-target trials (NoGo trials). Results revealed significantly greater inhibition (i.e., greater mean N2 amplitude) in bilinguals compared to monolinguals during NoGo trials even though both groups performed the task equally well (i.e., withheld a motor response). On Go trials where participants pressed a response button, neither ERPs nor RT distinguished the groups. Additionally, scores on a second language proficiency test (i.e., English in our bilingual group) were positively correlated with N2 amplitude. These findings are the first to directly link this bilingual advantage to a neural correlate of inhibition and to reveal that inhibition in bilinguals is moderated by second language proficiency. Results are discussed in the context of plasticity, and we propose that evaluating bilinguals at varying levels of second-language proficiency may serve as a model of human neuroplasticity.     

ERNEST BECKER'S PSYCHOLOGY OF RELIGION FORTY YEARS ON: A VIEW FROM SOCIAL COGNITIVE PSYCHOLOGY

This article distinguishes between three projects in Ernest Becker's (1924–1974) later work: his psychology of “religion,” his psychology of religion, and his psychology of Religion (with a capital R). The first is an analysis of culture and civilization as immortality projects, means by which to deny death. The second, which overlaps with the first, is a characterization of religion‐as‐practiced (e.g., by adherents of the world religions) as a particularly effective immortality project vis‐à‐vis death anxiety. The third is less social scientific and more theological; Becker argues for a view of God that is in the tradition of Søren Kierkegaard and Paul Tillich (and, arguably, Pseudo‐Dionysius, Augustine, and Thomas Aquinas). Focusing on the second of these projects—as much has already been written on the first, and little can be said about the third—this article evaluates Becker's claims about religion‐as‐practiced in light of recent developments in social cognitive psychology.     

存在主义视角下医护人员的死亡焦虑及其应对策略

从存在主义视角出发,探讨医护人员存在的死亡焦虑。通过剖析医护人员的特殊工作场域,揭示死亡焦虑在医护群体中呈现的特异性,即死亡焦虑的高水平及"存在性"特点,并借由分析存在主义心理治疗中所阐释的死亡焦虑的特点及应对方式,如内隐性、直面死亡、觉醒体验以及波动影响等理论,提出对医护人员开展死亡教育、唤起觉醒体验以及有效利用波动影响等应对死亡焦虑的策略,这对于当下从事临床一线的医护人员具有重要意义。     

信息保持、短时存贮与执行控制的脑模型

工作记忆的脑机制是认知神经科学研究的重要问题。研究者在分析大量脑成像研究数据的基础上,创建了许多解释工作记忆神经基础的模型。Smith和Jonides发展了工作记忆成分结构模型和贮存与执行加工分离模型。Postle和D’Esposito建构了工作记忆相对表征混合模型,D’Esposito, Postle和Rypma阐述了工作记忆加工阶段动态模型。Fletcher和Henson提出工作记忆额叶分区整合理论。该文通过对上述模型或理论的评价,总结了工作记忆脑成像研究中存在的问题,展望了该研究领域的发展趋势。     

脑机增强：公平问题及其反思

脑机接口增强性应用引起了人们的广泛热议。相比以治疗为目的的应用,当脑机接口用于增强健全人的身体和心理等功能时,所带来的问题可能更多、更复杂,容易带来公平上的问题和挑战。面对这些问题和挑战,需要辩证地分析,客观、理性地看待。从根本上讲,导致这些不公平不在技术本身。因此,需要深刻反思脑机增强公平问题产生根源的同时,也需要从两方面予以应对,一是重视脑机增强的公平风险,二是明确脑机增强的使用范围,避免滥用。     

厌恶情绪与自杀行为的关系

自杀导致人类死亡的人数与日俱增,然而自杀的心理机制却并不清楚。最近研究发现,厌恶情绪是导致自杀的主要情绪因素,个体因为自身厌恶而走向自杀。厌恶情绪是一种对自己和他人排泄物等反感的基本情绪,促进个体远离毒性和疾病,从而产生“免疫行为”。许多心理问题来自于对周围人或事物的厌恶,有自杀行为的个体对自身极其厌恶,说明他们的厌恶情绪出现了问题。如同躯体免疫攻击自身一样,自身厌恶是自杀意念的关键因素,早年创伤是其根源,生活压力和精神疾病也参与厌恶诱发自杀意念。厌恶诱发自杀意念的神经基础与HPA轴和五羟色胺系统有关。未来研究可利用神经影像和电生理等神经科学技术,检验自杀行为的神经机制,探讨厌恶情绪影响自杀行为的心理和神经机制。