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221.
Labon M 《Science and engineering ethics》2006,12(1):185-188
This paper comments on Polish legal guarantees for diseased persons with reference to the hazards that accompany experimental
treatment. While acknowledging that participation in a clinical research program provides patients with additional opportunities
for advanced treatment, the paper also points out that systems for monitoring patients participating in experimental treatment
require improvement.
This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic
and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005. 相似文献
222.
Henry SG 《Theoretical medicine and bioethics》2006,27(3):187-213
The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.An erratum to this article can be found at 相似文献
223.
Puente AE 《Neuropsychology review》2005,15(4):197-207
The practice and study of clinical neuropsychology is considered an empirical enterprise. However, such an approach may result
in missing the more humanistic or phenomenological side of the experience of brain dysfunction. This addresses a personal
journey rather than a professional and scientific one. In doing so, the limits of the discipline and the suffering and value
of the experience of the illness are presented.
An earlier version of this article was presented as the Presidential Address for the Division 40 (Clinical Neuropsychology)
of the American Psychological Association in August of 2003. 相似文献
224.
Biller-Andorno N 《Science and engineering ethics》2004,10(1):43-50
The current debate in medical ethics on placebos focuses mainly on their use in health research. Whereas this is certainly
an important topic the discussion tends to overlook another longstanding but nevertheless highly relevant question, namely
if and how the placebo effect should be employed in clinical practice. This paper describes the way the placebo effect is
perceived in modern medicine and offers some historical reflections on how these perceptions have developed; discusses elements
of a definition of the placebo effect; and suggests some conditions under which making use of the therapeutic potential of
the placebo effect can be ethically acceptable, if not warranted.
An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research
Today,” held in Warsaw, Poland on 12–13 April, 2003.
Nikola Biller-Andorno, MD, PhD, is Assistant Professor in the Dept. of Medical Ethics and History of Medicine, University
of Goettingen, Germany. Dr. Biller-Andorno also serves as an ethicist for the World Health Organization (WHO). This paper
does not necessarily reflect the views of the World Health Organization. 相似文献
225.
Edward P. Sheridan 《Journal of clinical psychology in medical settings》1999,6(2):211-218
A promising opportunity exists to continue psychology's move beyond its traditional mental health emphasis into a general health care discipline. Abundant empirical evidence supports that psychologists treat a wide array of physical disorders as well as psychological components of medical problems. The immediate issues confronting psychology's full emergence into the health care world are discussed and recommendations are offered to assure the success of this initiative.
Office of the Senior Vice President and Provost 相似文献
226.
Barbara Wharton 《The Journal of analytical psychology》1998,43(2):205-223
The author addresses the difficulties inherent in reporting clinical material. These fall into two main categories, the ethical problem of upholding confidentiality, and the technical problems which include the definition of analytical data, and the numerous ways in which truth can be distorted in the analytic context. It is advocated that consent be obtained from patients before publishing their material. It is also suggested that clinical reports should contain enough detail of the analytic interaction, including the analyst's thoughts and feelings, to convey the analytic process, and to enable the listener/reader to consider the evidence for himself and to draw his own conclusions. It is concluded that an analyst's anxiety about exposing a patient might obscure an anxiety about exposing himself. 相似文献
227.
Margarete Vollrath Svenn Torgersen Randolf Alns 《Scandinavian journal of psychology》1998,39(1):15-24
The aim of the study was to examine prospectively whether coping mediated the relation between Neuroticism and change in different clinical mental syndromes. Assessments were conducted with 154 former psychiatric outpatients six and seven years after their initial contact with an outpatient clinic. Dispositional coping mediated the relation between Neuroticism and change in four of the nine clinical scales of the Millon Clinical Multiaxial Inventory (MCMI-II) (Millon, 1987). High Neuroticism led to coping strategies of disengagement and the venting of emotions and to a lack of problem-focused coping, which in turn translated into a relative increase on the MCMI-II scales. The mediator model of coping was found to apply to the MCMI-II scales "somatoform disorder’, ‘dysthymia’, ‘alcohol dependence’ and ‘thought disorder’. Results are discussed under the perspective of an integration of the positions of the transactional theory of stress and personality psychology. . 相似文献
228.
Jeffrey J. Haugaard 《Journal of child and family studies》1998,7(3):377-392
Increased concern about the influence of pregnant women's substance use on fetal health has prompted a variety of actions, including calls for legal interventions against some pregnant women with chronic substance abuse problems. In this paper I examine the legal and social science arguments used to support and oppose these interventions. Several assumptions about the behaviors of pregnant women that are used to support the arguments are described. The types of social science research that could inform the ongoing debate about interventions with pregnant women are explored. 相似文献
229.
Up to now neither the question, whether all theoretical medical knowledge can at least be described as scientific, nor the one how exactly access to the existing scientific and theoretical medical knowledge during clinical problem-solving is made, has been sufficiently answered. Scientific theories play an important role in controlling clinical practice and improving the quality of clinical care in modern medicine on the one hand, and making it vindicable on the other. Therefore, the vagueness of unexplicit interrelations between medicine's stock of knowledge and medical practice appears as a gap in the theoretical concept of modern medicine which can be described as Hiatus theoreticus in the anatomy of medicine. A central intention of the paper is to analyze the role of philosophy of medicine for the clarification of the theoretical basis of medical practice. Clinical relevance and normativity in the sense of modern theory of science are suggested as criteria to establish a differentiation between philosophy of medicine as a primary medical discipline and the application of general philosophy in medicine. 相似文献
230.
Jurrit Bergsma 《Theoretical medicine and bioethics》1994,15(4):361-376
Recent research supports the hypothesis that more active engagement of the patient in occurring illnesses improves quality of life and probably even life expectancy.In this study experience and theoretical knowledge from psychotherapy is transplanted to clinical practice in order to improve the physician's engagement in the patient-disease relationship. By defining severe and long-term illnesses as a psychotrauma, the transfer of the psychotherapeutical model leads to the creation of a new triangular relationship: patient-illness-doctor. Practical examples are used as illustrations for the conceptual differences between psychotherapy and clinical medicine. Options for dialogue show the difference between adaptation (learning to live with) and adjustment (active coping strategies and controlling). The hypothesis is that a better dialogue will reduce illness-related stress, giving the patient better and more effective access to personal psychic and physical support systems. 相似文献