人类基因组研究与遗传学的历史教训

第１８届国际遗传学大会达成的八点共识对于人类基因组的研究及其应用具有重要意义,也指明了在遗传学及其应用问题上不同文化之间如何解决它们之间分歧的最佳途径。纳粹德国的优生实践和前苏联李森科学派的兴衰都给我们留下了不可忘记的教训。围绕中国母婴保健法的争论反映了科学、伦理和政策的交叉。我们的基因组研究和遗传服务是为了增进个人的健康和促进家庭的幸福,而不能也不应以减少残疾人口为目标。在基因组研究和遗传服务中     

Reflections of a reluctant clinical ethicist: Ethics consultation and the collapse of critical distance

The obvious appeal and growing momentum of clinical ethics in academic medical centers should not blind us to a potential danger: the collapse of critical distance. The very integration into the clinical milieu and the processes of clinical decision making, that clinical ethics claims as its greatest success, carries the seeds of a dilution of ethics' critical stance toward medicine and medical education. The purpose of this paper is to suggest how this might occur, and what potential contributions of ethics to medicine might be sacrificed as a result. Medical sociology will be used for comparison. Sociologists have found that they may function either as students and critics of established medical practices and educational philosophies, or as collaborative participants in them — but rarely both. It may be that professional ethics is most effective when it plays the role of stranger rather than insider, and is continually able to question the most basic assumptions and values of the enterprise with which it is associated. As with medical sociology, ethics and humanities must ask to what extent their desire for acceptance in the clinic requires their acceptance of the clinic: specifically, acceptance of basic assumptions about optimal ways of organizing medical education, socializing physicians-in-training, providing care, and even of defining medical ethics itself. The paper concludes by recommending that ethics reassert its strangeness in the medical milieu even as it assumes a more prominent role within the medical center.     

Clinical Ethics: Theory Or Practice?

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as the moral parameters of swift and urgent medical action in the face of limited supportive information.     

A Survey of Behavior Analysis and Behavioral Consultation Courses in School Psychology: Implications for Training School Psychologists

All 216 doctoral and specialist level school psychology training programs were mailed a seven question survey to determine how much behavioral consultation and behavior analysis course work school psychology students are offered. One hundred and twenty-eight surveys were returned, yielding a return rate of 58.26%. The results indicated that almost all programs offer didactic courses in consultation (98.79%) and behavior analysis/behavior modification (91.52%). The percentage of practicum devoted to behavioral consultation and behavior analysis/modification was considerably less (about 25% for each) than other subject areas. The results are discussed within the context of training needed to meet the needs of practitioners in the areas of behavioral consultation and behavior analysis/behavior modification.     

Boundary Violations and the Psychoanalytic Training System

A number of features of psychoanalytic training contribute to boundary violations and their sequelae. Intergenerational transmission of sexual misconduct is well-known and often operates unconsciously in the generation inheriting the legacy. Idealization and loyalty are frequent components of collusion and cover-up when a senior member of an institute is sexually involved with a patient. Other factors include the unique features of the termination of training analysis, the compartmentalization required in analytic work, and the ambivalent attitude towards autonomy and consultation.     

The relationship variable in behavioral consultation

Behavioral consultation has traditionally been conceptualized as a scientific-technological exchange process where the primary goal is the transfer of information. Perceived reluctance of school personnel to use behavioral techniques has been seen as a special problem of educational settings. However, current understanding of this reluctance has emerged from the treatment adherence literature which stresses the complexity of adherence in clinical settings. One important issue which has emerged is the critical importance of the consultation relationship. While behavioral consultation has utilized an expert model focused on client behavior and problem solving, the efficacy of a more collaborative consultation style has been recommended. Behavioral consultants need to attend to factors such as communication strategies that facilitate shared responsibility as well as to understand consultees' explanations for their problems and their treatment expectations. Such skills need to be incorporated directly into the education of behavioral consultants along with behavioral technology if the behavioral model is to be disseminated widely into educational practice.     

Resistance to Violence Prevention Interventions in Schools: Barriers and Solutions

Studies of the prevalence and impact of aggression among school-age children and adolescents document the pervasiveness of bully-victim problems and indicate clear linkages between bully-victim problems, psychological distress, and, in rare instances, lethal attacks on perceived tormentors or towards the self. Evidence is slowly accumulating to show how well-conceived school-based strategies can be effective in addressing bully-victim problems—if implemented and sustained. However, anecdotal evidence suggests many comprehensive school-based initiatives suffer from incomplete implementation, resulting in limited effectiveness. We propose that multiple factors nested within different levels of social ecological complexity (e.g., individual, school, community, and culture) limit the widespread use of schoolwide approaches to reducing bully–victim–bystander problems. Challenges arise at each of these levels and can potentially thwart efforts to produce meaningful changes in the problems of peer victimization in and around school. Drawing from efforts to implement and evaluate bully–victim–bystander programs, we describe a core set of potential barriers at each ecological level and offer possible strategies for action.     

The educational boundary1

In this contribution, the authors defi ne and discuss the educational boundary in analytic training, which they believe is an often neglected and useful concept in psychoanalytic education. The framework on which their discussion rests includes the recent attention of psychoanalysts to issues of boundaries and ethics. Their understanding of how clinical work affects the mind of the analyst educator, as well as the ways the personalities of various analysts affect their dealings with faculty peers and students, are the other cornerstones of their discussion. The authors contend that many of the institutional problems encountered in the training of analysts can be better understood when viewed through the prism of the educational boundary. They present examples which illustrate several of the ways psychoanalytic educators complicate the training experience of candidates, offer specifi c explanations as to why analysts struggle as they try to manage their educational interventions, and indicate in a discussion of potential remedies that those behaviors might be avoided if the educational boundary is in focus. They also provide an example of how the educational boundary can be more effectively managed.