The use of genetic test information in insurance: The argument from indistinguishability reconsidered

In the bioethical literature, discrimination in insurance on the basis of genetic risk factors detected by genetic testing has been defended and opposed on various ethical grounds. One important argument in favour of the practice is offered by those who believe that it is not possible to distinguish between genetic and non-genetic information, at least not for practical policy purposes such as insurance decision-making. According to the argument from indistinguishability, the use of genetic test information for insurance purposes should be permitted, because genetic test information is no different from non-genetic medical information in any relevant respect, therefore it would be inconsistent to prohibit the former whilst permitting the latter. This paper discusses and defends this argument and suggests a new, more tenable foundation.     

社会因素对剖宫产率的影响

近二三十年来,剖宫产率在世界范围内不断升高。究其原因,除了医学因素外,社会因素起着重要作用,从社会经济发展,社会科学文化水平、社会习俗观念、法律、医疗道德、国家计划生育政策、医学教育等多个角度分析了社会因素对剖宫产率的影响,并就如何发挥社会因素的积极作用,消除和避免其消极作用,使剖部率维持在合理的范围内进行了讨论。     

Identity and moral responsibility of healthcare organizations

In this paper the moral responsibility of a Healthcare Organization (HCO) is conceived as an inextricable aspect of the identity of the HCO. We attempt to show that by exploring this relation a more profound insight in moral responsibility can be gained. Referring to Charles Taylor we explore the meaning of the concept of identity. It consists of three interdependent dimensions: a moral, a dialogical, and a narrative one. In section two we develop some additional arguments to apply his concept of personal identity to organizations. The final section works out the relationship of three dimensions of identity to some actual issues in contemporary HCOs: the tension between care and justice, the importance of dialogues about the diversity of goods, and the relevance of becoming familiar with the life-story of the HCO. Identity of an HCO is established and developed in commitments to and identification with certain goods that are central for a HCO. However, many of these goods are interwoven with everyday practices and policies. Therefore, moral responsibility asks for articulation of goods that often stay implicit and should not be reduced to a merely procedural approach. However difficult this articulation may be, if it is not tried at all HCOs run the risk of drifting away from their very identity as healthcare institutions: to offer care to patients and to do this in accordance with demands of social justice.     

The factor structure of the Anxiety Sensitivity Index among Northern Plains Native Americans

Within our current research climate, an emphasis has been placed on examining the cross-cultural applicability of psychological tools, and exploring their utility with people of different backgrounds. Within this line of investigation lies the risk of classifying people too broadly and masking important regional, tribal, or dialectical differences. This may be particularly potent among Native Americans, given the number of distinct indigenous entities. This study examined the psychometric characteristics of the Anxiety Sensitivity Index with a tribally homogeneous sample, as compared to previous tribally-heterogeneous and majority culture findings. Results suggested that data from a homogeneous Native American sample poorly fit factor solutions reported from heterogeneous Native American and Caucasian samples, and favored a unifactorial solution. Implications for assessment with Native American peoples are discussed.     

Identity, narcissism and the emotional core

This paper describes the course of an analysis which demonstrates how borderline and narcissistic functioning can be understood in terms of a struggle with issues of identity. It shows how such functioning can come to exert a profound hold on the individual and why it seems, at times, a matter of life and death to the patient to avoid states of separation from the analyst. The paper suggests that these complex phenomena can be understood, perhaps surprisingly, in the simple terms of the nature of affect itself. The concept of the emotional core is introduced to embody and highlight that which lies beneath both Jungian and Freudian models (offering a potential bridge between the two models)--namely the psyche's essentially affective nature. It is suggested that the emotional core can serve as an organ of perception giving the individual both their primary relation to reality and an emotional attachment to others. This emotional core is understood to function in a narcissistic manner to preference experiences of sameness and in aversion to experiences of difference--a view consonant with Stern's understanding of infant development where the infant is able to distinguish self from other from the beginning of life (as Fordham also held); taking up Stern's terminology, it gives the individual a 'core' sense of being. There is, however, no stable, on-going sense of 'I' associated with this form of functioning as the individual is immersed in the latest affect to enter consciousness (as in the borderline state of mind) and consequently the individual comes to rely intensely on the other to determine their sense of being (the other becomes a self-regulating other in Stern's terms). The development of ego-functioning gives a more stable and on-going sense of 'I' to the individual, giving contact with the broader personality, allowing the individual to be less reliant on the other and orientating them to reality in a way more fitting to their overall needs. The paper describes how consciousness, which is not seen as identical with the ego, moves between the mode of functioning of the ego and that of the emotional core, i.e., shifting in and out of states where projective identification predominates. It elaborates the range of self-experience encompassing spiritual experience and states of disintegration (which are understood to have a similar structure) on one side, to ego-based experience (which can itself be defensive and rigid at times) on the other. It explores the consequences of such a view for analytic technique and relates it to the Jungian view of the self and the Freudian unconscious.     

Jung's view on myth and post-modern psychology

Post-modern psychology embodies two core themes, the social mind and the narrative self. Whereas the social-mind thesis seems diametrically opposed to Jung's position regarding human nature, the narrative-self thesis is associated with research and theorizing about personal myth and mythmaking in ways that could make contact with Jung's concerns. Jung's view is examined here with particular attention to McAdams' theory of narrative identity. It is suggested that the ostensible differences between Jung and post-modern psychology might reflect divergent interests, rather than necessarily irreconcilable worldviews.     

Demographic characteristics,social competence,and behavior problems in children with gender identity disorder: a cross-national,cross-clinic comparative analysis

This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study—the first cross-national, cross-clinic comparative analysis of children with gender identity disorder—found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.     

Crossing the Line: Case Studies of Identity Development in First-Generation College Women

In this paper we present four case studies of adult women from working class backgrounds who attended Hillside College (a pseudonym for one of the seven-sister colleges) during the early 1990s. Although research on women has led, over the past few decades, to a more complex picture of the contexts in which women develop their identities, one important context that has been underexplored is social class. Drawing on data from three lengthy interviews with each of our four participants, our purpose was to explore the identity concerns of adult women from working class backgrounds in their experience getting to and attending Hillside College, which has historically been home to the middle and upper social classes. Implications for college retention are discussed.     

Institutional conflicts in Jungian analysis

This paper explores how the institutional life of analytical psychology has been beset by its historical and continuing conflictual relationship with psychoanalysis. Stemming from a division in Jung's identity, that of the spiritual seeker and that of a mental health practitioner, the organizations of analytical psychology have repeatedly enacted that division, resulting in an unclear mission and considerable conflict. In England those conflicts have led to schisms; in America they have played out in internal conflicts within training institutes. Examples of areas of conflict are provided, along with suggestions for addressing these conflicts by recognizing them more openly.     

Revisiting Group Attachment: Ethnic and National Identity

The study of ethnic and national identity, owing to the complex interaction between individuals, groups, and systems, has not remained confined to traditional disciplinary boundaries. In particular, a branch of social-psychological research has provided insight into the most fundamental aspect of this phenomenon, subjective bonds between individuals and groups. Here, data derived from a Q-methodological study of Basque national identity are used to show that claims advanced within the existing literature appear to be restricted in their ability to explain subjective attachment to the nation; that is, they cannot adequately account for the types of bonds that emerged from the Basque case study. Primarily through Q methodology, an alternative explanation and method for uncovering the ties between individuals and groups is offered. In the place of previously vague and restrictive a priori categories of collective attachment, Q is shown to offer a means by which to explore the subjective nature of ethnic and national identification.