Medical Decision-Making: An Argument for Narrative and Metaphor

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different reasons supporting thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual's prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts'the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed.     

Social genomics: genomic inventions in society. The nature of what's to come

This paper identifies several kinds of intellectual mistakes that proponents of genetic engineering make, in defending their views and characterizing the views of their opponents. Results from research in the social sciences and humanities illuminate the nature of these mistakes. The mistakes themselves play a role in allowing proponents to gather support from other protagonists in the social controversies involving science and technology. Understanding the controversies requires understanding that innovations are components of complex and ill-structured social problems; the "right answer" does not follow from scientific or technological breakthroughs. If the problems are identified correctly, issues of non-economic or non-market values and political and individual rights will need to be addressed.     

The Definition of Moral Dilemmas: A Logical Problem

This paper concerns one of the undecided disputes of modern moral philosophy: the possibility of moral dilemmas. Whereas proponents of the possibility of moral dilemmas often appeal to moral experience, many opponents refer to ethical theory and deontic logic. My aim in this paper is to clarify some of the tension between moral experience and ethical theory with respect to moral dilemmas. In Part One I try to show that a number of logical arguments against the possibility of moral dilemmas, though apparently very different, turn out to be basically the same, as they are all based on the following concept of ought: if A ought to be done, doing B is impermissible and doing A itself is permissible. In Part Two I present an overview of several definitions of moral dilemmas that have been given by proponents of moral dilemmas: definitions that define moral dilemmas in terms of oughts and definitions that define them in terms of reasons. I conclude that, while reason is to weak, ought is too strong a concept to define moral dilemmas with. In this way, the arguments from Part One create a logical problem for proponents of the possibility of moral dilemmas to define moral dilemmas.     

The Use of Communication Technology in Private Practice: Ethical Implications and Boundary Dilemmas in Therapy

This study investigates the use of communication technology (CT) by therapists in private practice. CT has exploded in the last decade and therapists have begun to implement this technology in their work. It is important to understand better the types of technology therapists are using and how they decide which devices are most useful for clinical practice. Additionally, the availability of the therapist has long been debated and CT provides media to make therapists readily available. Results show that therapists have boundary concerns and ethical dilemmas regarding CT and often feel unprepared to handle inappropriate out-of-session contacts when they occur.     

构建病人自主择医的现代医学伦理观

“病人选择医生”这一重大改革举措可以得到病人自主择医权和改革实践的有力辩护与支持,同时,为使其形成有序合理格局,并进入可持续发展的正常轨道,也亟需以解决现实重大问题为基础,着力的构建病人自主择医权的现代医学伦理观。这个医学伦理观应由现代的伦理理念框架1管理伦理框架、程序伦理框架构筑成主体框架。     

Mentoring: Some ethical considerations

To counter confusion about the term ‘mentor’, and address concerns about the scarcity of mentoring, I argue for an “honorific” definition, according to which a mentor is virtuous like a saint or hero. Given the unbounded commitment of mentors, mentoring relationships must be voluntary. In contrast, the role of advisor can be specified, mandated, and monitored. I argue that departments and research groups have a moral responsibility to devise a system of roles and structures to meet graduate students’ and postdoctoral fellows’ needs for information and advice. An earlier version of this paper was presented at a conference sponsored by the National Science Foundation on Mentoring and Research Values: Students as Vital Human Resources, Chicago, March 1995.     

Moral Emotions

Emotions can be the subject of moral judgments; they can also constitute the basis for moral judgments. The apparent circularity which arises if we accept both of these claims is the central topic of this paper: how can emotions be both judge and party in the moral court? The answer I offer regards all emotions as potentially relevant to ethics, rather than singling out a privileged set of moral emotions. It relies on taking a moderate position both on the question of the naturalness of emotions and on that of their objectivity as revealers of value: emotions are neither simply natural nor socially constructed, and they apprehend objective values, but those values are multi‐dimensional and relative to human realities. The “axiological” position I defend jettisons the usual foundations for ethical judgments, and grounds these judgments instead on a rationally informed reflective equilibrium of comprehensive emotional attitudes, tempered with a dose of irony.     

儒学的一种缺弱:私德与公德

In a society dominated by Confucian ethics, a spirit of Confucian public morality can be seen in the Confucian debate over publicness and privateness, but it is usually activated in circumstances of large ethical crisis. Confucian theory mainly uses ethical relationships to create self and social identities, causing problems of identification in the public life and hindering the expression of moral feelings and actions, thus revealing a weakness in public morality. This is a space that Confucianism has not yet been able to cover, and also where it has room for growth. Translated by Huang Deyuan from Wen Shi Zhe 文史哲 (Journal of Literature, History and Philosophy), 2006, (1): 30–36     

On Being Lutheran In A Religiously Plural World

Abstract : For those of us who are self‐consciously Lutheran, the reality of contemporary religious pluralism engenders important theological questions. The thesis of this essay is that “being Lutheran” within the context of contemporary religious pluralism requires the creation of “Lutheran identity” that is pluralistic in structure, while simultaneously avoiding either theological exclusivism or theological inclusivism. The implications of this thesis are that (1) dialogue with the religious traditions of the world is of primary importance for thinking Lutherans, and (2) the church's witness and mission needs to be reconfigured in light of the practice of interreligious dialogue.     

The analyst's countertransference when supervising: friend or foe?

This paper explores transference and countertransference dynamics in the supervisory relationship and their impact on the task of supervision. The development of analytic theory in relation to supervision is described and the value-and ambiguity-of the concepts of 'mirroring', 'parallel process' and 'reflective process' are discussed. The impact of organizational dynamics on the supervisory relationship is investigated in relation to four main unconscious forces: a) organizational defences, b) power and authority, c) accountability and responsibility, d) ethical concerns. Clinical situations which illustrate these issues are described and explored and used as a basis for examining the role of the supervisor's countertransference in supervision. The different framework of practice in supervision, as opposed to analysis, is described in terms of its focus, the supervisor's ways of responding and the dynamic process, and the concept of refracted countertransference is introduced and explained.