医疗服务成本控制过程伦理范式的选择

不同伦理范式对医疗服务成本控制过程会产生不同的影响.运用经济伦理学及管理伦理学的原理和方法,结合医疗卫生服务机构的行业性质及特点,选择出现实可行的医疗服务成本控制过程的伦理范式.使医疗卫生服务机构在医疗服务成本控制过程中,从成本控制标准的确定、成本控制方法及途径的选择到成本控制结果的分析及考评等环节融入相关伦理内涵.使医疗服务成本控制更好地遵循恰当的伦理范式,更好地履行医疗卫生服务机构的宗旨和职责.     

Moral Stress in International Humanitarian Aid and Rescue Operations: A Grounded Theory Study

Humanitarian aid professionals frequently encounter situations in which one is conscious of the morally appropriate action but cannot take it because of institutional obstacles. Dilemmas like this are likely to result in a specific kind of stress reaction at the individual level, labeled as moral stress. In our study, 16 individuals working with international humanitarian aid and rescue operations participated in semistructured interviews, analyzed in accordance with a grounded theory approach. A theoretical model of ethical decision making from a moral stress perspective was developed. The practical implications of the study are discussed.     

Integrating Contextual Issues in Ethical Decision Making

Many issues in ethics arise in relation to the contexts in which psychologists work. However, most ethical decision-making models reproduce the way in which psychologists tend to approach ethics by focusing on ethical dilemmas and proposing a step-by-step response to deal with them. Although these models might be useful, their emphasis on reactive approaches and their lack of contextualization constitute significant limitations on their applicability. In this article, an approach to ethical decision making that highlights the importance of the context in developing proactive strategies to solve ethical issues is proposed. This approach is further explained through its application to medical and rural settings. The implications of these suggestions to the training in ethics are finally discussed.     

Multicultural Incompetence and Other Unethical Behaviors: Perceptions of Therapist Practices

The present study examined nonprofessionals' perceptions of culturally based and noncultural ethical violations. One hundred seventy-four undergraduates students read 12 vignettes depicting situations in which a clinician committed either a culturally based violation (e.g., sexist or ageist behavior) or a noncultural violation (e.g., breeching confidentiality or multiple relationship). Results indicated that participants were more likely to have unfavorable views of clinicians who had committed culturally based violations. In addition, results suggested that participants would be more likely to report a clinician who had committed a culturally based violation to a supervisor or ethics board.     

Unique Ethical Concerns in Clinical Trials Comparing Psychosocial and Psychopharmalogical Interventions

In recent years, there has been a particular emphasis placed on conducting randomized controlled trials (RCTs) that compare the relative efficacy of psychosocial and pharmacological interventions. This article addresses relevant ethical considerations in the conduct of these treatment trials, with a focus on RCTs with children. Ethical concerns, including therapeutic misconception, treatment preference, therapeutic equipoise, structure of treatments, and balancing risks versus benefits, are introduced through a clinical scenario and discussed as they relate to psychotherapy versus medication RCTs. In each case, suggestions are made for researchers seeking to minimize the impact of these ethical concerns on research participants.     

Professional Ethical Issues and the Development of Professional Ethical Standards in Counseling and Clinical Psychology in China

This article aims to summarize the current ethical issues in the field of clinical and counseling psychology and the process of developing professional ethical standards in China. First, through a review of the history of counseling and psychotherapy in China, general background information is provided. Important ethical issues are then discussed based on the results from several empirical studies. Finally, the process of developing the new edition of the Chinese Psychological Society Code of Ethics for Clinical and Counseling Psychology, the main contents as well as the considerations taken into account in the development of this code are presented.     

Implicit Mental Processes in Ethical Management Behavior

This article examines the relationship between implicit mental processes and ethical decisions made by managers. Based on the dual-process view in social and cognitive psychology, it is argued that social cognition (e.g., moral judgments) can rely on two different modes of information processing. On one hand, moral judgments reflect explicit, conscious, and extensive cognitive processes, which are attributed to explicit attitude. On the other hand, moral judgments may also be based on implicit, automatic, and effortless processes referring to implicit attitude. To test this thesis, a study involving 182 participants was conducted. The results support the thesis.     

Empirical Research on Ethical Issues in Pediatric Research

Although there is usually agreement about the ethical principles that should govern research on children, there may be little agreement on how those principles should be interpreted into research procedures in some instances. Empirical research on ethical issues that arise in research on children can often elucidate ways to improve on existing research practices and ways to resolve debates about best practices. Following in the success of evidence-based medicine, evidence-based ethical problem solving in human research can enable investigators to avoid such poor alternatives as doing nothing, endlessly debating, or acting on the basis of hunch or time-honored but dubious research practices. A variety of approaches to evidence-based ethical problem solving are illustrated in this article.     

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.     

A Study on School Leaders' Ethical Orientations in Taiwan

The purpose of this study is to explore the ethical orientations of Taiwan's school leaders by means of a questionnaire survey of 573 school leaders. A multidimensional ethical framework, including utilitarianism, justice, care, critique, and virtue, was used. The results demonstrate that the most frequent ethical orientation of Taiwan's school leaders is justice. Second, the ethical orientation of Taiwan's school leaders is influenced by Confucian ethics to some degree, especially in terms of virtue ethics. However, the ethical orientation of school leaders significantly varies depending on gender, age, position, years of teaching experience, and educational administration ethics training.