“临床路径”服务模式对于推进合理用药的伦理价值

药品是治病救人的物质基础,但要真正达到健康的目的,合理用药才是关键。从医学伦理学的视角来看采取临床路径服务模式推进临床合理用药,体现着“人本主义”的伦理原则,有利于患者“知情同意”原则的实现,有利于降低不合理的医药费用,有利于监测治疗效果,减少药物不良反应。     

道德推脱对员工道德决策的影响：德行领导的调节作用

运用问卷调查的方法,以819名员工为研究被试,探讨了德行领导在道德推脱影响道德决策过程中的调节作用。采用层次回归分析的方法研究发现：德行领导对道德推脱与道德识别、道德判断之间的关系具有调节作用;但德行领导不会对道德推脱与道德意图之间的关系产生调节作用,而会对道德意图产生显著的直接影响。     

Applied Participatory Ethics: Bridging the Social Justice Chasm Between Counselor and Client

The authors introduce an applied participatory ethics paradigm consistent with the contemporary focus on social justice in the practice of counseling, emphasizing participation of all rightful parties, including the client, in ethical decision‐making processes. The paradigm is an adaptation and expansion of the work of Prilleltensky, Rossiter, and Walsh‐Bowers ( 1996 ) and rests on their conceptualization of restrictive and participatory orientations. The origins of the model's added elements in 4 areas of rehabilitation and counseling literature (i.e., ethical knowledge and practices, the therapeutic alliance or relationship, client involvement, and client empowerment) are described. Finally, interrelationships between the different phases and elements of the model are discussed.     

Do as I Do: The Effect of Teachers’ Ethical Leadership on Business Students’ Academic Citizenship Behaviors

We studied the impact of teachers’ ethical leadership on students’ moral identity and academic citizenship behaviors. Data from 256 student–teacher matching dyads were collected from one of the top 5 Pakistani business schools. Confirmatory factor analysis was used to ensure factorial validity of the measures that were employed, and the hypothesized relationships were tested using structural regression models that utilized structural equation modeling in AMOS with 5,000 bootstrap samples. Based on social learning theory, the results supported the hypothesis that teachers’ ethical leadership had significant direct and indirect positive effects (i.e., through the students’ moral identity) on the students’ academic citizenship behaviors that were directed toward other students and the school. This study contributes to existing literature on ethical leadership and organizational citizenship behavior by highlighting useful implications of these organization-based constructs in an academic context.     

负责任创新理论在生物医学伦理治理中的应用及启示

“负责任创新”是目前全球公认的理想发展愿景,近年来成为生物医学伦理治理的重要理论,基于Web of Science核心数据库,运用VOSviewer软件,通过对生物医学伦理治理的文献分析,发现“负责任创新”理论被广泛运用于基础医学、临床治疗、全球医疗卫生系统等诸多生物医疗领域;在不同治理情景中界定出创新、价值和评价三类责任主体,政府责任在具体实践中起到重要作用;在案例实践中完善了四维度框架中的伦理审查方式,为更好地将该理论运用到我国生物医学伦理治理中提供借鉴意义。

     

Erikson's General and Adult Developmental Revisions of Freudian Thought: “Outward,Forward, Upward”

In this paper I explore Erik Erikson's revisions of Freudian thought and reasons for his conceptual departure. I show Erikson as the second stage psychoanalytic theorist who shifted thought upward in consciousness, outward to the social world, and forward throughout the complete life span. I explore Erikson's dispute of Freud's reductionism and predeterminism, and illustrate Erikson's movement afield of a model of mental illness, fragmentation, and negation. I explore Erikson's view that the social world is both inside and outside the psyche, rather than solely external to the person as Freud had held. Addressed is Erikson's conversion of Freud's notions of adult morality to a developmental view of the adult as a potentially moral–ethical person, and Erikson's revision of Freud's concepts of the potentially rational adult to a view of the adult with rational and emotional attributes. These words are Erikson's (1975, p. 39) terms for his theoretical focus. Erikson said that he had felt compelled to alter Freudian views, for the second stage psychoanalytic thought in which he participated required a focus on healthy development instead of attention to deviations from health. Such thought also required analysis of the importance of consciousness and of engagement in the social world, as well as a theory of adult development that extends throughout the mature years to chart the person's psychosocial growth and the development of principled behavior. To Erikson, Freud's views were reductionistic due, in part, to their placement within Newtonian and Darwinian thought. Further, Freud's thought was based on the assumption of an invariably moral person, and of the human who would eventually rise above the irrational powers that he found to govern the self. In this paper, I take up these points. I look to Erikson's revisions of Freudian thought, emphasizing the ways in which he made us think differently about psychological life and about adults in their ongoing development. This synthesis adheres to the points Erikson himself made about his departure from Freud, thoughts that appear in Erikson's (1987b) Harvard notes and marginalia, in his audiotapes, and in portions of his published writings.     

Teaching ethical analysis in environmental management decisions: A process-oriented approach

The general public and environmental policy makers often perceive management actions of environmental managers as “science,” when such actions are, in fact, value judgments about when to intervene in natural processes. The choice of action requires ethical as well as scientific analysis because managers must choose a normative outcome to direct their intervention. I examine a management case study involving prescribed burning of sagebrush (Artemisia tridentata) communities in south-central Montana (USA) to illustrate how to teach students to ethically evaluate a management action by precisely identifying: 1) the proposed management action, 2) the deficiency of the system to be remedied by the action, 3) the stakeholders affected by the action, and 4) the category and type of values affirmed in the management action. Through such analysis, students are taught to recognize implicit and explicit value judgments associated with management actions, identify stakeholders to whom managers have legitimate ethical obligations, and practice a general method of ethical analysis applicable to many forms of environmental management. An earlier version of this paper was presented at the Fourteenth Annual Meeting, Association for Practical and Professional Ethics, February 24–27, 2005.     

Common-Sense Virtue Ethics and Moral Luck

Moral luck poses a problem for out conception of responsibility because it highlights a tension between morality and lack of control. Michael Slote’s common-sense virtue ethics claims to avoid this problem. However there are a number of objections to this claim. Firstly, it is not clear that Slote fully appreciates the problem posed by moral luck. Secondly, Slote’s move from the moral to the ethical is problematic. Thirdly it is not clear why we should want to abandon judgements of moral blame in favour of judgements of ethical deplorability. Finally this paper defends an alternative solution to the problem of moral luck, which focuses on judgements of probability, but which has been rejected by Slote.     

Establishing ethics in an organization by using principles

Laws, codes, and rules are essential for any community, public or private, to operate in an orderly and productive fashion. Without laws and codes, anarchy and chaos abound and the purpose and role of the organization is lost. However, danger is significant, and damage serious and far-reaching when individuals or organizations become so focused on rules, laws, and specifications that basic principles are ignored. This paper discusses the purpose of laws, rules, and codes, to help understand basic principles. With such an understanding an increase in the level of ethical and moral behavior can be obtained without imposing detailed rules. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Ethical Issues in Cancer Genetics: 1) Whose Information Is It?

This article presents and discusses four clinical cases that exemplify the complexity of ethical dilemmas concerning the provider's obligation to disclose or withhold genetic information from patients. Case 1: What is the responsibility of the cancer genetics provider to ensure that a positive test results is shared with distant relatives? Case 2: To ensure that results go to at-risk relatives, do we have the right to ignore the wishes of the designated next-of-kin? Case 3: Do we have the right to reveal a familial BRCA1 mutation to a patient's relative, who is at 50% risk? Case 4: Do we have an obligation to reveal that a patient is not a blood relative and therefore, not at risk to have inherited a familial mutation? These cases form the basis for discussing the provider's dual obligations to keeping patient confidentiality and informing patients and families about risk (i.e. duty to warn). We also provide a summary of consensus points and additional discussion questions for each case.