The early history of lay analysis,especially in Vienna,Berlin and London: Aspects of an unfolding controversy (1906‐24)1,2

Before the First World War, it had been taken for granted that psychoanalysis was carried out by doctors. The IPA, however, also included non‐physicians. This corresponded to Freud's view that psychoanalysis was a basic science (psychology of the unconscious) with manifold fields of application in medicine as well as in the humanities. It was for the latter application that Freud specifically recruited a number of researchers, e.g. Rank. After 1918, helped by a general boom in psychotherapy, these people too began to work as therapists. This led to a debate about lay analysis within the ‘Secret Committee’ that has so far received little attention and is one focus of this paper. Abraham had only allowed doctors to become members of his group. Similarly the Berlin Policlinic was established as a place for the postgraduate training of doctors. On the other hand, Freud (together with Rank) continued to maintain his broader view of psychoanalysis. In 1920/21, he already wished that analysts would not become a subgroup within the medical profession, but a profession of their own, defined by their special training. The big problem of the late 1920s, that different attitudes to the lay question threatened the autonomy of local or national groups and the integration of the IPA, also became visible at that early time in a conflict between London (Jones) and Vienna/Berlin.     

Ethics of field research: Do journals set the standard?

To determine whether ethical issues concerned with field research are addressed in the peer-review process, instructions to authors and reviewers of 141 (mainly natural science) journals were examined to ascertain how often ethical issues were mentioned. Only one-third (n=41) of responding journals addressed ethical issues in their instructions to authors or reviewers. When ethical issues were considered, most of the journals limited their concerns to ethical issues associated with animal and general human experimentation. No journal mentioned ethical practices in working with indigenous peoples or on traditional lands. Only two journals addressed the ethics of research in sensitive areas in their instructions to authors, only one in its instructions to reviewers. We suggest that peer-reviewed journals respond to an emerging issue in ecological research by formally incorporating research ethics into their instructions to authors and reviewers. Furthermore, these instructions should address the ethical issues associated with field research and in working with indigenous peoples and on traditional lands.     

加强医学伦理审查体系建设的医学人道主义反思

好的伦理治理需要好的伦理审查、好的伦理组织和好的伦理委员。伦理审查是对涉及人的研究的科学性与伦理性进行审查,其中存在技术话语与伦理话语两套体系,分别代表着医学人道主义的两个方面。其中后者居于主导地位,二者应当统一于伦理话语。伦理审查的认知基础、价值观念、问题分析、问题处理和评价反思均应体现人道主义的要求。风险和受益的计算同样如此。伦理审查活动是人道主义的实践过程,需要体现科技发展与维护人的尊严融合的伦理治理理念;形成科技创新与人文关怀融合的伦理审查机制;建立科学精神与人文精神融合的伦理教育体系。

     

论医院伦理委员会的建设

医院伦理委员会作为维护医患关系之间权益公平的中介力量,把医学技术与人文关怀结合起来,在医患之间构筑起一种新型的关系,让患者得到细致入微的人本关怀。目前,我国在依法推进、规范医学伦理审查方面仍是空白,所以应尽快对医院伦理委员会的工作性质及作用做出明确的规定,以保障医疗工作更加安全。     

Stakeholder Opinions and Ethical Perspectives Support Complete Disclosure of Incidental Findings in MRI Research

How far does a researcher’s responsibility extend when an incidental finding is identified? Balancing pertinent ethical principles such as beneficence, respect for persons, and duty to rescue is not always straightforward, particularly in neuroimaging research where empirical data that might help guide decision making are lacking. We conducted a systematic survey of perceptions and preferences of 396 investigators, research participants, and Institutional Review Board members at our institution. Using the partial entrustment model as described by Richardson, we argue that our data supports universal reading by a neuroradiologist of all research MRI scans for incidental findings and providing full disclosure to all participants.     

医学期刊载文的伦理学审查情况分析——以《中国学校卫生》为例

通过查阅《中国学校卫生》近5年纸质期刊,查看文章“对象与方法”中有无“知情同意”或“获得伦理学审查”等信息。结果显示,获得伦理学审查或知情同意的文章884篇,各年份获得伦理学审查、知情同意及总体检出率差异均有统计学意义(χ²=366.29,43.58,219.83,P<0.01)。各年份获得伦理学审查、知情同意的心理学研究及总体检出率(χ²=107.55,16.80,58.66);获得伦理学审查的干预性研究及总体检出率(χ²=44.40,18.46);获得伦理学审查的涉及生物样本的研究检出率(χ²=17.47),差异均有统计学意义(P<0.01)。今后应不断加强引导和教育,加强科研人员及编辑的伦理意识。     

研究者发起的临床研究项目伦理审查现实矛盾与对策思考

通过对我国研究者发起的临床研究项目伦理审查现状进行分析,从研究者发起的临床研究项目伦理审查执行力不强、监管不到位,临床研究设计伦理观念不足以及研究者伦理意识薄弱三个方面入手进行问题剖析。结合相关法规与工作实践,提出了强化卫生行政部门监管职能,加强研究者发起的临床研究项目主管部门监管,包括加强医疗机构伦理监管体系建设、完善伦理委员会标准操作规程、加强研究者伦理培训以及加强伦理宣传普及四个方面对策,以期提高研究者发起的临床研究项目伦理审查质量,促进其更加科学规范开展。     

ART临床应用伦理调控的特点

解决ART应用中引发的伦理问题、难题的基本对策之一是加强医学伦理调控 ,推进医学伦理精神对医学过程的渗入 ,ART医疗机构伦理委员会是医学伦理调控体制化的表现和实现这种调控的重要途径 ,它以特定的主体形式和审查、咨询、教育、督查、建议等活动方式 ,形成对调控对象某种监督的客观效果。     

Pluralism and ethical dialogue in Christian healthcare institutions: the view of Caritas Catholica Flanders.

In this article, the place and the nature of an ethical dialogue that develops within Christian healthcare institutions in Flanders, Belgium is examined. More specifically, the question is asked how Christian healthcare institutions should position themselves ethically in a context of a pluralistic society. The profile developed by Caritas Catholica Flanders must take seriously not only the external pluralistic context of our society and the internal pluralistic worldviews by personnel/employees and patients, but also the inherent inspiration of a Christian healthcare institution. This article concludes with ten general orientations that could shape the ethical dialogue from a Christian inspiration in a pluralistic context.     

MAX EITINGON AND THE STRUGGLE TO ESTABLISH AN INTERNATIONAL STANDARD FOR PSYCHOANALYTIC TRAINING (1925‐1929)2

This paper deals with the first years of the IPA's International Training Commission (ITC). The author begins by outlining the Berlin model of training, including some less familiar aspects, and he describes how the foundation of the ITC in 1925 was designed for promoting the general establishment of institutionalised training according to this pioneer model. In relation to lay analysis, he highlights the issue of central power versus local autonomy with regard to admission policy. The latter part of the narrative is devoted to an ITC subcommittee (‘Eitingon Committee’), appointed in 1927, which tried to formulate training guidelines for the whole IPA, again with a clear Berlin profile. The discussion of the draft of these guidelines among all branch societies (with Freud himself participating) revealed some interesting disagreements, while the ‘closed’ nature of the system, as opposed to what later came to be called an ‘open system’, was hardly challenged. The initiative failed, apparently through American opposition, but essentially because of the developmental gap between local societies as to the institution of specialised psychoanalytic training. The paper is based largely on unpublished material and also provides some information about Max Eitingon, the least well known of the early leaders of psychoanalysis.