Autonomy,Reciprocity, and Responsibility: Darwall and Levinas on the Second Person

Abstract

Stephen Darwall’s The Second‐Person Standpoint converges with Emmanuel Levinas’s concern about the role of the second‐person relationship in ethics. This paper contrasts their methodologies (regressive analysis of presuppositions versus phenomenology) to explain Darwall’s narrower view of ethical experience in terms of expressed reactive attitudes. It delineates Darwall’s overall justificatory strategy and the centrality of autonomy and reciprocity within it, in contrast to Levinas’s emphasis on the experience of responsibility. Asymmetrical responsibility plays a more foundational role as a critical counterpoint to ‘mean‐spirited’ reciprocity than Darwall’s laudable distinction between accountability and revenge, and responsibility even founds this distinction. The experience of being summoned to asymmetrical responsibility amplifies the meaning of ‘authority’, which is a presupposition for Darwall. Finally, asymmetrical responsibility helps develop decentred reasoning, invites risk beyond the boundaries of reciprocity at moments when autonomy appears endangered, reconciles respect and care at the experiential level, and presses to extend the scope of moral obligation.     

Circles of Solicitude and Concern

Abstract

Heidegger distinguishes between concern for things and solicitude for other Dasein. As Dasein is already being‐in‐the‐world and being‐with from the start, there is no need to define what another Dasein is to recognize it. In this paper it is argued that Dasein is thrown into circles of care, where the distinction between solicitude and concern is given. Although this undermines any attempts to regard a comatose patient as non‐Dasein, it raises questions about Dasein’s relations with animals. It is suggested that Dasein’s relations with animals could be captured by inserting another circle, for which the German word versorgen might be suitable.     

新生儿重症监护病房患儿家属心理状况分析

探讨新生儿重症监护病房（NICU）住院患儿家属的心理状况及影响因素。采用焦虑自评量表（SAS）及自行设计的调查问卷对190名NICU住院患儿家属进行调查。结果显示患儿家属表现出不同程度的焦虑,与全国常模（29．78±0．46）相比,其焦虑情绪标准分49．54±1．07,高于常模组（P〈O．05）。影响因素主要包括文化水平、家庭人均收入及患儿病情严重程度等。患儿父母关注的主要问题包括：病情严重程度、预后、医护人员解释病情满意度及病房探视制度。笔者认为医护人员应加强与患儿家属的有效沟通,满足其心理需求,提高医疗护理质量,促进医患关系和谐。     

构建高质量的外科医学教育体系

医学教育是贯穿医疗职业生涯全过程的行为,是伴随医学进步和发展的重要工程.医学教育的质量直接影响医疗的质量和医学人才的素质,尤其是外科学领域,是以有创性的手段、方法治疗疾病.医生的职业素养、医疗水平均取决于医学教育的结果.医疗质量不能简单地用医生的学历衡量,学历教育是载体,其中应充实培养能力的教育项目、内容,以适应未来就职、就业的社会需求.医疗质量、医疗水平对医院而言是生命线,是生产力.同时,医生的教育及教育的质量是医疗质量的基础与保障.随着医学的飞速发展,医疗技术的日新月异,医学模式的改变,构建新的医疗环境下的医学教育体系,显得更为重要.     

Center-Based Care for Young Children: Examining Predictors of Quality

The authors collected information from caregivers, trained observers, and parents to investigate quality elements in child-care programs designed for young children in center-based settings. Participants were 75 parents of children aged 15 to 36 months and their caregivers from 13 child-care centers in a southeastern state. Observers collected indicators of program quality and process and structural quality indicators, including adult-child ratio, group size, use of planned activities, use of child-designated space, housekeeping activities, and caregiver-child interactions. Participants responded to questions regarding their child-rearing beliefs, social support networks, perceived stress levels, and demographic characteristics. The best predictors of higher quality care and sensitive caregiver-child interaction in centers were specialized caregiver training, higher adult-child ratios, use of planned activities, and less perceived stress by caregivers. Implications of these findings are discussed.     

Being ordinary in extraordinary places: Reflective practice of the total situation in a total institution

This paper examines a ‘Foulkesian type’ Balint group for psychiatry trainees set in a high secure forensic hospital. Within a Balint group, group processes and dynamics are not examined. Deviation from this format is construed as resistance, and destructively getting in the way of the primary task.

This paper reports on a case‐based reflective practice group operating on a more Foulkesian group analytic model and argues that the revised principles of method proposed here – paying attention to context; group processes; and creating an atmosphere where group curative factors are in play – can help trainees to sustain an emotional reservoir for their patients. Further, these principles do not get in the way of the primary task but can add to an understanding of the individual transference and counter‐transference issues, and can place these in context within the organization and society. This is particularly important in total institutions such as forensic units.

Clinical material from this group is used to support this claim.     

Some thoughts and responses to The Francis Report

This response to the report by lawyer Robert Francis into the failure of National Health Service (NHS) care in Mid-Staffordshire is fairly positive about its conclusions but points out that without consideration of personal, psychosocial factors in care, on the ward, in the institution things are unlikely to improve, the report leaves much unconsidered. Francis emphasises that patient care is at the very centre of the NHS, this is obvious but so often forgotten. He comments that the unhelpful blame culture still exists. Missing from Francis’ analysis is a psychological perspective – the systemic factors he mentions are administrative not relational. This response is an attempt to redress the balance in thinking about the improvement of care for patients and of the working lives of staff.     

Organizational schism: Looking after a psychiatric service

What is opposed to psychoanalysis is not psychiatry but psychiatrists. (Freud, 1916–1917, p. 254)