From case management to prevention of scientific dishonesty in Denmark

In 1992, The Danish Medical Research Council established a national committee on scientific dishonesty with the twofold task of handling cases of scientific misconduct and taking preventive initiatives. Scientific dishonesty was proven in only five cases, but in another nine cases lesser degrees of deviations from good scientific practice were found. The experiences from a total of 24 treated cases indicated that three key areas were at the basis of most of the accusations and the deviations from good practice: uncertainty about 1) authorship, about 2) rights and duties to use scientific data and about 3) agreements at the initiation of joint studies. As a consequence guidelines on good practice have been issued on these key subjects. An earlier version of this paper was presented at a symposium, Scientific Misconduct. An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.     

Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.     

Evidence-Based Psychotherapy and Counselling in the UK: Critique and Alternatives

Developments in empirically supported therapy or evidence-based practice in the UK are outlined and critically examined. Perceived advantages and disadvantages are set out, with a commentary. It is asserted that the evidence-based ethos is seriously flawed and that psychotherapy is essentially a faith-based craft, not a thoroughly researchable scientific enterprise. Some alternatives to evidence-based practice are briefly outlined, before turning to an exploration of the wider context of anthropathology in which therapy takes place and against which it must acknowledge its limitations. Broad-brush conclusions are drawn.     

传统儒家、道家哲学生态观比较

儒家、道家哲学生态观既有共同点,又存在差异。在生态存在论上,两者都是一种生成论世界观,强调人与自然万物的内在联系。不过,道家注重自然运化过程的自然性、一体性,儒家则强调自然运化的生命特征,肯定人与万物的差别;在生态价值论上,道家偏重“自然”的价值．强调自然运化的自然目的性和价值性,肯定人和万物的自然本性的价值。儒家则偏重“人文”价值。它强调人与社会的生存价值．肯定主体德性的价值;在生态实践观上,道家强调“自然无为”的实践原则,“自然无为”体现了对自然自组织、自协调智慧的信任。道家实践观体现在个人生活方式上具有消减性特征,强调慈爱利物、俭啬有度、知和不争。儒家强调发挥人的主体能动性,肯定主体对人与社会、人与自然关系的协调作用。在对农业生产实践的治理上。儒家强调顺应天时、因地制宜和“谨其时禁”。     

Genetic Counseling for Fragile X Syndrome: Updated Recommendations of the National Society of Genetic Counselors

These recommendations describe the minimum standard criteria for genetic counseling and testing of individuals and families with fragile X syndrome, as well as carriers and potential carriers of a fragile X mutation. The original guidelines (published in 2000) have been revised, replacing a stratified pre- and full mutation model of fragile X syndrome with one based on a continuum of gene effects across the full spectrum of FMR1 CGG trinucleotide repeat expansion. This document reviews the molecular genetics of fragile X syndrome, clinical phenotype (including the spectrum of premature ovarian failure and fragile X-associated tremor-ataxia syndrome), indications for genetic testing and interpretation of results, risks of transmission, family planning options, psychosocial issues, and references for professional and patient resources. These recommendations are the opinions of a multicenter working group of genetic counselors with expertise in fragile X syndrome genetic counseling, and they are based on clinical experience, review of pertinent English language articles, and reports of expert committees. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the facts and circumstances of a specific case, will always supersede these recommendations.     

情境理论的迁移观及其教育意义

支撑—活动观、社会共享认知观以及实践共同体观是当前情境理论中具有代表性的迁移观点。这些观点分别从不同的角度强调情境特性对迁移的影响,并主张在常规的学校教育中突出情境、尤其是社会文化与社会实践情境的作用。     

“Mind the gaps”: An empirical approach to engineering ethics, 1997–2001

A survey on ethical issues in engineering was administered over a five-year period to Stanford engineering students and practicing engineers. Analysis of its results strongly suggests that important disconnects exist between the education of engineering students regarding ethical issues in engineering on the one hand, and the realities of contemporary engineering practice on the other. Two noteworthy consequences of these gaps are that the views of engineering students differ substantially over what makes an issue an ethical issue, while practicing engineers exhibit significant disagreement over what is the most important non-technical aspect of being a responsible engineering professional in contemporary society. These divergences impede the recognition of ethical issues and of specific moral responsibilities of engineers in concrete professional practice. It is argued that the use of suitably refined and probing surveys of engineering students and practicing engineers about ethical issues in engineering is an important although neglected empirical approach to the study of engineering ethics. Such an approach can enhance the prevailing case study method and combat over-tidy theoretical-analytical approaches to the subject. When a train arrives at a station in the London Underground, a public announcement cautions passengers to “mind the gap”, i.e. heed the space between the station platform and the carriage while entering or exiting. An early draft of this paper was presented at the International Conference on Ethics in Engineering and Computer Science, Case Western Reserve University, Cleveland, Ohio, March 21–23, 1999.     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.