Losing a training analyst for ethical violations: A candidate's perspective

The author presents her experience as the analysand of a training analyst who was investigated and expelled for ethical violations with another patient, including sexual-boundary violations, during her analytic training. While boundary violations by training analysts are not uncommon, the particular trauma experienced by 'bystanders' such as candidates and supervisees is not discussed in the literature, nor the response of institutes to the educational problems that are generated. The author illustrates the complications for candidates that arise from the dual roles of training analyst as educator and analyst when he or she faces investigation or censure, including isolation and secrecy, which promote various splits in the candidate, analytic dyad and group, as well as loyalty conflicts. The discussion covers three phases of the author's experience as a candidate-analysand, namely the period encompassing the institute's ethics investigation, the announcement of findings to her and to the institute as a group, and the ensuing individual and group dynamics generated by her analyst's expulsion from the institute and revocation of his medical license. Theoretical perspectives are utilized to understand the group regression, including contamination and contagion fears, which occurred in the wake of the training analyst's expulsion, and the impact of these processes on the candidate, including the pressure to function as a 'container' for projections of the group. Implications and recommendations for candidates and institutes are made for dealing helpfully with trainees who are affected by the process of dealing with a training analyst's ethical violations. Short-term and longer-term outcomes of the experience are considered.     

医者不可不慈仁，病者不可猜鄙——构建和谐的医患关系

医患和谐是医学的本质要求。目前医患关系紧张是在市场经济和高科技背景下,价值选择和制度安排失当造成的。要充分利用传统文化的资源,同时适应时代要求,在价值选择和制度安排上促进医患和谐。     

制度伦理与我国社会转型期医患关系

我国社会转型期中出现的诸多医患利益冲突向人们提出了严峻挑战,亟需对其加以调节和平衡.这种调节与平衡,不能完全甚至不能主要地交由市场去运作,不能完全任凭医患双方自由地去博弈;政府必须明确并履行自己的职责,为正确调节与平衡社会转型期的医患利益创立一个全方位的合理的框架.     

垂体瘤侵袭性概念的多元化思考

垂体腺瘤是颅内常见的良性肿瘤,但却存在较高的手术不全切除率和术后复发率,因此1940年Jefferson提出侵袭性垂体腺瘤的概念,认为这部分肿瘤的生物学行为实际上是介于良性垂体腺瘤和恶性垂体癌之间,肿瘤侵袭性生长。随后各个专业的医生们从各自的角度对侵袭性进行了诠释,形成了目前多元化的概念。如解剖学的诊断,影像学的和手术学的标准,还有新近出现的分子生物学和病理学等的诊断等等。使得诊断标准众多,概念混乱,这里做一综述,以期能对侵袭性提出一个相对合理的解释。     

A coherent moral relativism

Moral relativism is an attractive position, but also one that it is difficult to formulate. In this paper, we propose an alternative way of formulating moral relativism that locates the relativity of morality in the property that makes moral claims true. Such an approach, we believe, has significant advantages over other possible ways of formulating moral relativism. We conclude by considering a few problems such a position might face.     

多重模型疗法简介

多重模型疗法(Multimodal Therapy)是由美国临床心理学家阿诺德     

CHRISTIAN REALISM AND AUGUSTINIAN (?) LIBERALISM

Augustine's ontology, ecclesiology, and soteriology have recently been mined to help Christian realists and liberals respond to the problems that pluralism and conflict create for democratic societies. The results challenge those secularists who object to the late antique prelate's “moralizing” as well as others who insist that “public reason”—not religious traditions—makes for more meaningful political conversations and for collaboration “across differences.” But the results also raise the question whether Augustine would have gone along with the realists and liberals he has inspired and outfitted.     

RELIGIOUS REASONS AND POLITICAL ARGUMENTATION

In Evangelium Vitae Pope John Paul II calls for a renewal of culture to combat the culture of death. He criticizes various aspects of a pluralistic, liberal society—a type of society that he claims is based on moral relativism and a view of democracy that becomes a substitute for moral law. He maintains that such a view trivializes moral choice. In this essay I argue that John Rawls's notion of a liberal society as an overlapping consensus of comprehensive doctrines can avoid relativism while allowing for reasonable debate among opposed positions. While Rawls maintains that comprehensive doctrines, including religions, should employ a form of public reason that is not a unique feature of any one comprehensive doctrine, I argue that this requirement is too strong. One is often justified in appealing to features of comprehensive doctrines other than one's own, features that are unique to the doctrines themselves. Such an appeal does not pretend to be neutral as public reason would seem to be. In the final section of the paper I discuss some suggestions made by the Pope regarding actions in civil society that are independent of debates about legal change and suggest some ways in which they might contribute to desired cultural transformation.     

Political and interpersonal aspects of ethics consultation

Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record.     

Having a voice and getting a hearing: An educational perspective on free speech in a plural society

This paper examines Ronald Dworkin's claim that the right to free speech does not include a right to circumstances that encourage citizens to speak nor a right to competent and sympathetic understanding on the part of listeners. Drawing on familiar arguments for the existence of other human rights, the paper challenges Dworkin's claim. Even if, however, the challenge fails and it is not possible to show that there is such a right, that is not the end of the story. It is argued that democratic societies should try to foster conditions in which citizens are encouraged to speak and are listened to sympathetically in the interests of the well-being and flourishing of the polity. The important role education has to play in this is explored.