Cognitive-behavioural interventions in a patient with an anxiety disorder related to diabetes

This study extends the data on the efficacy of cognitive interventions for patients with chronic medical problems and describes the case of a 37-year-old woman with an anxiety disorder related to diabetes. The effects on panic frequency, use of safety behaviour and related beliefs were investigated after the introduction of two main cognitive-behavioral interventions. The results are consistent with predictions from the cognitive model of panic. This case demonstrates the usefulness of directly challenging the 'meaning' of the feared situation in order to produce clinically significant improvements in the management of physical disease.     

评中国思想家对道德与法律之关系的探索

儒家礼法合一论的真义是对“善法”的追求 ,对“恶法”的否定。因为善法体现了儒家的道德精神 ,反映了一种人道主义的价值取向 ,而恶法则是反人道的。墨家强调“法不仁不可以为法” ,其真实的意思是不道德的法律不是真正的法律 ,与儒家的礼法合一论有相似之处。法家主张“法虽不善犹善于无法” ,从而否定了法律的道德基础和价值根据。今天 ,我们在立法中贯彻道德的法律化取向需要谨慎从事 :一是注意把那些体现时代精神、合乎社会潮流的道德予以法律化 ,不能把落伍于时代的道德法律化 ;二是切忌把过高的道德义务转化为法律义务。必须认识到 ,应该法律化的道德只是“底线道德” ,而高层次的道德是不宜法律化的 ,否则就是强人所难。     

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。     

European values in bioethics: why,what, and how to be used?

Are there distinctly European values in bioethics, and if there are, what are they? Some Continental philosophers have argued that the principles of dignity, precaution, and solidarity reflect the European ethos better than the liberal concepts of autonomy, harm, and justice. These principles, so the argument goes, elevate prudence over hedonism, communality over individualism, and moral sense over pragmatism. Contrary to what their proponents often believe, however, dignity, precaution, and solidarity can be interpreted in many ways, and it is not clear which reading would, or should, be favored by popular opinion. It is therefore dangerous to think that any one understanding of "European", or any other, values could be legitimately imposed on those who have different ideas about morality in health care and related fields. Bioethical principles should be employed to promote discussion, not to suppress it.     

The Ethics of Type 1 Diabetes Prediction and Prevention Research

There are approximately one million cases oftype 1 diabetes in the US, and the incidenceis increasing worldwide. Given that two-thirdsof cases present in childhood, it is criticalthat prediction and prevention research involvechildren. In this article, I examine whethercurrent research methodologies conform to theethical guidelines enumerated by the NationalCommission for the Protection of Human Subjectsof Biomedical and Behavioral Research, andadopted into the federal regulations thatprotect research subjects. I then offer twopolicy recommendations to help researchersdesign studies that conform to these ethicalrequirements.     

Argumentation and Evidence

This essay explores the role of informal logicand its application in the context of currentdebates regarding evidence-based medicine. This aim is achieved through a discussion ofthe goals and objectives of evidence-basedmedicine and a review of the criticisms raisedagainst evidence-based medicine. Thecontributions to informal logic by StephenToulmin and Douglas Walton are explicated andtheir relevance for evidence-based medicine isdiscussed in relation to a common clinicalscenario: hypertension management. This essayconcludes with a discussion on the relationshipbetween clinical reasoning, rationality, andevidence. It is argued that informal logic hasthe virtue of bringing explicitness to the roleof evidence in clinical reasoning, and bringssensitivity to understanding the role ofdialogical context in the need for evidence inclinical decision making.     

The Morality System with and without God

What I set out to do is to cast some doubt on the thesis that, in Bernard Williams's words, any appeal to God in morality either adds nothing at all, or it adds the wrong sort of thing. A first conclusion is that a morality of real, inescapable and (sometimes) for the agent costly obligations, while being at home in a theistic metaphysic, does not sit easily with metaphysical, atheistic naturalism. The second conclusion is that Christine Korsgaard's impressive ethical project which is neutral towards theism and atheism fails in giving a satisfying account of such obligations. My final claim is that a theistic account in terms of a strong divine command theory might succeed where non- and atheistic accounts seem to founder.     

The ‘Medical Body’ As Philosophy's Arena

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: (i) as a salutary reminder of the extent to which thereality even of the human body is constructed; and (ii) as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy's traditional (and traditionally abstract) questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate.     

Living with Contradictions: The Taken-for-Granted in Israeli Political Discourse

Two apparently contradictory ideas are closely linked in Israeli political discourse: Israel is powerful and independent and Israel is vulnerable and dependent. This study used content analysis and focus groups, as well as existing survey data analyzed by others, to explore how this paradox has been reflected in newspapers and conversations during six different time periods from 1948 to 1996. The goal was not to explain the paradox but to examine its consequences for Israeli perceptions of U.S. policy in the Middle East—and, in the process, to explore Israeli self-images. The nature of U.S. strategic interests was originally treated as problematic and in need of political discussion, but in the past 25 years these interests have become taken for granted. Surprisingly, even after the end of the Cold War, a critical discourse moment in which a reexamination of U.S. interests in the Middle East would seem inevitable, the U.S. role remains taken for granted and largely unexamined. The strong/vulnerable paradox explains this absence of discussion: Examining U.S. interests too closely upsets the delicate balance that keeps the sense of vulnerability in check.     

Toward a New Concept of Global Morality

The human community faces today the most serious challenges ever to have confronted the planet in the areas of health, environment, and security. Science and technology are essential for responding to these challenges. More is needed, however, because science is not equipped to deal adequately with the values dimensions and the political issues that accompany the challenges. For an adequate response, there must be cooperative effort by scientists and statespersons, informed for moral leadership by the religious wisdom that is available. The religious communities can provide this spiritual dimension, thereby fulfilling their traditional role, but it will require their coming to terms with the character of the scientific and technological base of contemporary culture. The paper lays the conceptual groundwork for understanding these issues.