Hermeneutics of Clinical Practice: The Question of Textuality

In this article I scrutinize the question whetherclinical medicine, in order to be considered ahermeneutical enterprise, must be thought of as areading of different texts. Three differentproposals for a definition of the concept of text inmedicine, suggested by other hermeneuticians, arediscussed. All three proposals are shown to beunsatisfying in various ways. Instead of attempting tofind a fourth definition of the concept of textsuitable to a hermeneutics of medicine, I then try toshow that the assumption that one needs to operatewith the concept of text in order to develop ahermeneutics of medicine is false. Clinicalinterpretation can be shown to essentially consist ina dialogical hermeneutics, the pattern of which can befound in the philosophy of Hans-Georg Gadamer. Thiskind of hermeneutics is not a methodology of textreading, but an ontological, phenomenologicalhermeneutics in which understanding is a necessaryfeature of the being-together of human beings in theworld. This being-together in and through languagetakes on a peculiar form in the clinical encounter,since the medical meeting is typically characterizedby an asymmetrical enstrangement and has a specificgoal – health for the patient – absent in other formsof hermeneutics. Central issues of Gadamer'sphilosophy, e.g. fusion of horizons, are shown tofit the structure of clinical practice.     

Professional Autonomy in the Health Care System

Professional autonomy interferes at a structural level with the variousaspects of the health care system. The health care systems that can bedistinguished all feature a specific design of professional autonomy,but experience their own governance problems. Empirical health caresystems in the West are a nationally coloured blend of ideal type healthcare systems. From a normative perspective, the optimal health caresystem should consist of elements of all the ideal types. A workableoptimum taking national values into account could be attained bygovernance structures that also introduce elements from other ideal typesystems. Thus a normative approach to medical practice guaranteeing anessential degree of professional autonomy for a relationship of trustbetween the patient and the physician, could be combined with anefficient and equitable allocation of health care resources.     

Hermeneutics of Medicine in the Wake of Gadamer: the Issue of Phronesis

The relevance of the Aristotelian concept ofphronesis – practical wisdom – for medicine and medical ethics has been much debated during the last two decades. This paper attempts to show how Aristotle’s practical philosophy was of central importance toHans-Georg Gadamer and to the development of his philosophical hermeneutics, and how,accordingly, the concept of phronesiswill be central to a Gadamerian hermeneutics of medicine. If medical practice is conceived of as an interpretative meeting between doctor and patient with the aim of restoring the health of the latter, then phronesis is the mark of the good physician, who through interpretation comes to know the best thing todo for this particular patient at this particular time. The potential fruitfulness of this hermeneutical appropriation of phronesis for the field of medical ethics is also discussed. The concept can be (and has been) used in critiques of the conceptualization of bioethics as the application of principle-based theory to clinical situations, since Aristotle’s point is exactly that problems of praxis cannot be approached in this way. It can also point theway for alternative forms of medical ethics, such as virtue ethics or a phenomenological andhermeneutical ethics. The latter alternative would have to address the phenomena of healthand the good life as issues for medical practice. It would also have to map out in detail the terrain of the medical meeting and the acts of interpretation through which phronesis is exercised. This revised version was published online in June 2006 with corrections to the Cover Date.     

临床医学人才培养目标的探讨

通过复阅文件资料、问卷调查,从历史回顾、现状研究等着手,对新世纪医学本科人才培养目标进行了探讨。提出临床医学专业本科人才的总体培养目标是：面向现代化、面向世界、面向未来,具有较高的医学人文素养、较宽的医学基础理论、较强的医学实践能力,具有创新创业精神,融医疗、预防、保健、康复为一体的应用型医学人才。本研究对于进一步整体优化课程结构和改革教学内容具有十分重要的意义。     

刍议综合性大学医学教育的发展方向

国际上一流的综合性大学都设有医学院,高水平的医学院也基本上都在综合性大学内。据此提出现阶段我国综合性大学医学教育应向研究型、国际化、现代化的方向发展,并就其发展对策提出了自己的看法。     

Serious misapplications of military research: dysfunction between conception and implementation

Researchers and technologists involved in the development of weapon systems can take their work to such extremes as to cause unplanned injury or death to others and lasting damage to the environment, reviewed here. In some cases innocent human casualties and ecological harm may actually be programmed and achieved. An analysis is proffered, attributing blame, and indicating efforts to correct the situation. The ethics involved are “complexified”, moral boundaries are exceeded, and humanity is transgressed as it develops solutions to the problem. The license to make mistakes becomes more limited with the passing of the years... Primo Levi, chemist¹ To use the term coined in 1994 by John L. Casti of the Santa Fe Institute.     

智能手机成瘾者的注意执行控制功能:心智游移的作用

智能手机成瘾可能会影响个体的注意执行控制功能,以往研究结果在该影响是否取决于实验刺激与成瘾物的相关性上存在不一致,研究关注心智游移在其中的作用。采取《大学生智能手机成瘾量表》筛选被试90人分为成瘾组和非成瘾组。实验一采用反应的持续注意任务考察不同水平智能手机成瘾者的心智游移特点,采用《白日梦量表》辅助研究,结果发现智能手机成瘾被试量表得分显著更高,在实验中更多地评估任务表现,且其心智游移与偶然性的任务疏忽、一般性任务疏忽以及反应分离状态有关。实验二采用AX版本的持续操作任务探究智能手机成瘾者的注意执行控制功能中心智游移的调节作用,结果发现高频心智游移的智能手机成瘾者比低频心智游移的智能手机成瘾者维持目标更困难。研究对于理解智能手机成瘾对个体认知的影响具有一定的启示作用。     

Too Close for Comfort? Faculty–Student Multiple Relationships and Their Impact on Student Classroom Conduct

Professors are increasingly encouraged to adopt multiple role relationships with their students. Regardless of professor intent, these relationships carry risks. Left unexamined is whether student–faculty social multiple relationships impact student in-class behaviors. Provocatively, our exploratory study provides empirical support suggesting that when undergraduate students perceive that their professors engage in the multiple faculty–student relationships of friendships, drinking (alcohol) relationships, and sexual partnerships, students report they are more likely to engage in uncivil behaviors in the professor’s classroom. Accordingly, our study provides a backdrop against which to think more substantively about the professorial role and the boundaries that accompany it.     

Perceptions of Academic Dishonesty in a South African University: A Q-Methodology Approach

The prevalence of academic dishonesty is a matter of considerable concern for institutions of higher education everywhere. We explored students’ perceptions of academic dishonesty using Q methodology, which provides insights that are different from those obtained through surveys or interviews. South African students ranked 48 statements, giving reasons why students cheat, on an 11-column grid, anchored by strongly agree and strongly disagree. Q factor analysis was used to identify groups of individuals who share the same perspective. The three perspectives that emerged viewed academic dishonesty as (a) moral transgressions, (b) pressure transgressions, or (c) confused transgressions. These suggest different approaches to addressing the issue.