姑息治疗及其在肿瘤学中的地位

本文对姑息治疗的历史及概念作了详细的介绍,解释了其不同阶段的内涵,作为医学学科之一,姑息治疗的内容主要包括了疾病伴随或治疗所致症状的诊断评估、预防和治疗,心理和非癌性躯体疾病的预防和治疗,姑息治疗的科研、教学和教育以及终末期病人的治疗和护理等,特别纠正了对“安乐死”的看法。在肿瘤学中,经过40多年,它已从治疗中的辅助角色迅速成为肿瘤综合治疗中的主角,且贯穿于始终。它倡导多学科协作,与抗癌治疗完整结合,对无法治愈的晚期癌症患者以缓解症状、改善生活质量为主要目标,在全球范围内,很大一部分晚期肿瘤病人已从姑息治疗中明显获益。它的有力实施,也是我们创建和谐社会的重要反映。     

Interpersonal Psychotherapy for Late Life Depression: Current Status and New Applications

Interpersonal Psychotherapy (IPT) is an empirically-supported treatment for depression and other mental disorders. This article discusses the structure of IPT, its use with older adults, and research that supports its efficacy with depressed older people. Depressed older persons with significant health problems or cognitive impairment present special challenges for those conducting IPT and other psychotherapies. Promising new psychotherapies developed for depressed older adults with cognitive impairment and those living in nursing homes are reviewed. Recommendations are made for use of IPT with older adults in nursing homes.     

医疗保健领域的功利主义理论

在医疗保健领域功利主义具有重要作用。功利主义主张根据行为的结果进行道德判断,功利主义认为医疗保健政策应该满足大多数人的利益,应该根据治疗效果决定享有权和相应的治疗措施。这一思想在医疗保健领域体现为成本效益分析,通过收益的大小确定医疗资源分配的限度和范围。     

Protection of Life and Human Dignity: The German Debate between Christian Norms and Secular Expectations

The German debate on bioethics and medical ethics turns on achange in the meaning of human dignity. Such dignity is increasinglyrendered contingent upon a person's empirically assessable qualityof life. In contrast to such dignity-endowed human life, a merelybiological human life is taken to disqualify its bearer fromsuch dignity, depriving his life of the protection "respectfor human dignity" would otherwise guarantee. The idea of a"life not worth living" or "undignified life" evokes categories,which were developed at the beginning of the 20th century, andlater informed the crimes of National Socialist medicine inGermany. Against this secular development, this article analysesthe theological and church-based discussion of basic bioethicalquestions in Germany, especially the controversy among Protestants:once Protestant ethicists abandon an explicitly theologicalbasis for their arguments, their conclusions come to closelyresemble those of the secular participants in the debate. Asa result, such Protestants relativize fundamental ethical norms.They subordinate, along with their secular environment, theprotection of life to respect for autonomy. They thus preparethe ground for a revival of the risky concepts of the past.     

The Lost Voice: How Libertarianism and Consumerism Obliterate the Need for a Relational Ethics in the National Health Care Service

This article analyzes the contribution Christian ethics mightbe able to make to the ethical debate on policy and caregivingin health and social care in the United Kingdom. The articledeals particularly with the concepts of solidarity and subsidiaritywhich are essential in Christian social ethics and health careethics, and which may be relevant for the ethical debate onhealth and social caregiving in the United Kingdom. An importantargument in the article is that utilitarian and market-drivenpolicies in the National Health Service (NHS) and the socialcare system have marginalized the position of the elderly andhave seriously impoverished the quality of care for the elderly.The neglect of the elderly and other vulnerable groups is alsothe result of widespread consumerist attitudes among patientsand of libertarian models of noninterference which are affirmedby a public ethos of self-sufficiency and counter-dependency.Those who need care dare not make their need known to othersand ask for help, while simultaneously those who could helpare so intimidated by the public affirmation of privacy andnegative rights that they do not dare to offer help except ifthis is explicitly demanded. This distant and standoffish attitudeis in an important way responsible for the fact that the voiceof those in need is altogether lost to the public forum. Christianethics puts much emphasis on responsibility and solidarity withthe needy other but is not able to have much impact on the deliveryof care in a secularized society and health care system likethe NHS. Nonetheless, Christianity still has a powerful andrespected voice, by speaking up for those who cannot speak forthemselves, such as the elderly and the handicapped. Christianscan find allies in the ethics of care and other relational approachesin health care ethics in order to combat libertarianism, consumerism,and utilitarianism.     

The quality of caregiving in child care: relations to teacher complexity of thinking and perceived supportiveness of the work environment

This study examined the relationship between the complexity of thinking about children by child care teachers and observed teachers' caregiving for infants and toddlers. It was hypothesized that the perceived supportiveness of the work environment would affect this relationship. Fifty‐six child care teachers completed a survey assessing complexity of thinking about children's behaviour as well as a measure of the perceived opportunities for professional development. Teachers' quality of caregiving was assessed using the Caregiver Interaction Scale. Planned contrasts revealed that when professional development opportunities were perceived unfavourably, teachers who were complex in thinking about children's behaviour provided significantly more sensitive care than did teachers who were less complex in their thinking. Findings indicate that the complexity of teachers' thinking about children may be very important in understanding teacher's sensitivity when the quality of the work environment is poor. High‐quality work environments may buffer teachers with less complexity of thinking from being less sensitive with children. Efforts to improve quality of care could focus on individual teachers to improve their complexity of thinking as well as on the work environment to make it more supportive of teachers' professional development. Copyright © 2008 John Wiley & Sons, Ltd.     

The Impact of Specific Psychotherapist Beliefs Regarding Managed Care on Prospective Psychotherapy Clients

The purpose of this study was to investigate the separate impact of each of thirteen therapist beliefs that, presented collectively, were previously found to have a significantly negative impact on prospective clients' attitudes toward managed care psychotherapy (Pomerantz, 2000). Participants in this study initially completed a brief questionnaire measuring their willingness to enter psychotherapy and their expectations regarding psychotherapy under managed care. Participants subsequently completed the same brief questionnaire again after being instructed to imagine seeing a hypothetical psychologist and being presented with the psychologist's supposed beliefs regarding managed care (which were actually derived from survey data by Murphy et al., 1998). Results suggest that almost every discrete therapist belief had a significantly negative impact on participants' attitudes toward managed care psychotherapy. Several specific therapist beliefs produced particularly salient negative effects. Implications regarding ethics and informed consent are discussed.     

A Critical Theory of the Self: Wittgenstein,Nietzsche, Foucault

Critical thinking, considered as a version of informallogic, must consider emotions and personal attitudesin assessing assertions and conclusions in anyanalysis of discourse. It must therefore presupposesome notion of the self. Critical theory may be seenas providing a substantive and non-neutral positionfor the exercise of critical thinking. It thereforemust presuppose some notion of the self. This paperargues for a Foucauldean position on the self toextend critical theory and provide a particularposition on the self for critical thinking. Thisposition on the self is developed from moretraditional accounts of the self from Descartes toSchopenhauer, Nietzsche and Wittgenstein.     

Community‐oriented primary care: a multidisciplinary community‐oriented approach to primary care?

Developing more of a local public health focus, and involving local communities in Great Britain in health care decision‐making, are key aspects of the radically changing face of primary care. Community‐oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ‘Modern and Dependable NHS’, but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd.     

Primary prevention of psychological difficulties in vulnerable mothers: pilot programme evaluation

This pilot study evaluated a primary prevention programme delivered to mothers who were considered to be vulnerable to the development of psychological difficulties (N = 11). Beneficial effects were noted in terms of mood and coping, as well as a reduction in the mothers' attendance at their general practitioners surgery. Copyright © 2001 John Wiley & Sons, Ltd.