上帝之手——高道德风险的生命技术何以从伦理学与神学获得辩护

克隆人的出现是后生命科学时代开始的标志;原有的高新生命科学技术发展时期是科学过渡带;人类基因组计划、克隆人与胚胎干细胞研究是后生命科学事件。传统伦理学和神学伦理学在后生命科学时代理论资源桔竭,已达边界;我们“只有同意识形态断裂,彻底改变其结构,才能有真正的科学”;我们必须一边从传统中寻求辩护、一边解放伦理学和神学（经典理论后现代化）。清除障碍,获得解放。     

风险偏爱特征的实验研究

本研究采用等级排序的方法 ,60名被试分别在大、小两种恒定的期望值条件下 ,对不同风险来源和不同风险水平的抽彩方案进行偏爱排序 ,以此来检验组合理论有关风险偏爱模式的假设。结果发现 :( 1 )被试的风险偏爱模式以单峰模式为主 ;( 2 )期望值的大小和不同的风险来源对偏爱模式没有显著影响。通过与美国研究者的结果比较发现 ,中美被试对于固定收益、中等风险和高风险评为最不偏爱的数量上存在显著差异。     

Incorporating a Psychological Counselor in a Cancer Risk Assessment Program: Necessity, Acceptability, and Potential Roles

Evidence suggests that cancer risk assessment may be associated with increased psychological distress. This exploratory study assessed the necessity and acceptability of incorporating psychological counseling into routine clinic procedures at a cancer risk program. Following a visit to a university-based cancer risk clinic, patients (N = 102) completed an anonymous self-report instrument. Participants reported experiencing current stress and anxiety (41%), depression (29%), and suicidal ideation (2%). Patients with a history of cancer were more likely to be experiencing current emotional difficulties. Sixty-nine percent of the participants found the visit with the psychological counselor to be helpful, while 41% of the participants reported interest in follow-up psychological services. Interest in receiving future psychological services was positively correlated with levels of anxiety, depression, and cancer worry. This pilot study demonstrates the acceptability and potential role for psychological counselors in increasing adjustment in high-risk patients undergoing genetic counseling for inherited cancers.     

Diverse knowledges and competing interests: An essay on socio-technical problem-solving

Solving complex socio-technical problems, this paper claims, involves diverse knowledges (cognitive diversity), competing interests (social diversity), and pragmatism. To explain this view, this paper first explores two different cases: Canadian pulp and paper mill pollution and siting nuclear reactors in seismically sensitive areas of California. Solving such socio-technically complex problems involves cognitive diversity as well as social diversity and pragmatism. Cognitive diversity requires one to not only recognize relevant knowledges but also to assess their validity. Finally, it is suggested, integrating the resultant set of diverse relevant and valid knowledges determines the parameters of the solution space for the problem. The author is a Professor of Philosophy at The University of Sudbury, Ontario, Canada.     

What does the public think of placebo use? The Canadian experience

Part of the National Placebo Initiative in Canada included public consultations, based on the belief that the views of the public should inform Canadian policy development on what constitutes appropriate placebo use. Public consultations took place nationally in 2003. A deliberative dialogue approach was used, or a structured discussion format designed to facilitate the consideration of complex issues and build consensus. The placebo debate was characterized as having 3 distinct approaches and each were explored. The first approach “Maximize Patient Protection” identified the need for experts to determine appropriate placebo use and that placebos should only be allowed under very restricted conditions. The second approach “Maximize Medical Knowledge” identified that placebos give essential information about the safety and efficacy of new drugs, and are appropriate when the rights, safety and well-being of research participants are ensured. The third approach “Maximize Patient Autonomy” identified that the current system of regulating placebo use is paternalistic and that patients should be able to define what is in their best interests and have more leeway to determine for themselves if they wish to participate in a placebo-controlled trial. Advantages and disadvantages of each approach were considered and feedback on what constitutes appropriate placebo use was sought. The major findings were that: PCTs were considered a valuable and acceptable part of advancing medical knowledge; research using placebos must be valid and justifiable; a patient-centred approach needs to be fostered; patient autonomy (choice) should be a first consideration and take clear precedence in trials of low to medium risk; patient protection (or health) may need to “trump” patient autonomy at higher levels of risk and/or patient vulnerability; placebos are not a violation of the duty of care as duty of care is best met by identifying a choice for patients, whenever a choice is available. These consultations clearly were not designed to produce conclusive evidence, but rather to provide some useful insights into what the public may think about placebo use; additional studies are indicated. Funding for the public consultations was provided by Health Canada and the Canadian Institutes of Health Research. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Mutual Help Groups, Perceived Status Benefits, and Well-Being: A Test with Adult Children of Alcoholics with Personal Substance Abuse Problems

A field experiment was conducted to examine the potential effects of mutual help group participation on perceived status benefits, depression, and substance use among adult children of alcoholics (ACOAs) with personal substance abuse problems. Participants were randomly assigned to attend either ACOA-specific mutual help group meetings or substance abuse education classes during the initial month that they were enrolled in a residential treatment program for low-income substance abusers. Analyses were based on assessments made at baseline, a 1-month posttest, and a 6-month follow-up. Results indicated that participation in the mutual help group promoted perceived status benefits, which in turn led to reductions in depression and substance use. These findings have clear implications for consumers of ACOA groups and can inform research on the social psychological underpinnings of different types of mutual help groups.     

The Psychological Dimension of Informed Consent: Dissonance Processes in Genetic Testing

This paper discusses the issue of the psychological dimension of informed consent. In this paper, the author proposes that informed consent is a continuous variable rather than a dichotomous one. When clients better understand their motives and actual, rather than just perceived degree of choice in pursuing a particular option in a medical setting, their level of informed consent is greater. Findings from existing literature in the field of genetic testing are examined in terms of dissonance theory. These findings suggest that testing candidates sometimes overestimate their coping skills and minimize the threat to psychological integrity that a particular genetic result may pose. Counseling directed towards realistic appraisal of degree of choice in pursuing testing is examined as an aspect of supporting informed consent and possibly reducing the potential for adverse psychological outcome in the longer term.     

Questions of culture,age and gender in the epidemiology of suicide

Cultural values were examined as predictors of suicide incidence rates compiled for men and women in six age groups for 33 nations for the years 1965, 1970, 1975, 1980, and 1985. Hofstede's cultural values of Power-Distance, Uncertainty Avoidance, and Masculinity (i.e., social indifference) were negative correlates of reported suicide, and Individualism was a strong positive correlate. The proportion of variance in suicide reports generally related to these four cultural values was R2 = 0.25. Suicide by women and by middle-aged people was most related to cultural values, even though international variance in suicide is greater for men and for the elderly. Suicide incidence for girls and young women showed unique negative correlations with Individualism. For all age groups, Individualism predicted a greater preponderance of male suicides, and Power-Distance predicted more similar male and female suicide rates. Social alienation and Gilligan's feminist theory of moral judgment were hypothesized to explain some gender differences.     

The role of teachers' perceived control and children's characteristics in interactions between 6-year-olds and their teachers

The study aimed at an understanding of child-teacher interactions in school preparatory classrooms. Relations between observed interactions and sex of the child, teachers' ratings of their perceived control, and of children's undercontrolled and overcontrolled problem behaviors, social competence and work efficiency were studied. Thirty-six teachers and 92 six-year-olds, 39 girls and 53 boys, from 19 classrooms were directly observed on 2-5 occasions during a total mean of 60 minutes per child. The results showed that interactions involving teacher support behaviors were the most common, but comparatively less well explained by the predictors. Associations were found between perceived control and two types of teacher command interactions. For teacher commands initiated by child externalizing behavior, the relation with perceived control was shown to hold for boys only. Male sex and rated undercontrolled problems were predictive of more interactions initiated with externalizing behaviors and also of more restrictive teacher responses following child positive behaviors. Overcontrolled children, who had teachers high in perceived control, were more often met with support behavior when they were off-task. It was concluded that teacher perceptions of control and of child behaviors as well as sex of the child contribute to ongoing processes in preschool classrooms and that the chosen methodology could be used to further the search for factors affecting interactions in preschool settings.     

Appraised psychological workload, musculoskeletal symptoms, and the mediating effect of fatigue: a structural equation modeling approach

The aim of the present study was to test two structural models of the relationship between appraised psychological workload and musculoskeletal symptoms from the neck, shoulder, and upper and lower back with different aspects of perceived fatigue as mediating variables. In this cross-sectional study a questionnaire survey was conducted among employees at three Swedish assembly plants (n= 305). The proposed models were tested for one general fatigue dimension--lack of energy--and four specific fatigue dimensions--physical discomfort, physical exertion, lack of motivation, and sleepiness--using structural equation modeling. The results indicate that the role of perceived fatigue in the relationship between appraised workload and musculoskeletal symptoms is different for different aspects of fatigue. The general fatigue dimension, lack of energy, does not mediate the relationship. As regards the specific fatigue dimensions, the relationship is partially mediated by physical discomfort and lack of motivation but not by physical exertion or sleepiness. Appraised psychological workload has a unique effect on musculoskeletal symptoms not mediated by fatigue.