Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment.     

When Is It Ethical for Physician-Investigators to Seek Consent From Their Own Patients?

Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about “dual-role” consent reflects the view that distinct normative commitments govern physician–patient and investigator–participant relationships, and that blurring the research–care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the physician-investigator; that it can compromise the voluntariness of the patient-participant’s consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force—and the ethical acceptability of dual-role consent—varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent.     

免费师范生的教师职业认同与学习动机及学业成就的关系研究

研究以714名免费师范生为被试,采用问卷测量法,考察了其教师职业认同状况、内部和外部学习动机特点,以及教师职业认同、学习动机和学业成就之间的关系。结果发现:(1)在教师职业认同上,免费师范生对教师职业的内在价值认同显著高于外在价值认同,外在价值认同显著高于意志行为认同,职业认同的总体情况略高于中等水平,还有一定的提升空间;(2)内部学习动机比较积极,且显著高于外部学习动机;(3)教师职业认同和学习动机、学习动机和学业成就之间均存在显著的正相关,且教师职业认同对学业成就有稳定的预测力;(4)外部学习动机在教师职业认同和学业成就之间起了部分中介的作用。     

Support and self-care: professional reflections of six New Zealand high school counsellors

In many Western societies there is increasing demand for counselling; in turn, heightened levels of support needs have been identified for counsellors themselves. Despite calls for practitioners to adopt a more proactive approach to self-care, research suggests many still pay insufficient attention to alleviating on-the-job stress or achieving ‘work–life balance’. These issues were examined within the context of inviting six high school counsellors in New Zealand to talk generally about their professional lives. The authors suggest findings support calls for counsellor education programmes to offer structured opportunities for trainees to reflect upon the task of discursively constructing professional roles.     

医学职业显规则何以不再“败走麦城”

近些年来,医学职业显规则接连受挫,医学职业生态呈现非常态甚至反常态。其根本原因在于,医学职业显规则与潜规则二者并存且此消彼长。职业规则是职业精神的核心。若要真正颠覆医学职业潜规则,让医学职业显规则回归医学职业生活,从而恢复或重构医学职业精神,就必须克服现存的医学职业显规则的致命性缺欠,进行自身优化,即强化自己的权威性、情境性与实用性。     

心理学毕业生专业技能调查及其对专业改革的启示

通过对204名心理系历届本科毕业生的调查,结论如下：(1)毕业生对心理学专业教学总体满意度一般,其中对专业实践安排的满意度最低;(2)毕业生认为最重要的技能是“进行心理活动课程”和“心理咨询”,最欠缺的技能是“心理治疗”和“心理咨询”;(3)心理学应用技能课程包含“心理咨询及治疗”、“心理课程及教育”、“心理测评及应用”三个因素。在调查基础上,本文提出了心理学专业改革的设想。     

Infant Distress During Immunization: A Multimethod Assessment

The purpose of this study was to comprehensively describe infant procedural distress and pain across assessment modalities, and to compare similarities and differences across measures. A multimethod assessment of distress was conducted to investigate infants (N = 37) undergoing routine immunizations. Measures of infant distress included Parent report, nurse report, infant heart rate, and an observational measure of infant distress. Parents rated their infant's distress and pain significantly higher than did nurses. Observational and physiological ratings of infant distress were found to vary significantly by phase, and there were no correlations between adult ratings of pain and distress and physiological ratings. Findings suggest that infant procedural distress can be assessed in a number of manners. The discordance between these measures emphasizes the need for multimethod assessment of pediatric procedural distress in both research and clinical settings. Given the differences between parent and nurse ratings, clinicians should be aware that different assessment methods might lead to different conclusions about infant procedural distress.     

The impact of affective information on the professional judgments of more experienced and less experienced auditors

This study examines whether the presence of realistic, yet irrelevant, affective information differentially influences the professional judgments of more experienced and less experienced auditors. In this study, auditors with different experience levels were either provided or not provided with information designed to elicit a negative interpersonal emotional reaction towards a manufacturing client when making an inventory obsolescence risk judgment. The results indicate that the inventory obsolescence risk assessments of less experienced auditors were significantly higher when they were provided with negative affective information on a client than when no such information was provided. No such differences were found for the more experienced auditors. This study suggests that professional experience is one factor that influences individuals' assessments of the informational value of affective reactions. This has implications for developing effective training programs to increase professionals' awareness of the influence that emotional reactions can have on their judgment. Copyright © 2002 John Wiley & Sons, Ltd.     

真实型领导对员工工作投入影响的多重中介效应模型

为了考察真实型领导影响员工工作投入的内在作用机制,采用真实型领导行为量表、职业认同量表、情感承诺量表、组织支持感量表和工作投入量表对308名企业员工进行施测,结果发现：（1）真实型领导通过职业认同、情感承诺和组织支持感的间接作用对员工的工作投入产生影响;（2）职业认同、情感承诺和组织支持感在真实型领导影响员工工作投入的过程中起完全中介作用。