完善医学生职业道德培养教育途径

为了提高我国医学生职业道德教育的有效性和实效性,需不断完善和健全现有职业道德培养渠道,并拓展新渠道。在探讨研究国外医学生道德培养途径基础上,博采众家之长,形成以职业道德教育贯穿于专业教育全过程为特征,以职业道德教育与临床医疗实践相结合,以提高医学生自我道德教育能力为目的,适合我国特点的医学生职业道德培养途径。     

Confi dentiality with respect to third parties: A psychoanalytic view

It is assumed that confi dentiality is not one singular ethical entity but a conglomerate of quite different issues depending upon clinical context and the sector of information sharing at stake. The focus here is on how to think psychoanalytically about requests for information from third parties (payers, courts, public security). Defi ning confi dentiality as a promise to 'never tell anything' outside of the relationship omits evaluation of the impact of the third's listening on the combined freedom of thought and freedom of speech in analyst and analysand. Circulation of information outside the dyad need not be toxic, need not disrupt the analytic couple's openness to new meaning. Key to contamination and inhibition of analytic work is whether or not disclosure serves an analytic end. Current defense of confi dentiality relies heavily on the models of protection of privacy and professional secrecy, which, though useful and relevant, fail to encompass the transitional, intersubjective space engendered by the analytic process. Suggestions are made for alternate sources of paradigms better suited to represent the latter. Offered for discussion is a draft of a confi dentiality policy with respect to third parties that is informed by psychoanalytic theory and clinical practice rather than by local legal jurisdiction or original disciplines ethics codes.     

The impact of yoga on the professional and personal life of the psychotherapist

This study explored the impact of a regular practice of yoga in the personal and professional lives of psychotherapists. Six licensed psychotherapists were interviewed about their perceptions regarding the influence of their yoga training on their personal and professional lives. These effects were then categorized into common patterns that emerged as four themes addressing professional growth and the self care of the therapist. These themes are: internal/self awareness, balance, acceptance of self and others, and yoga as a way of life.     

“SLANG”—Sensitive Language and the New Genetics—an Exploratory Study

SLANG—Sensitive Language and the New Genetics—is a concept that arose out of informal discussions between a number of interested parties, both consumers and professionals, who were becoming increasingly uneasy with some of the language commonly used in medical genetics. Some language choices were felt by the authors to be inappropriate for a variety of reasons. Poor language choice may impede an individual's understanding of a genetic condition or important medical information and the chosen words themselves may simply be perceived as discriminatory and even offensive. SLANG is an important concept to explore partly because literature in this area confirms that language choices in medical settings can be of great significance to both patients and families. Studies have shown how language choices impact on professional practice by, as one example, changing the intended meaning of medical information and affecting individual perception of risk and choice which, in turn, may affect individual or familial well-being. In addition language choice has the power to affect how individuals perceive themselves and are viewed by others. This paper presents the results from our pilot study and discusses the implications for health professionals with particular reference to medical genetics settings.     

Emotional engagement in professional ethics

Recent results from two different studies show evidence of strong emotional engagement in moral dilemmas that require personal involvement or ethical problems that involve significant inter-personal issues. This empirical evidence for a connection between emotional engagement and moral or ethical choices is interesting because it is related to a fundamental survival mechanism rooted in human evolution. The results lead one to question when and how emotional engagement might occur in a professional ethical situation. However, the studies employed static dilemmas or problems that offered only two choices whose outcome was certain or nearly so, whereas actual problems in professional ethics are dynamic and typically involve considerable uncertainty. The circumstances of three example cases suggest that increasing personal involvement and uncertainty could have been perceived as changes, threats, or opportunities and could therefore have elicited an emotional response as a way to ensure the reputation, integrity or success of oneself or a group to which one belongs. Such emotional engagement is only suggested and more studies and experiments are required to better characterize the role of emotional engagement in professional ethics.     

A professional ethics learning module for use in co-operative education

The Professional Practice Program, also known as the co-operative education (co-op) program, at the University of Cincinnati (UC) is designed to provide eligible students with the most comprehensive and professional preparation available. Beginning with the Class of 2006, students in UC’s Centennial Co-op Class will be following a new co-op curriculum centered around a set of learning outcomes Regardless of their particular discipline, students will pursue common learning outcomes by participating in the Professional Practice Program, which will cover issues of organizational culture, technology, professional ethics, and the integration of theory and practice. During their third co-op work term, students will complete a learning module on Professional Ethics. To complete the learning module students must familiarize themselves with the code of ethics for their profession, create a hypothetical scenario portraying an ethical dilemma that involves issues covered by the code, resolve the dilemma, and explain why their resolution is the best course of action based upon the code of ethics. A three-party assessment process including students, employers and faculty complete the module. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Theoretical and methodological elements for integrating ethics as a foundation into the education of professional and design disciplines

The paper addresses the integration of ethics into professional education related to the disciplines responsible for the conception and creation of the artificial (artefactual or technology). The ontological-epistemological paradigm of those disciplines is understood within the frame of the sciences of the artificial as established by Herbert Simon (1969). According to that paradigm, those sciences include disciplines not only related to the production of artefacts (technology), such as engineering, architecture, industrial design, etc, but also disciplines related to devised courses of action aimed at changing existing situations into preferred ones, like medicine, law, education, etc. They are centered on intentional action and at their core is the activity of design, which is their common foundation and attitude, or their common culture. The science of design becomes the broader foundational discipline for any professions engaged in the intentional transformation of the world. The main distinction between design disciplines and scientific ones rests on the object-project dichotomy. Indeed, contrary to Science that sees the world as an object to be observed, Design sees the world as a project and acts upon the world through projects, which are grounded in intentions, ends, and values. Design disciplines are meant to transform the world, or part of it, and are teleological. Being so, they are embodied in an act that is ethical and their ontology-epistemology must be addressed also through practical reason to resituate all professional disciplines according to their involved nature. The paper introduces theoretical, methodological, and ethical elements to establish a model that integrates ethics into the education of the professional disciplines, design-based disciplines, responsible for the creation of the artificial, artefactual or technological, world. The model is articulated around the notions of ethical engagement and responsibility through the act of design understood as action with intention situated in a project, common in all professional disciplines. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

A survey of genetic counselors' strategies for addressing ethical and professional challenges in practice

There is limited research about ethical and professional dilemmas that genetic counselors encounter in their practice and their strategies for addressing them. In this study, 454 genetic counselors rated the frequency with which they encounter each of 16 ethical/professional challenges identified and categorized previously (McCarthy Veach P, Bartels DM, LeRoy BS (2001) J Genet Couns 10(2):97–119). Over 40% indicated these issues occurred frequently: patient emotions, diversity, financial constraints, uncertainty, and colleague error. Two hundred and fifty-five respondents provided personal anecdotes describing exceptionally challenging situations and recommended strategies for addressing them. Most of their anecdotes involved informed consent, value conflicts, confidentiality, colleague error, withholding information, and resource allocation. The most frequently recommended strategies were further discussion with patient, consultation with other professionals, and referral to other health sources. Thirty-five respondents were unable to/did not offer strategies. Respondent demographics were not related to frequency of issues, type of anecdote, or recommended strategies. Practice, policy, and research implications are discussed.     

Ethical implications in the allocation of scarce medical resources in Poland

The health care system in Poland is undergoing major change and it is possible that these changes could affect clinical research. Therefore, the situation of funding of health care is important for the future of medical research in this country. Some questions relevant in this field will be addressed. Since funds for health care and scientific research remain inadequate, their allocation raises moral, economic, legal and organisational dilemmas. The clinical aspects of resource allocation also include physicians’ responsibilities towards their patients. Scientific research, clinical medicine, and clinical research have a common denominator: they rely on trust. The physician should be a fiduciary of the patient as well as being a researcher for the benefit of the patient and for society. Some physicians and researchers, despite unethical conduct, escape disclosure and punishment, but decision-makers who wrongly allocate funds for health care and research are never held accountable for their actions. An earlier version of this paper was presented at a symposium, Scientific Misconduct: An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.     

Re-Evaluating Professional Autonomy in Health Care

Professional autonomy, as the symbol of the traditional freedom ofdecision-making of medical professionals is criticized. This essayexamines the critique. It analyses the underlying assumption that theautonomy of health professionals is incompatible with the need fororganisation and management in order to control rising health carecosts. It is argued that the concept of professional autonomy should beredefined, not through restricting the decision-making freedom ofindividual health professionals, but through expanding the concept intothe sphere of management, so that managers will take responsibility forpatient care.