Confidentiality, privacy, and the facilitating role of psychoanalytic organizations

Burgeoning external threats to confidentiality by claims to clinical information create unprecedented challenges for psychoanalysts. Internal threats arise from the use of clinical material for educational, scientific and historical purposes. Traditionally, confidentiality is considered a patient's right and an analyst's obligation; privacy is not usually stated as a professional requirement. Little consideration has been given to the impact of the confidentiality and privacy dilemmas that analysts encounter throughout their careers. There has been no systematic examination of the confidentiality policies of psychoanalytic organizations, nor has their role in facilitating maintenance of patient confidentiality and analysts' privacy been made explicit. The research reported here was undertaken to address these issues and to obtain baseline information about the current confidentiality policies and practices of psychoanalytic organizations in three English-speaking countries (Britain, Canada and the USA). The author discusses survey results in the light of the challenges which arise at each phase of the analytic career. She makes suggestions as to how psychoanalytic organizations can and should facilitate analysts' resolutions of contemporary confidentiality and privacy dilemmas.     

Our obligations to future generations: the limits of intergenerational justice and the necessity of the ethics of metaphysics

Abstract

Theories of intergenerational justice are a very common and popular way to conceptualise the obligations currently living people may have to future generations. After briefly pointing out that these theories presuppose certain views about the existence, number and identity of future people, I argue that the presuppositions must themselves be ethically investigated, and that theories of intergenerational justice lack the theoretical resources to be able to do this. On that basis, I claim it is necessary to do the ‘ethics of metaphysics’ in order to fully comprehend what, if anything, we may owe future generations. I defend these claims against some important objections.     

Reasonable Impartiality and Priority for Compatriots. A Criticism of Liberal Nationalism’s Main flaws

Distinguishing between reasonable partiality and reasonable impartiality makes a difference in resolving the serious clashes between priority for compatriots versus cosmopolitan global duties. Defenders of a priority for compatriots have to acknowledge two strong moral constraints: states have to fulfil all their special, domestic and trans-domestic duties, and associative duties are limited by distributive constraints resulting from the moral duty to fight poverty and gross global inequalities. In the recent global context, I see four main problems for liberal-nationalist defenders of priority for compatriots: (i) Reasonable particularists often forget that associative duties for compatriots compete with many sub-national and trans-domestic associative duties. (ii) They tend to forget that associative national duties compete with other, strong special (contractual, reparative) obligations regarding not only citizens and residents inside nation-states but also trans-domestic obligations across state borders. (iii) They do not properly discuss the problem of unallocated duties in addressing global poverty and insecurity. (iv) The design of supra-national and global mediating institutions, and the crafting of policies to remedy the misallocation of duties and to coordinate the required state activities is an urgent task neglected by liberal nationalists. In the recent context, reasonable partialitys bias towards partiality is most unwelcome and morally dubious. Reasonable impartialitys bias towards cosmopolitanism helps to stimulate a drastic shift in obligations and stimulates productive trans-national institutional design.     

Conflict of interest in Croatia: doctors with dual obligations

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the medical profession that address problems of conflict of interest. An earlier version of this paper entitled was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Resisting for other reasons*

Does a victim have to intend to resist oppression in order to discharge her obligation to do so, or is it sufficient to resist oppression intentionally in the course of pursuing other plans and projects of importance to her? I argue that resisting intentionally can be sufficient: given the ways that oppression interferes with the lives of victims, trying to counteract that interference by living the life you want is genuine resistance. Requiring that victims have justice-oriented or agency-preserving reasons before their actions count as resistance will distort or miss a wide range of everyday responses to oppressive burdens.     

Solidarity and Cosmopolitanism

The review article examines the relation of solidarity and cosmopolitanism in contemporary political, philosophical and sociological debates. In some contexts, solidarity and cosmopolitanism are closely related, in others they are understood to be incompatible. The main body of the report is divided into three parts displaying a tentative classification of the reviewed literature on the subject. The first part serves to outline a general account of solidarity, the communal obligations that follow from it, and its opposition to the moral arguments grounding cosmopolitan obligations. The second part deals with the actual development and realization of solidarity and cosmopolitanism, as well as the tension between both within the European Union. The third part considers some arguments for the extension of solidarity relations beyond state or nation towards cosmopolitan affiliations, obligations and institutions. Finally, a reading of solidarity and cosmopolitanism is offered in which both are compatible with each other.

Is conscientious objection incompatible with a physician’s professional obligations?

In response to physicians who refuse to provide medical services that are contrary to their ethical and/or religious beliefs, it is sometimes asserted that anyone who is not willing to provide legally and professionally permitted medical services should choose another profession. This article critically examines the underlying assumption that conscientious objection is incompatible with a physician’s professional obligations (the “incompatibility thesis”). Several accounts of the professional obligations of physicians are explored: general ethical theories (consequentialism, contractarianism, and rights-based theories), internal morality (essentialist and non-essentialist conceptions), reciprocal justice, social contract, and promising. It is argued that none of these accounts of a physician’s professional obligations unequivocally supports the incompatibility thesis.

流行病防控的伦理分析

目前学界对流行病防控的伦理探讨尚十分欠缺,而现有的生命医学伦理学理论不能较好地解决流行病防控中的伦理问题,应用伦理学亟需对流行病防控做出伦理回应。流行病防控中主要涉及隐私、自由和正义三个方面的伦理问题,亦即个人权利或自由与公共健康的冲突问题。流行病防控对个人行为的家长主义干预,特别是对个人自愿自涉行为的强家长主义干预必须得到伦理证明。流行病防控与社会正义和人权也有十分密切的关系,促进正义与保护人权是流行病防控的应有之意。     

麻醉医生是外科的内科医生——浅谈21世纪麻醉医生的责任与义务

在科学技术高速发展的21世纪,西医外科学取得了相当大的成绩。心脏直视手术,器官移植的巨大成功标志着外科学已经进入了一个崭新的时代。但这些成绩的取得离不开麻醉学科的发展。麻醉医生是外科的内科医生,这句话里有两层含义,一是表明了麻醉医生在外科领域里所要承担的责任;二是在今后的医学发展中麻醉学研究的方向及自身的义务。本文将从麻醉学科的历史定位、现代定位和责任与义务三个层面展开讨论,为中国麻醉事业美好的明天而努力。