未成年患者的同意能力研究

众所周知,医疗机构必须在取得成年患者的有效同意后才能实施医疗行为。而当患者是未成年人时,这种对医疗行为的同意是否有效呢?对此,国内外法学均未形成统一的定论。通过比较国外医事法学领域相对成熟的同意能力理论,初步建立我国未成年患者的同意能力理论体系,其中评估方法是关键。     

Informed Consent Procedure for Clinical Trials in Emergency Settings: The Polish Perspective

Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients’ to give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants. Whereas the Declaration of Helsinki, Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow waivers from participants’ consent or deferred consent for emergency research, the regulations of most European Community countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting regulations on a waiver from a participant’s consent in emergency research exist and the regulations on surrogate consent of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should become a large part of important public health priorities.     

告知患者癌症诊断的利弊分析及有效告知的方法

告知患者癌症诊断是肿瘤科的核心问题。法律和医学伦理原则要求医务人员应掌握肿瘤患者的心理和其他方面的特殊性,及时、充分地与患者及家属进行沟通,严格履行肿瘤患者的知情同意原则。本文旨在对告知患者癌症诊断的利弊及有效告知癌症诊断的方法进行分析,以期为临床肿瘤医疗、护理工作提供指导。     

The embodied self: thinking psychoanalytically in a time of 'science'

Abstract :  In order to be relevant in our 'scientific' times, it is necessary that we psychoanalysts situate our ideas in thoughtful and respectful relationship to neighbouring disciplines such as genetics, cultural studies, and neuro-anatomy. In this paper I suggest that, although psychoanalysis still continues to have valuable contributions to make to the understanding of human sexual experience and behaviour, in order to make these contributions relevant we must tune in with openness to the challenges posed by the unfolding discoveries in the other disciplines that grapple with the arena of human sexuality.
I will suggest ways in which research on sexual desire and gender identity may be assimilated into psychoanalytic thinking and give some examples of its use in analytic practice.     

基于比较视野下当代大学生性心理与教育的研究

在从比较的视野对国内学者针对不同性别、不同专业、不同学校类型等的大学生性心理特点以及中外高校大学生性教育的历史与现状、性教育的对象、性教育的内容与形式、性教育的队伍、性教育的成效等差异进行分析、对比研究的基础上,从中获得启示和借鉴,以推动我国高校对当代大学生性教育的有效开展。     

Community-Based Interventions to Reduce Low Income, African American Women's Risk of Sexually Transmitted Diseases: A Randomized Controlled Trial of Three Theoretical Models

A community-based sample of disadvantaged African American women (n = 445) was recruited to participate in 1 of 3 theoretically driven experimental interventions based on either the theory of gender and power, social learning theory, or cognitive behavioral theory. Intervention outcomes were compared with a waiting list control condition. From baseline to postintervention, women in the experimental interventions showed differential change on cognitive indices (knowledge and attitudes) and skill acquisition (partner negotiation skills, correct condom application, lubricant selection, and information-provision to social networks) whereas control participants were unchanged. Women in the 3 experimental interventions also completed follow-up assessments for 1 year following the interventions. In all 3 experimental conditions, condom use increased relative to the control group and there were no differences between the experimental interventions. Women who participated in one of the theoretically grounded interventions continued to increase condom use over the following year. Women entering new relationships reported significantly more condom use than did women who remained in ongoing relationships. The findings suggest that intervention models that have proven effective for women who engage in high-risk behavior may be less effective for women in established relationships for whom risk is primarily derived from the extrarelationship behavior of their partners.     

The Coming-Out Process and Its Adaptational and Health-Related Associations Among Gay, Lesbian, and Bisexual Youths: Stipulation and Exploration of a Model

A model is proposed and explored that links the coming-out process to the psychological functioning (i.e., self-esteem and distress) and sexual behaviors of gay, lesbian, and bisexual youths recruited from gay-focused community-based and college organizations in New York City. The coming-out process is multidimensional, consisting, as defined here, of involvement in gay/lesbian activities, attitudes toward homosexuality, comfort with homosexuality, self-disclosure of sexual identity to others, and sexual identity. The coming-out dimensions were related to self-esteem, distress, and unprotected sexual behaviors. In addition, the relations between the coming-out dimensions and unprotected sexual behaviors were explained by psychological functioning. In particular, limited involvement in gay/lesbian activities was associated with more unprotected sex. Negative attitudes toward homosexuality were related directly to more unprotected sex, and they were related indirectly to more unprotected sex by means of increasing emotional distress. These and other findings have implications for designing preventive interventions to increase the youths' psychological functioning and reduce their unprotected sexual behaviors.     

Multigenerational Sexual Abuse: A Cognitive Developmental Approach to Understanding Mothers in Treatment

This paper takes a cognitive developmental perspective in the qualitative analysis of 9 interviews of women who were sexually abused as children and whose children were also sexually abused. It discusses ways in which the development of cognitive self-understanding can by stymied by childhood sexual abuse and how this, in turn, can affect a woman's ability to parent her children and take full advantage of psychotherapy. It studies the recovery process that participants describe at various stages of a social cognitive developmental model of self-understanding. Finally, it promotes the use of a cognitive developmental perspective in clinical work and offers suggestions for counselors addressing issues of childhood sexual victimization.     

Sexual Morality: Is Consent Enough?

The liberal view that valid consent is sufficient for a sex act to be morally legitimate is challenged by three major philosophies of sex: the Catholic view of sex as ordained for procreation and properly confined to marriage, the romantic view of sex as bound up with love, and the radical feminist analysis of sex in our society as part and parcel of the domination of women by men. I take a critical look at all three, focusing on Mary Geach's recent statement of the procreation view, Roger Scruton's theory of sexual desire as naturally evolving into intimacy and love, and several radical feminist discussions of sex in sexist society which argue that the notion of consent is unhelpful and, indeed, irrelevant. I argue that none of these lines of argument is convincing, and that consent remains the touchstone of morally permissible sex – although, dmittedly, it may not be very helpful in discussing ideals of human sexuality.     

It takes two to tango: Research and practice as an amazing dance

This paper offers an appreciative critique of Kim Etherington's recent book, Narrative Approaches to Working with Adult Male Survivors of Male Child Sexual Abuse. I discuss the issues raised in the book with reference to one of my current clients. Etherington does not produce new substantive theory: the power of this work is in the narrative. Her important contribution lies in the reflexivity with which she encounters her material. The use of critical reflexivity challenges the subject/object dichotomy inherent in much positivistic research, and presents a much‐needed approach to process that is congruent with the lived experience of counselling. I would suggest that research is more likely to succeed in informing practice if the material is open to personal interpretation by the reader/therapist. Further, I would claim that the activity of using research creatively is itself a heuristic process: useful learning is most likely to occur if the dialogic relationship with the client and therapist is mirrored in the relationship between the therapist and the research text.