Professional Autonomy in the Health Care System

Professional autonomy interferes at a structural level with the variousaspects of the health care system. The health care systems that can bedistinguished all feature a specific design of professional autonomy,but experience their own governance problems. Empirical health caresystems in the West are a nationally coloured blend of ideal type healthcare systems. From a normative perspective, the optimal health caresystem should consist of elements of all the ideal types. A workableoptimum taking national values into account could be attained bygovernance structures that also introduce elements from other ideal typesystems. Thus a normative approach to medical practice guaranteeing anessential degree of professional autonomy for a relationship of trustbetween the patient and the physician, could be combined with anefficient and equitable allocation of health care resources.     

Differences in the justification of choices in moral dilemmas: effects of gender, time pressure and dilemma seriousness

The effects on moral reasoning of gender, time pressure and seriousness of the issue at hand were investigated. In Experiment 1, 72 university students were presented with moral dilemmas and asked what actions the actors involved should take and to justify this. Women were found to be more care-oriented in their reasoning than men, supporting Gilligan's moral judgment model. Both time pressure and consideration of non-serious as opposed to serious moral dilemmas led to an increase in a justice orientation compared with a care orientation in moral judgments. In Experiment 2, a similar task was given to 80 persons of mixed age and profession, and the participants' moral reasoning was coded in terms of its being either duty-orientated (duty, obligations, rights) or consequence-oriented (effects on others). Men were found to be more duty-oriented than women, and time pressure to lead to a greater incidence of duty orientation.     

Envisioning a kinder,gentler world: On recognition and remuneration for care workers

In this paper, I argue that thestatus of those who take care of persons withdisabilities, and persons with disabilities,are inextricably linked. That is, devaluingthe status of one necessarily devalues that ofthe other. Persons with disabilities and thosewho help care for them must form an alliance toadvance their common interests. This alliancecan gain insight and inspiration from feministthought insofar as caretaking is literallylinked to problems of the representation ofcaretaking as ``women's work,' and morephilosophically, by borrowing from the toolboxof feminist social, political, and economicanalyses. This revised version was published online in June 2006 with corrections to the Cover Date.     

A Study of Church Members During Times of Crisis

The purpose of the current study was to understand what church members experience during a situational crisis and identify the resources of social support that are helpful for them. By identifying the degree to which personal religious beliefs and participation in a particular congregation help people in crisis, this study sought to provide a foundation from which religious as well as mental health professionals can understand the psychological benefits of religious involvement. For the purposes of this research the investigators developed the Crisis Appraisal and Coping Interview Protocol. The research team collected interview data from 26 members of one Southern Baptist congregation within two weeks of a crisis event. Qualitative analysis identified several key themes that appeared which are discussed.     

Hunger Pangs: Transference and Countertransference in the Treatment of Foster Children

In working with children, clinicians are often confronted with physical as well as psychological hunger—demands for real along with symbolic feeding. Foster children, who have suffered actual neglect and deprivation, often stir powerful and primitive feelings about the place and importance of the real and the symbolic in psychotherapy. These parentless children explicitly and implicitly announce that they need a family, not a therapist. In response, the therapist, particularly the young and inexperienced clinician, may devalue the therapeutic relationship and unconsciously move into a parental role, feeling that without the protection of a family the child will inevitably fall into the enormous emotional, economic, and systemic cracks in the world of foster care. Clinical material illustrates these points.     

A Meta-Ethical Critique of Care Ethics

A meta-ethical analysis demonstrates that care ethics is a grounded in a distinct mode of moral reasoning. This is comprised primarily of the rejection of principles such as impartiality, and the endorsement of emotional or moral virtues such as compassion, as well as the notion that the preservation of relations may override the interests of the individuals involved in them. The main conclusion of such a meta-ethical analysis is that such meta-ethical foundations of care ethics are not sound. Reasonable alternatives for care ethics may be its formulation as an additional principle within an established principlist framework, or the move to a dialogical ethics, where the good to be acted upon is not decided in advance but rather critically discussed and established within the encounter of the parties involved. This revised version was published online in August 2006 with corrections to the Cover Date.     

Expanding the concept of birthparent loss to orphans: Exploratory findings from adolescents in institutional care in South Korea

Conservative estimates of the number of orphaned and abandoned children suggest there are approximately 132 million worldwide, of whom the majority reside in Asia followed by Sub-Saharan Africa. Research on alternative care for children in need of parental protection have largely been siloed by care setting (i.e. institutional care, adoption, foster care) without consideration of risk factors across care types. One factor specific to alternative care that occurs for all children across care settings is disruption and disconnection of birth parents as a consequence of out-of-home placement. Thus, the purpose of this cross-sectional study of 170 adolescents in institutional care in South Korea was to explore whether a common risk factor specific to the experience of family removal and placement in alternative care, cognitive appraisal of birth parent loss, was present and was a risk factor for more mental health and behavior problems. Findings affirmed the majority of adolescents in institutional care had thoughts about birth parents, but most did not express negative emotions towards birth parents. A more negative appraisal of birth parent loss was found to be a significant predictor of more depressive symptoms, PTSD symptoms, and internalizing behavior problems, but not more externalizing behavior problems. Findings suggest cognitive appraisal of birth parent loss may be a risk factor for more mental health and internal behavior problems for youth in institutional care and that systems of alternative care need to assist youth in having information about their birth parents regardless of contact.