Justice and Long-Term Care: A Theological Ethical Perspective

The relevance of justice for the current debate on long-termcare is explored on the basis of demographic and economic data,especially in the U.S. and Germany. There is a justice questionconcerning the quality and availability of long-term care fordifferent groups within society. Mapping the justice debateby discussing the two main opponents, John Rawls and RobertNozick, the article identifies fundamental assumptions in boththeories. An exploration of the biblical concept of the "optionfor the poor" and its influence on a new "ecumenical socialteaching from below" leads to the conclusion that a Christianethical account of long-term care will argue for a system thatguarantees decent care to every citizen. The German model ofSoziale Pflegeversicherung is presented as one possible optionfor putting this ethical guideline into political practice.In a final reflection, the role of religious affiliation forlong-term care is discussed by looking at empirical data andby naming seven dimensions of faith-driven long-term care.     

With Hope and Imagination: Imaginative Moral Decision-Making in Neonatal Intensive Care Units

Although the role of imagination in moral reasoning is often neglected, recent literature, mostly of pragmatist signature, points to imagination as one of its central elements. In this article we develop some of their arguments by looking at the moral role of imagination in practice, in particular the practice of neonatal intensive care. Drawing on empirical research, we analyze a decision-making process in various stages: delivery, staff meeting, and reflection afterwards. We show how imagination aids medical practitioners demarcating moral categories, tuning their actions, and exploring long-range consequences of decisions. We argue that imagination helps to bring about at least four kinds of integration in the moral decision-making process: personal integration by creating a moral self-image in moments of reflection; social integration by aiding the conciliation of the diverging perspectives of the people involved; temporal integration by facilitating the parties to transcend the present moment and connect past, present, and future; and epistemological integration by helping to combine the various forms of knowledge and experience needed to make moral decisions. Furthermore, we argue that the role of imagination in these moral decision-processes is limited in several significant ways. Rather than being a solution itself, it is merely an aid and cannot replace the decision itself. Finally, there are also limits to the practical relevance of this theoretical reflection. In the end, it is up to care professionals as reflective practitioners to re-imagine the practice of intensive care and make the right decisions with hope and imagination.

A Heideggerian Defense of Therapeutic Cloning

Debates about the legitimacy of embryonic stem-cell research have largely focused on the type of ethical value that should be accorded to the human embryo in␣vitro. In this paper, I try to show that, to broaden the scope of these debates, one needs to articulate an ontology that does not limit itself to biological accounts, but that instead focuses on the embryo’s place in a totality of relevance surrounding and guiding a human practice. Instead of attempting to substantiate the ethical value of the embryo exclusively by pointing out that it has potentiality for personhood, one should examine the types of practices in which the embryo occurs and focus on the ends inherent to these practices. With this emphasis on context, it becomes apparent that the embryo’s ethical significance can only be understood by elucidating the attitudes that are established towards it in the course of specific activities. The distinction between fertilized embryos and cloned embryos proves to be important in this contextual analysis, since, from the point of view of practice, the two types of embryos appear to belong to different human practices: (assisted) procreation and medical research, respectively. In my arguments, I highlight the concepts of practice, technology, and nature, as they have been analyzed in the phenomenological tradition, particularly by Martin Heidegger. I come to the conclusion that therapeutic cloning should be allowed, provided that it turns out to be a project that benefits medical science in its aim to battle diseases. Important precautions have to be taken, however, in order to safeguard the practice of procreation from becoming perverted by the aims and attitudes of medical science when the two practices intersect. The threat in question needs to be taken seriously, since it concerns the structure and goal of practices which are central to our very self understanding as human beings.     

Using a new analysis of the best interests standard to address cultural disputes: Whose data,which values?

Clinicians sometimes disagree about how much to honor surrogates’ deeply held cultural values or traditions when they differ from those of the host country. Such a controversy arose when parents requested a cultural accommodation to let their infant die by withdrawing life saving care. While both the parents and clinicians claimed to be using the Best Interests Standard to decide what to do, they were at an impasse. This standard is analyzed into three necessary and jointly sufficient conditions and used to resolve the question of how much to accommodate cultural preferences and how to treat this infant. The extreme versions of absolutism and relativism are rejected. Properly understood, the Best Interests Standard can serve as a powerful tool in settling disputes about how to make good decisions for those who cannot decide for themselves.     

人际心理治疗的发展

人际心理治疗是一种有时间限制、基于操作手册和生活事件、诊断指向的实证性心理治疗方法。它最初主要被用于重型抑郁成年患者的门诊治疗,现已被用于治疗多种心理障碍。人际心理治疗过程变化包括：是否还赋予患者“病人”角色、人际关系问题领域的变化、如何处理结束和安排时间等。不过,有关治疗过程的研究还很少。为了更好地满足大众的需要,它与其他心理治疗成分进行了整合及其自身的简化。文章最后讨论了人际心理治疗发展的特点和问题     

Prevalence of mental health problems in Australian university health services

General practice patients report greater mental health problems than the general population, and students attending one university health service have reported greater prevalence rates at the end of the academic year. This study assessed the overall prevalence rate of mental health problems in university students using a cross‐sectional survey design of 1,168 students from three large, predominantly urban, Australian university health services. Approximately half of the students attending university health services reported elevated levels of psychological distress. The majority of severely distressed students had not sought any professional assistance for mental health problems. While there is scope for general practitioners to take a lead role in the identification of mental health problems in tertiary students, adequate treatment pathways need to be available. Implications for the role of universities in prevention work are discussed.     

Witnessing to Hope in the Christian Community Through Irony

The concept of witnessing to hope reminds us that nurturing hope is fundamentally a communal endeavor. In the Christian tradition, this witnessing takes a particular form. It involves the use of the ironic imagination: Death leads to new life, the poor are considered blessed, and the faithful boast in their suffering. It is argued that a central pastoral task is stimulating the ironic imagination. While this can take place in a number of settings, the focus here is on public worship. Practical examples of how this task might be executed are offered.

无痛人流利弊谈

无痛人流术是对早孕妇女的一种人文关怀,它缓解了手术对身体和精神上的痛苦,但也引发了一些医疗、认识和社会问题。文中阐述了我国人流现状和无病人流术的实施方法,分析了无痛人流的利与弊。指出应加强生殖健康教育和避孕知识宣传,规范医疗广告,让青年妇女正确认识无痛人流。     

癌症姑息治疗的临床意义和社会伦理思考

姑息医学作为医学学科之一,内容包括癌痛控制,处理缓解其他症状。癌症姑息治疗缓解了紧张的医患关系,有效的防止有限医疗资源的浪费及分配不公,同时姑息治疗给人们留下诸多社会伦理思考,如告知、癌痛控制等问题。如何将姑息治疗扩展到其他非恶性疾病面临着巨大挑战。     

医学人文关怀在儿科临床实践中的应用

医学的人文精神决定了医疗服务必须体现人文关怀。医学人文关怀是医疗活动的重要组成部分,如今培养人文关怀精神已越来越成为医学教育中不可分割的一部分。儿科学,专科性强,对象特殊,疾病发展变化迅速,工作风险较大。这要求儿科医生应具有更扎实的临床基本功,同时也需要表现人文关怀精神并融入临床实践的每一个环节。这是高质量医疗服务和医学模式转换的必然要求,并且有助于正确决策,减少医疗纠纷。本文目的旨在阐明人文关怀与儿科临床实践之间的关系及其在儿科临床实践中的重要性,并针对目前存在于儿科临床实践中人文冷漠现象提出一些建设性意见。