医学伦理学教育教学的改革与实践——2011年全国医学伦理学教育教学学术研讨会综述

2011年12月3日～4日;由中华医学会医学伦理学分会、广州医学院、广州市医学伦理学重点研究基地等单位共同主办的全国医学伦理学教育教学研讨会在广州召开.来自中华医学会医学伦理学分会、国家医师资格考试中心、广州市社科联等单位的领导;以及全国20多所高等院校的40余名医学伦理学专家学者参加了会议.与会的专家学者围绕医学伦理学教材建设、医学伦理学考试改革、医学伦理学教学方法探索等相关主题展开了深入而热烈的讨论.通过交流与研讨;参会的专家学者对医学伦理学教育教学领域的部分重要问题和基本问题达成了共识;对一些争论性问题进行了深入的交流;同时还针对医学伦理学教育教学的现状提出了一些有待研究的新问题.     

医学伦理学是否可教及其他--关于医学伦理学教育的再思考

医学伦理学是否可教?如果可教,应该教规范还是教价值?如何拉近医学伦理学教育与现实的距离?怎样评价医学伦理学教学的效果?不仅是临床医生和卫生管理工作者,即使作为医学伦理学研究工作的学者也都对这些问题存在着不同程度的误解,这影响了医学伦理学学科地位的确立.     

医学生医学伦理学教育的困境及对策

医学伦理学是保证医疗卫生事业健康发展的因素,对医学伦理学教育的重要性、教育形式及认同感的影响因素进行问卷调查,调查显示,学生最认可的医学伦理学教育方式是临床教师言传身教,最不认可的是公共思想品德课程;对医学伦理学的认可受社会因素、学校因素、医学生个人多种因素影响。并结合结果剖析目前医学伦理学教育存在的体制死板、师资力量匮乏、社会实践活动少等问题,提出树立正面的榜样以培养高尚的医学伦理学意识、加强医学伦理学教育类课程的建设、增加实践教学、发挥教师言传身教等方法,以提高医学生医学伦理学教育的质量。     

勇于面对现实提升伦理判断力——一项对300份医学伦理学案例写作的调查研究

通过对北京大学四所附属医院医学生300份医学伦理学案例写作的分析,了解医学生的伦理关怀和基本的价值趋向,并对当前医学伦理学教育存在的弊端进行反思.研究发现,医学生具有强烈的现实主义伦理关怀,具有批判思维的潜能,但同时又充满冲突和困境.然而,医学伦理学教育应该着重培养医学生道德能力,同时建构一个全面的支持性系统.     

检验医学的医学伦理学思考

检验医学发展迅速,然而对其医学伦理学的思考却常被人忽视.本文对日常检验工作中存在的伦理学问题进行了初步撂讨,从检验机构设置、检验项目管理、日常检验工作及检验与临床的沟通等方面思考了当今检验医学领域医学伦理学的现况.加强检验医学的医学伦理学建设,真正体现出对患者的人文关怀.     

加强医学伦理学教育指导医疗实践

通过对五所医院医务人员和两所医科大学的学生从医学伦理学教育和伦理培训等四方面进行现场调查和分析,提出目前在医科大学,医学伦理学已经逐步被认识和接受;医学伦理在临床实践和医疗科研中已有较大的影响;医学伦理委员会的工作需要进一步加强;医学伦理教育任重道远.     

教学和医疗查房中应重视伦理学相关问题

当前,在教学和医疗查房中多有忽视医学伦理学相关问题,因此,在教学和医疗查房中应将医学伦理学相关问题融入整合到教学和医疗查房中,这是教学和医疗查房的现实需要,医学模式和医患模式转变的客观要求,医学专业属性和人的属性的内在要求。融入整合的内容主要是教学和医疗查房所涉及的医学伦理实践教育内容和医学临床实践教育内容。融入整合的方法主要是借助病历报告、上级医师询问病历、病例讨论、正反案例分析、教师点评、总结等平台进行。     

检验医学的医学伦理学思考

检验医学发展迅速,然而对其医学伦理学的思考却常被人忽视。本文对日常检验工作中存在的伦理学问题进行了初步探讨,从检验机构设置、检验项目管理、日常检验工作及检验与,临床的沟通等方面思考了当今检验医学领域医学伦理学的现况。加强检验医学的医学伦理学建设,真正体现出对患者的人文关怀。     

医务人员对医学科研伦理的认知及培训情况调查

调查某三甲医院医务人员对医学科研伦理的认知及培训情况。选取该院300名医务人员作为研究对象,了解其对医学伦理委员会的认知情况以及教育培训情况。结果显示,医务人员对医院设置医学伦理委员会、科研需通过委员会审核的认知及工作期间参加医学伦理学培训的占比分别为48.33%、39.33%和54.00%;医生对医学伦理委员会的知晓情况优于技师和护士,硕士及以上学历的医务人员对医学伦理委员会的知晓情况优于大专及以下学历,差异均有统计学意义(P0.05)。医务人员对医学伦理学的认识不足,工作期间接受的培训也较少,医院应重视医学伦理学的建设工作。     

男性不育症诊疗中的伦理学思考

男性不育症是影响男性身心健康的重要疾患.生殖医学,特别是辅助生殖技术突飞猛进的发展,给男性不育症患者带来了福音,同时也给社会带来了许多伦理学问题.在工作中,医生应将伦理学原则与诊疗规范相结合,思考遇到的伦理学问题,自觉遵守医学伦理学规范.唯有这样,才能使生殖医学健康发展,才能保证患者最大程度受益.     

Ethics education and value prioritization among members of U.S. hospital ethics committees

Calls for ethics education for members of hospital ethics committees presume that the effects and benefits of such education are well-established. This is not the case. A review of the literature reveals that studies consistently have failed to uncover any significant effect of ethics education on the moral reasoning, moral competency, and/or moral development of medical professionals. The present paper discuss this negative result and describes the author's national study of the value priorities of members of hospital ethics committees. This study discovered correlations between moral decision making and factors like age and type of institution where the committee operates. The results of this study also resemble those of previous studies in finding no correlation between ethics education and moral decision making. The author concludes that there is a need for more research on the effects of nonmoral personal, societal, and institutional factors on the moral reasoning of members of hospital ethics committees. Further, in the absence of any firm empirical basis, calls for ethics education for medical professionals and ethics committee members should be rethought.     

Medical Ethics Education: A Survey of Opinion of Medical Students in a Nigerian University

In Nigeria, medical education remains focused on the traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition. In order to ascertain the adequacy of this method of moral formations, we studied the opinions of medical students in a Nigerian university towards medical ethics training. Self administered semi-structured questionnaires were completed by final year medical students of the College of Medicine, University of Ibadan, Nigeria. There were 82 (64.1%) male and 44 (34.4%) female respondents. The median age was 26 years. Most students (80.5%) responded that they did not receive enough training in medical ethics. The ethics instructions they received did not sufficiently prepare them for the ethical challenges they came across as medical students. Though inadequate, the few hours of lecture and discussion on human values and professional etiquette which they received positively influenced their moral reasoning. They identified end-of-life issues, dealing with financial issues and handling socio-cultural beliefs of patients and relations as some challenges that medical doctors are ill-prepared for by their current training. Most, 85.9% believed that formal medical ethics education would be worthwhile as it would enhance the making of complete and better doctors. They recommended incorporating bioethics as a course in the medical school curriculum. Nigerian medical students encounter ethical challenges for which they have not been adequately trained to resolve. They recommended formal medical ethics training in their curriculum and a uniform bioethics programme in the country.     

近视激光手术治疗几个问题的探讨

近视眼是目前全球发生率最高的屈光不正,我国的近视准分子激光手术水平已与世界先进水平同步,并处于快速、稳健的发展中。依据辩证法正确评价近视激光手术的优缺点,遵循系统论的整体性、最优化、动态化和模型化的基本原则,可以进一步提高激光手术治疗的视觉质量,促进近视激光手术治疗的健康发展。     

中国古代医德教育对现代医学生医德教育的启示

医德医风已成为全社会普遍关注的焦点,特殊职业要求医务工作者应具有高尚的医德,而高尚医德的培养应从医学生教育阶段开始,努力提高医学生的医德素养。我国传统的医德教育方法,如医学生人品的选拔,老师言传身教,徒弟满师传统等等对于培养现代医学生关爱病人、救死扶伤的医德风范仍具有积极的借鉴意义。     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

"伦理"与"道德"概念的三重比较义

“伦理”与“道德”是伦理学或道德哲学中的两个核心概念,但二者长期处于概念模糊和逻辑混乱状态,导致伦理学和道德教育“名不正而言不顺”。通过对这两个概念进行以词源学为基础的三重比较:汉语言文化中的比较、英语文化中的比较、中西文化中的比较,我们可以得出的结论是:当代“伦理”概念蕴含着西方文化的理性、科学、公共意志等属性,“道德”概念蕴含着更多的东方文化的情性、人文、个人修养等色彩。“西学东渐”以来,中西“伦理”与“道德”概念经过碰撞、竞争和融合的过程,目前二者划界与范畴日益清晰,即“伦理”是伦理学中的一级概念,而“道德”是“伦理”概念下的二级概念。二者不能相互替代,它们有着各自的概念范畴和使用区域。     

Does change in ethical education influence core moral values? Towards history- and culture-aware morality model with application in automatic moral reasoning

In this study, we focus on ethical education as a means to improve artificial companion’s conceptualization of moral decision-making process in human users. In particular, we focus on automatically determining whether changes in ethical education influenced core moral values in humans throughout the century. We analyze ethics as taught in Japan before WWII and today to verify how much the pre-WWII moral attitudes have in common with those of contemporary Japanese, to what degree what is taught as ethics in school overlaps with the general population’s understanding of ethics, as well as to verify whether a major reform of the guidelines for teaching the school subject of “ethics” at school after 1946 has changed the way common people approach core moral questions (such as those concerning the sacredness of human life). We selected textbooks used in teaching ethics at school from between 1935 and 1937, and those used in junior high schools today (2019) and analyzed what emotional and moral associations such contents generated. The analysis was performed with an automatic moral and emotional reasoning agent and based on the largest available text corpus in Japanese as well as on the resources of a Japanese digital library. As a result, we found out that, despite changes in stereotypical view on Japan’s moral sentiments, especially due to historical events, past and contemporary Japanese share a similar moral evaluation of certain basic moral concepts, although there is a large discrepancy between how they perceive some actions to be beneficial to the society as a whole while at the same time being inconclusive when it comes to assessing the same action’s outcome on the individual performing them and in terms of emotional consequences. Some ethical categories, assessed positively before the war, while being associated with a nationalistic trend in education have also disappeared from the scope of interest of post- war society. The findings of this study support suggestions proposed by others that the development of personal AI systems requires supplementation with moral reasoning. Moreover, the paper builds upon this idea and further suggests that AI systems need to be aware of ethics not as a constant, but as a function with a correction on historical and cultural changes in moral reasoning.     

The Effectiveness of Ethics Education: A Quasi-Experimental Field Study

Ethical conduct is the hallmark of excellence in engineering and scientific research, design, and practice. While undergraduate and graduate programs in these areas routinely emphasize ethical conduct, few receive formal ethics training as part of their curricula. The first purpose of this research study was to assess the relative effectiveness of ethics education in enhancing individuals’ general knowledge of the responsible conduct of research practices and their level of moral reasoning. Secondly, we examined the effects of ethics education on the positive psychological outcomes of perspective-taking, moral efficacy, moral courage, and moral meaningfulness. To examine our research hypotheses, we utilized a pretest–posttest quasi-experimental design consisting of three ethics education groups (control, embedded modules, and stand-alone courses). Findings revealed that both embedded and stand alone courses were effective in enhancing participants’ perspective-taking, moral efficacy, and moral courage. Moral meaningfulness was marginally enhanced for the embedded module condition. Moral judgment and knowledge of responsible conduct of research practices were not influenced by either ethics education condition. Contrary to expectations, stand alone courses were not superior to embedded modules in influencing the positive psychological outcomes investigated. Implications of these findings for future research and practice are discussed.     

Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment.