论循证医学的医疗伦理模式及其缺陷

循证医学的诞生促成了一种有别于传统医学的新的医疗伦理模式,增进了医疗的"善"与研究的"真"、医生的自律与他律、医生自主与病人价值观之间的统一,让参与各方共同承当医疗道德责任,更为合理地配置了有限的医疗资源.但是,循证医学又存在着研究的"真"不一定导致医疗的"善"、医疗结局难以测量、合乎科学与伦理双重规范的试验难以执行、管理者权力失去制衡、补充与替代医疗及某些特殊群体受到不公正待遇等医学伦理问题.对此,应该采取一种更为开放、多元的态度,公平地对待各种来源的证据、包容其它的医学实践方式、艺术化地实施循证医学,不断完善这一新的医疗伦理模式.     

卫生经济伦理学对医疗完全市场化的质疑

不管处于什么发展水平的国家,都需要进行持续的卫生保健改革,这已成为整个社会政治改革的一部分,卫生保健改革已经融入整个世界的社会大变革中.卫生经济问题无一不具有道德成分,无一能离开伦理政策得以解决.我们对中国医疗卫生体制改革的伦理学展望中,提倡一种"公平优先,兼顾效率"的价值观.我们需要正确认识市场的目标、价值和规律,正确理解和发挥政府和市场的调节作用,促进医疗卫生体制改革的健康发展.     

卫生经济伦理学对医疗完全市场化的质疑

不管处于什么发展水平的国家,都需要进行持续的卫生保健改革,这已成为整个社会政治改革的一部分,卫生保健改革已经融入整个世界的社会大变革中。卫生经济问题无一不具有道德成分,无一能离开伦理政策得以解决。我们对中国医疗卫生体制改革的伦理学展望中,提倡一种“公平优先,兼顾效率”的价值观。我们需要正确认识市场的目标、价值和规律,正确理解和发挥政府和市场的调节作用,促进医疗卫生体制改革的健康发展。     

略论伦理经济

本文将不再坚持传统的伦理与经济的二分法的观点,不把伦理看作只是对经济存在一种能动的反作用。试图从一个新的伦理经济的视角研究,伦理经济把伦理本身看作是渗透在经济之中的一种经济因素,经济本身内涵着伦理价值。伦理与经济互相渗透,互相作用,在一定意义上互为一体。因为问题过于宏大和复杂,无法进行全面研究,只从伦理道德作为伦理精神和作为资本如何与经济因素融合这样二个方面加以论证。     

Ethical Issues in Counselling and Health in Primary Care

Primary care is the first contact with the health service for patients and is thus the meeting point for people with different perspectives on emotional and psychological issues. The counselling model needs to examine the moral problems posed by these difficulties, and its own differences from the standard health care model, where cure and symptomatic relief rather than personal growth may be the aim. Key situations and relationships are examined against a background of accepted ethical principles (respect for autonomy, the duty to care, minimising harm, and being fair) from the viewpoint of all involved in the encounter, with particular reference to conflicts, responsibilities, confidentiality, and methods of referral and joint working.     

我国医疗卫生改革中的伦理缺席

"中国的医疗卫生体制改革从总体上说是不成功的"结论的发表在社会上引发了对卫生改革的种种议论,从卫生改革的设计、实施和评估三方面论述了由于政府的缺位和伦理学的缺席,将卫生改革引向功利主义的死胡同,使得卫生改革背离了公正的目标而导致失败.但退回计划经济体制下的办医模式同样没有出路,在今后的深化改革中,必须强调医学目的,贯彻以人为本的指导思想,加大政府的投入,围绕公正目标,建立覆盖全民的医疗保障体制.     

美国家庭的衰弱:对卫生保健制度的一些启示

传统社会的人并不孤单,当他们生病、衰老时会得到家庭成员的照料.在美国,越来越多的孩子出生在婚姻之外,家庭正在逐步消失.在那些经济和社会资源来源极少的人群中,传统家庭消失得最为迅速,预示着日益增加的社会反常状态.即使对于卫生保健极为重要的非正式支持网络没有丧失,传统家庭也一样正在衰弱.因此,医疗改革必需重视家庭医疗保健储蓄账户,以阻止家庭完整性的剧烈衰弱.     

Confidant Relations Among Taiwanese: Implications for Ethnic Chinese Health Care Treatment

The select individual(s) whom one trusts in sharing important personal matters is sometimes referred to as a confidant. The confidant relationship has received increasing attention in recent years as a major social factor contributing to individual health and wellness. Yet, little empirical data has been available to guide health researchers, policy-makers, and practitioners. In this study, 142 adult Taiwanese responded to a structured questionnaire. Participants comprised 105 females, 32 males, and five with sex unspecified (overall mean age?=?33.8, age range?=?18 to 74 years). They were asked whether they had a confidant, and if so, to describe various features of this relationship. Contrary to previous studies conducted in Europe and the Americas, our investigation found that Taiwanese men were equally likely as Taiwanese women to have a confidant (87.5 % of males and 89.5 % for females). Taiwanese women were significantly more likely to have a female rather than a male confidant, whereas males showed no such sex difference. A significantly higher percentage of confidants were non-family members rather than spouses or other immediate/extended family members. This finding is consistent with research on the relatively minor salience of emotional intimacy in Taiwanese marriages and the hierarchical structures of many Taiwanese families. The implications of our findings for enhancing Taiwanese and broader ethnic Chinese health treatment are discussed.     

Ethical Implications in Screening for Ethics Violations

The process of admittance to membership in a psychological organization is an opportune time to take into consideration any questionable behavior in the professional background of a prospective member. Membership application forms of the American Psychological Association (APA) and 58 affiliated organizations are reviewed to determine the kinds of questions that are asked about ethical misconduct. The nature of the inquiry differs considerably from one association to another, with a preponderance of organizations avoiding any direct questions about professional ethics. Discussion is focused on how these different screening strategies impact on the applicant and the organization. There is a demonstrated need for appropriately formulated queries. A case is made for resolving current inconsistencies among associations by adhering to a unified procedure in the ethical screening of psychologist applicants.     

A memo from the central office: the "Ethical and Religious Directives for Catholic Health Care Services"

In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that the bishops seek to protect.     

The Ethical Standard of Care

The recent TeGenero phase I trial of a novel monoclonal antibody in healthy volunteers produced a drastic inflammatory reaction in participants receiving the experimental agent. Commentators on the ethics of the research have focused considerable attention on the role of financial considerations: the for-profit status of the biotechnology company and Contract Research Organization responsible respectively for sponsoring and conducting the trial and the amount of monetary compensation to participants. We argue that these financial considerations are largely irrelevant and distort ethical appraisal of this tragic research. Except for administering the antibody to all 6 participants nearly simultaneously, the trial appears to fulfill all of the critical ethical requirements for clinical research—social value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for enrolled participants.     

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested.     

Ethical Challenges for Jewish Long Term Care Providers

ABSTRACT

This article discusses the particular ethical challenges and opportunities facing Jewish long term care providers. The discussion begins with background on Jewish healthcare ethics generally and then notes several problems in applying traditional principles in concrete situations today. Specific ethical dilemmas characterizing long term care are described, and their implications for practice within Jewish facilities are explicated. Finally, suggestions are offered regarding special contributions that can be made to both the Jewish community and the larger society by bringing the perspective of Jewish healthcare ethics to the arena of long term care provision and policy-making for aging citizens.     

Mental Health,Culture and Spirituality: Implications for the Effective Psychotherapeutic Care of Australia's Ageing Migrant Populations

SUMMARY

In this essay, attention is given to discussing the notions of and influences of culture, mental health and spirituality. Research shows that people who came to Australia either as immigrants or refugees are at risk of suffering a disproportionate incidence of mental problems relative to the rest of the Australian population. Older male immigrants are particularly at risk. A key variable influencing the mental health of immigrants/refugees in Australia is the social conditions in which they live. Another largely unrecognised variable influencing mental health is spirituality. The extent to which the expression of spirituality promotes mental health and healing, however, will depend on cross-cultural perceptions of what spirituality is, and how it influences mental health, illness and recovery. Whatever the perceptions of spirituality, it is important to understand that its roots are cultural, and its influence is on meaning construction. Meaning construction, in turn, is itself culturally mediated and framed. Given this, it is crucial that culture-what it is and how it influences human experience-is understood by health professionals if they are to be able to provide meaningful and therapeutically effective care to culturally diverse people and their mental health problems. A central aim of this essay is to facilitate this understanding.     

Predictors of Recent Mental Health Service Use in a Medical Population: Implications for Integrated Care

This study investigated the relationship between physical and mental health and psychosocial variables and recent (within the last 12 months) mental health service use among 240 medical patients recruited from general and specialty outpatient clinics at an academic medical center. Results indicated 43.3% of the participants had recently received mental health services in the form of psychotropic medication (75%), psychotherapy (2%), or a combination of these treatments (20.2%). Among patients with moderate to severe symptoms of anxiety or depression, approximately two-thirds were receiving mental health treatment. Moreover, four variables (healthcare provider referral for mental health services, perceived need for mental health services, prior use of mental health services, and frequency of medical appointments) were significant unique predictors of recent mental health service use. This suggests collaborative/integrated medical care may increase needed mental health service use.     

论权力合法性的伦理意蕴

权力合法性是公众对权力的确证,任何政治权力均会涉及合法性,但在以往的研究中,学界只倾注于权力合法性的政治视角,忽视了权力合法性应有的内核——伦理道德因素。事实上,在权力合法性的诸多支撑要素中,伦理因素是个极为重要的因素,它是公民体认权力是否正当的前提,是权力赢得合法性的驱动器,研究和巩固权力合法性必须从伦理道德因素入手。     

关于麻醉后监测治疗室的伦理思考

麻醉后监测治疗室(post-anesthesia care unit,PACU)中医学高新技术设备对确保手术后患者的安全发挥极其重大的作用,然而PACU中也产生许多危机与伦理冲突.为了PACU的良性发展,我们认为如下伦理准则必须遵循:科学认定准则、最佳选择准则、精益求精准则、无伤准则、患者自主准则.