公民逝世后器官捐献的伦理审查与监督

在器官移植的供体来源为尸体器官时,无器官移植资质的医院常没有针对公民逝世后器官捐献做伦理审查。基于此现状,结合国内《执业医师法》《侵权责任法》《人体器官移植条例》《医疗机构管理条例》等有关法律法规,探讨在医疗机构环境下,公民逝世前后的器官捐献伦理审查和监督制度,以进一步尊重公民的尊严和意愿,保护隐私,避免医生职务利益冲突,规范和完善公民死亡判定与器官捐献工作流程,切实维护公民权益,增进社会公众对器官捐献伦理的认识和支持。     

《人体器官移植条例》颁布后面临的问题与对策

《人体器官移植条例》规范引导着我国器官移植健康发展,然而,随着《条例》对器官移植供、受者条件的严格限制,尸体供器官数量迅速下降,亲属活体移植逐步占据主导地位,由此引发一系列问题。结合《条例》,就器官来源短缺、保障活体供者安全、亲属活体供者选择和器官移植伦理委员会作用等问题做出较详细的分析,提出解决方法和对策。     

中国器官捐献立法完善的若干意见

《人体器官移植条例》颁布已有十余载,虽解决了器官捐献无法可依的问题,但因其内容不完备及严格的条件限制,已成为我国器官捐献发展的障碍。从人体器官捐献存在的主要问题及立法现状入手,借鉴国外器官捐献立法现状,论述该条例中器官捐献内容存在的问题,提出完善我国器官捐献的三条建议:(1)出台专门的《人体器官捐献法》;(2)从扩大活体器官捐献供体范围、适当放宽遗体器官捐献条件、建立器官捐献的有效激励机制、规范器官分配原则6个方面完善《人体器官移植条例》;(3)明确脑死亡标准,确立脑死亡立法。     

器官捐献推定同意原则在我国的境遇研究

器官捐献推定同意原则为一些国家立法承认,但在实施中尚存在伦理、法律等争议。该原则在我国的实施既存在逻辑原点方面的认识误区,也存在难以保障有效的知情同意、缺乏良好的信任环境和器官捐献公众平台建设滞后等困难。实行器官捐献推定同意应以维护人的自由平等为前提,以尊重人的自主自愿为基础,以保障愿意捐献器官的人能够实现合理合法捐献愿望为目的。同时,还需要具备存在同意的极大可能性等法律要件和充分的知情同意宣传教育,广泛的公众参与,良好的社会信用体系,方便易行的退出机制以及公正的器官分配体系等伦理条件。     

拓宽尸体器官来源的法律思考

世界各国获取尸体器官的法律规定各不相同:自愿捐献、推定同意、有偿捐献、需要决定原则、胎儿供体问题.中国有着任何国家无法比拟的人体器官资源,由于没有可实施的器官移植法律,大量的良好器官被白白浪费掉.中国应该借鉴国外行之有效的法律条文,制定正确的拓宽尸体器官来源的法律,为繁荣器官移植事业做出贡献.     

关于器官捐献中"推定同意"原则的再推定——兼与颜青山博士商榷

《医学与哲学》2 0 0 1年第 1期 ,发表了颜青山博士撰写的《论“推定同意”的伦理限制》一文 (以下简称颜文 ) ,该文就邱仁宗先生所倡导的器官捐献中的“推定同意”问题提出了质疑 ,无疑给人以新意和启迪 ,但正如作者所“推定”的 ,是否确实有“言过其实”之处。笔者在此就“推定同意”问题略陈管见 ,以期与颜先生共勉。1　关于推定同意的形而上基础首先 ,颜文认为 :“自愿捐献因为高度尊重个人的自主性 ,因此其形而上基础是个人主义的”[1] 。不知颜先生在此所指的“个人主义”是何意 ?一般而言 ,个人主义指称以个人为本位 ,强调个人利益的…     

活体器官移植中变相买卖人体器官的形式与防范

就活体器官移植而言,识别变相买卖人体器官的情形并加以防范,是亟待研究的重要课题。在活体器官移植中,人体器官买卖可能发生在非亲属之间,也可能发生在亲属之间。非亲属间的器官买卖主要表现为假冒亲属关系以及非法地下器官移植。亲属间器官买卖的主要情形是通过物质利益诱导供者捐献。防范人体器官变相买卖的措施有:将参与人体器官买卖的中介及医疗机构纳入刑法调整的对象;规范医务人员诊疗活动,严惩器官买卖涉案人员;净化网络,铲除非法器官交易滋生的环境;切实提高医院伦理委员会的审查能力;提高公众生命意识,珍视生命。     

公众对活体大器官移植的认知态度与对策

对河南地区公众关于活体大器官移植态度进行的抽样调查结果显示：（1）公众赞成开展活体大器官移植;（2）多数公众反对器官买卖,但赞成器官买卖的也有相当大的比例;（3）亲情是亲属活体器官捐献者愿意捐献的主要原因。针对调查结果,我们在比较分析的基础上,提出了相关对策,促使活体大器官移植技术更好地造福于人类。     

法哲学视域下的活体器官悔捐问题研究

器官移植是医学技术的重大进步,挽救了很多患者的生命,只是面临着器官短缺的问题。目前,我国《人体器官移植条例》赋予了捐献者任意悔捐的权利,但任意悔捐带来了诸多弊端。所以,有必要不拘泥于"实定法",而从法哲学的视域分析悔捐问题。研究发现是否捐献器官应由个体自由决定;但做出捐献承诺后应诚实守信;对悔捐行为,应区分情况,适当追责。如此,活体器官捐献方能实现三大法律原则:意思自治、诚实守信、信赖保护,器官移植才能走得更远。     

公众对活体大器官移植的认知态度与对策

对河南地区公众关于活体大器官移植态度进行的抽样调查结果显示:(1)公众赞成开展活体大器官移植;(2)多数公众反对器官买卖,但赞成器官买卖的也有相当大的比例;(3)亲情是亲属活体器官捐献者愿意捐献的主要原因.针对调查结果,我们在比较分析的基础上,提出了相关对策,促使活体大器官移植技术更好地造福于人类.     

Intrahemispheric response competition between vocal and unimanual performances in normam adult human males.

Subjects balanced a dowel rod vertically on the left and right index finger singly and while simultaneously repeating phrases. With right-handed subjects who had no left-handed relatives, concurrent verbalization shortened right- but not left-handed balancing. Increased phonetic difficulty of the phrases produced an increased decrement on right-handed balancing, but left-handed balancing was unchanged; it also produced more verbalization errors on trials with the right hand, but not with the left. Concurrent verbalization shortened balancing duration with both hands of left-handers. Right-handers with left-handed relatives produced variable results. Concurrent humming also selectively interfered with right-handed balancing. It was concluded that the results conform to an interpretation based on intrahemispheric interference between incompatible, simultaneously produced sets of responses.     

Disclosure of Genetics Research Results after the Death of the Patient Participant: A Qualitative Study of the Impact on Relatives

When a gene mutation is identified in a research study following the death of the study participant, it is not clear whether such information should be made available to relatives. We report here an evaluation of the impact on relatives of being informed of study results that detected pathogenic BRCA2 mutations in a male relative, now deceased, who had early onset (under the age of 55) prostate cancer. The breast and ovarian cancer risk was unknown to the living relatives. Qualitative analysis of interviews with thirteen relatives indicated that those who had a higher risk perception, resulting from an awareness of cancer family history or experiential knowledge of cancer in their family, tended to adjust more easily to the results. All participants believed that genetics research results of clinical significance should be fed back to relatives. Those who were fully aware of the BRCA2 results and implications for themselves felt they had benefited from the information, irrespective of whether or not they had elected for genetic testing, because of the consequent availability of surveillance programs. Initial anxiety upon learning about the BRCA2 result was alleviated by genetic counselling. Factors influencing those who have not engaged with the information included scepticism related to the relative who attempted to inform them, young age and fear of cancer. Those who had not sought genetic counselling did not attempt further dissemination, and some were not undergoing regular screening. Implications for informed consent in genetics research programs, and the requirement for genetic counselling when research results are disclosed, are discussed. Names have been changed to protect the privacy of study participants.     

Ethical Issues in Cancer Genetics: 1) Whose Information Is It?

This article presents and discusses four clinical cases that exemplify the complexity of ethical dilemmas concerning the provider's obligation to disclose or withhold genetic information from patients. Case 1: What is the responsibility of the cancer genetics provider to ensure that a positive test results is shared with distant relatives? Case 2: To ensure that results go to at-risk relatives, do we have the right to ignore the wishes of the designated next-of-kin? Case 3: Do we have the right to reveal a familial BRCA1 mutation to a patient's relative, who is at 50% risk? Case 4: Do we have an obligation to reveal that a patient is not a blood relative and therefore, not at risk to have inherited a familial mutation? These cases form the basis for discussing the provider's dual obligations to keeping patient confidentiality and informing patients and families about risk (i.e. duty to warn). We also provide a summary of consensus points and additional discussion questions for each case.     

神经培养的发展史与启示

简述神经培养技术与各学科关系的现状并回顾神经培养的发展历史,将神经培养历史划分为萌芽期、起步期、迅速发展阶段和新发展阶段等.从神经培养技术发展的角度入手,分析了新技术的突破与学科发展的密切关系.     

Communication Between Breast Cancer Patients Who Received Inconclusive Genetic Test Results and Their Daughters and Sisters Years After Testing

Inconclusive genetic test results including screening recommendations for the breast cancer patients and their first-degree relatives are the most common outcomes of BRCA 1/2 testing. Patients themselves should communicate these results to their relatives. Our aim was to explore communication of breast cancer genetic counseling results with daughters and sisters over a long period of time. Breast cancer patients, who had received an inconclusive DNA test result 7–14 years earlier, completed a self-report questionnaire. Additionally, in-depth interviews were conducted and analysed thematically. Of the 93 respondents, 85 (91 %) considered themselves responsible for communicating genetic test results to relatives. In-depth interviews (n?=?14) showed, that counselees wanted ‘to hand over’ their responsibilities to communicate the test results and screening recommendations to their sisters. Although most patients had informed their daughters and sisters about the genetic test results, usually little is spoken about genetic test results and screening recommendations once the duty of informing is completed. We recommend that, similar to the procedure for BRCA1/2-mutation carriers, a separate letter for first-degree relatives of patients with an inconclusive test result should be provided. In this way information about risks and screening recommendations can be verified by family members years after genetic testing has been completed.     

The relationship of relatives' attributions to their expressed emotion and to patients' improvement in treatment for anxiety disorders

In a test of Hooley's (1987) attributional model of expressed emotion (EE), attributions for negative behaviors and events in patients' lives were examined in relatives of 74 outpatients with panic disorder with agoraphobia or obsessive-compulsive disorder. Attributions were extracted from 10-minute problem-solving interactions between relatives and patients, whereas EE was assessed during a separate interview with the relative. Consistent with prior findings in relatives of individuals with other disorders, relatives who made greater proportions of attributions of patient responsibility demonstrated significantly higher levels of EE-hostility. In addition, nonspousal relatives (mostly parents) who attributed any negative behaviors or events to a patient's disorder were significantly higher in emotional overinvolvement (EOI); no such relationship was found for spouses. Finally, patients with relatives who made attributions to the patient's disorder received less benefit from behavior therapy than did those whose relatives made no such attributions, even when EE variables were controlled.     

浅析知情同意权在我国立法中的不足

分析了我国在知情同意问题上的法律规则,指出我国现有法律存在四方面的立法缺陷,即对医生同时柯加告知义务与不告知义务,使医生陷入两难处境;在病人同意权方面只要求实验性和特殊诊疗措施征得病人同意,同意的主体上多且乱,过份强调病人家属的同意,侵害或剥夺了病人的自主权;对知情同意权的含义认识不清;知情权与同意权相分离而没有形成完整统一的病人知情同意权,在此基础上,提出完善我国立法的建议。     

Hypnotic susceptibility and familial handedness

The possible relationship between hypnotic susceptibility and familiar handedness was examined. In a mass-testing session of students enrolled in introductory psychology classes, subjects were administered the Harvard Group Scale of Hypnotic Susceptibility, Form A and were also required to complete a questionnaire that ascertained information on their dominant handedness and that of their immediate family relatives. Subjects who had immediate sinistral relatives scored significantly lower in hypnotic susceptibility compared to those who had a history of familial dextrality. When immediate relatives of the original subject pool were tested on hypnotic susceptibility level, sinistral relatives scored lower in susceptibility than dextral relatives. This may indicate the existence of a familial component in hypnotic susceptibility.     

Psychometric detection of schizotypy: perceptual aberration and physical anhedonia in relatives of schizophrenics.

We administered scales of Perceptual Aberration (PERAB) and Physical Anhedonia (PHYSAN), traits that may be related to risk for schizophrenia, to 54 schizophrenics, 146 of their first-degree relatives (evaluated for schizophrenia-related disorders), and 178 normal subjects (screened for psychotic disorders in them or their relatives). For both scales, there was a significant effect of group membership. For the PERAB scale, the schizophrenics had higher scores than the normal subjects, who had higher scores than the relatives. For the PHYSAN scale, schizophrenics had higher scores than their relatives, who had higher scores than the normal subjects. Patterns of familial correlations also suggested that physical anhedonia, but not perceptual aberration, may be familial among schizophrenics and their relatives. The PHYSAN scale, but not the PERAB one, may be a useful indicator of liability for schizophrenia among the relatives of affected probands.