新生儿重症监护室中放弃治疗的伦理问题

对于新生儿重症监护室中的一部分危重新生儿,虽然可以借助高新尖的医疗技术挽留他们的性命,但却不能避免其出现影响远期生存质量的后遗症。因此患儿家属和医务人员陷入了是否对这些危重新生儿实施放弃治疗的两难困境。对NICU中放弃治疗的对象、伦理学依据、伦理学意义以及如何实施放弃治疗的问题加以讨论,为NICU医务人员提供有益参考。     

新生儿重症监护室中放弃治疗的伦理问题

对于新生儿重症监护室中的一部分危重新生儿,虽然可以借助高新尖的医疗技术挽留他们的性命,但却不能避免其出现影响远期生存质量的后遗症.因此患儿家属和医务人员陷入了是否对这些危重新生儿实施放弃治疗的两难困境.对NICU中放弃治疗的对象、伦理学依据、伦理学意义以及如何实施放弃治疗的问题加以讨论,为NICU医务人员提供有益参考.     

新生儿重症监护室（NICU）中放弃治疗的决策

随着现代主义哲学与伦理学,尤其是生命价值理论对"放弃治疗"的支持,以及相关科学标准和程序法则的建立,对于新生儿重症监护室中的一部分病情危重且又预后不良的新生儿来说,理应作出放弃治疗的决策。但在实施的过程中,存在许多困难,医生有客观告知的义务,但最后的决策权仍在患儿父母。从NICU中放弃治疗的对象、依据、医院面临的困境、决策的实施以及解决实施过程中矛盾冲突的对策方面加以讨论。     

新生儿重症监护室(NICU)中放弃治疗的决策

随着现代主义哲学与伦理学,尤其是生命价值理论对"放弃治疗"的支持,以及相关科学标准和程序法则的建立,对于新生儿重症监护室中的一部分病情危重且又预后不良的新生儿来说,理应作出放弃治疗的决策.但在实施的过程中,存在许多困难,医生有客观告知的义务,但最后的决策权仍在患儿父母.从NICU中放弃治疗的对象、依据、医院面临的困境、决策的实施以及解决实施过程中矛盾冲突的对策方面加以讨论.     

关于白血病患儿放弃治疗的思考

对于那些不可治愈、无治疗价值的晚期白血病患儿,虽然借助现代医疗技术可以使他们的生命得以延长,但生命质量却得不到提高,选择放弃治疗可能更符合伦理学和患儿及家庭的最佳利益。对白血病患儿放弃治疗的原因进行了分析,并对这一社会问题进行了伦理、法律和医学等方面的思考。     

关于白血病患儿放弃治疗的思考

对于那些不可治愈、无治疗价值的晚期白血病患儿,虽然借助现代医疗技术可以使他们的生命得以延长,但生命质量却得不到提高,选择放弃治疗可能更符合伦理学和患儿及家庭的最佳利益.对白血病患儿放弃治疗的原因进行了分析,并对这一社会问题进行了伦理、法律和医学等方面的思考.     

放弃治疗与生命质量--对生命质量和"放弃"的求证

卫生资源严重短缺和“善待生命”传统的冲突将在卫生经济伦理学的建构中得到缓释 ,后现代主义哲学与伦理学 ,尤其是生命价值理论对“放弃治疗”予以理论支撑 ,而它源于医学科学技术发展、经济伦理背境和西方各种哲学和伦理学反传统的思潮 ,并指导“放弃治疗”的科学标准的建立和程序法则。     

放弃治疗与生命质量：对生命质量和“放弁”的求证

卫生资源严重短缺和“善待生命”传统的冲突将在卫生经济伦理学的建构中得到缓解,后现代主义哲学与伦理学,尤其是生命价值理论对“放弃治疗”予以理论支撑,而它源于医学科学技术发展、经济伦理背境和西方各种哲学和伦理学反传统的思潮,并指导“放弃治疗”的科学标准的建立和程序法则。     

放弃治疗面面观

放弃治疗有广义和狭义两种概念,根据临床实践分为主动放弃和被动放弃、单方放弃和双方放弃、明示放弃和暗示放弃、完全放弃和部分放弃。有许多的放弃治疗从患者本人、亲属、医务人员和医疗付费等方面考虑都有积极的意义。在医学伦理学中放弃治疗一直是一个有争议的问题,其道德意义在于体现了唯物主义观点,对人生命的尊重和社会公益原则。对其立法问题有待解决。     

肝癌肝移植与放弃治疗的伦理选择

探讨我国肝癌肝移植现状及其伦理要求.在我国卫生资源短缺且分配不公的形式下,肝移植手术大幅度增长的背后隐藏的是尖锐的伦理冲突.后现代主义哲学与伦理学,尤其是生命价值理论对放弃治疗予以理论支撑.在肝癌肝移植与放弃治疗的伦理冲突中,做出公平审慎的选择.     

Ethical Dimension of Paediatric Cochlear Implantation

In congenitally or prelingually deaf childrencochlear implantation is open to seriousethical challenge. The ethical dimension ofthis technology is closely related to both asocial standard of quality of life and to theuncertainty of the overall results of cochlearimplantation. Uncertainty with regards theacquisition of oral communicative skills.However, in the western world, available datasuggest that deafness is associated with thelowest educational level and the lowest familyincome. Notwithstanding the existence of aDeaf-World, deafness should be considered as ahandicap. Therefore, society should provide themeans for the fulfilment of a deaf child'sspecific needs.For the time being there is no definitiveanswer with regard the best way to rehabilitatea particular deaf child. Therefore,communitarian values may be acceptable. If thedeaf child parents' decide not to implant,their decision should be respected. Guardiansare entitled to determine which standard ofbest interest to use in a specificcircumstance. They are the proper judges ofwhat (re)habilitation process is best for theirdeaf child. However, most deaf children areborn to two hearing parents. Probably, theywill not be acculturated in the Deaf-World. Itfollows that cochlear implantation is awelcomed (re)habilitation technology.If auditory (re)habilitation will in the futureprovide the necessary communicative skills, inparticular oral language acquisition, customs,values and attitudes of the hearing worldshould be regarded as necessary to accomplish adeaf child's right to an open future. Ifcochlear implantation technology will provideall deaf children with the capacity to developacceptable oral communicative skills –whatever the hearing status of the family andthe cultural environment – then auditory(re)habilitation will be an ethical imperative.     

End of Life Pediatric Research: What About the Ethics?

Clinical trials are required in order to develop new treatments and improve both patient life expectancy and quality of life. In this respect the last 10 years proved their efficiency. However clinical research shows one of the most difficult dilemmas from an ethical point of view. Patients included in clinical trials are submitted to known and unknown risks and hazards, but rarely benefit from the results. This is even more evident when clinical trials use children who are terminally ill. The core consideration becomes how far should we go with research when considering the child best interest.     

Ethical considerations in neuroimaging and its impact on decision-making for neonates

Neuroimaging can now provide information about structure and function. Despite new and improved neuroimaging technologies applicable to the newborn, predictions about later cognition, learning, social and emotional behavior, and neuromuscular capabilities, based on images of a fetus inside or a newborn outside the womb, are fraught with difficulties that go beyond technical ones. The interpretation of neuroimages may be necessary but it is not sufficient for decision-making related to the withholding or withdrawing of medical support for neonates. As the explanatory reach of neuroimaging increases, there will still need to be consideration of ethical issues as they relate to the best interests of the neonate and the neonate's parents, the quality of life of the neonate and non-beneficial treatment. Once this is appreciated, the boundary between the technical and the ethical will be less often disputed.     

小康社会与公民道德断想

应当把社会伦理关系的变革和主体道德人格的完善列为全面建设小康社会的基本的价值目标 ,不仅要切实理顺经济伦理关系 ,而且必须逐步建立起与社会主义市场经济体制相适应的、公正的政治伦理关系和文化伦理关系。小康社会的道德要求包括经济交往中的效率与公平、政治生活中的正义与民主、文化领域中的服务与奉献。小康社会的人格理想将以追求人性的自我完善和人格的自主、自觉、自由为基本特点。小康社会也将使人们的行为方式发生这样或那样的变化。     

Surrogate medical decision making on behalf of a never-competent, profoundly intellectually disabled patient who is acutely ill

With the improvements in medical care and resultant increase in life expectancy of the intellectually disabled, it will become more common for healthcare providers to be confronted by ethical dilemmas in the care of this patient population. Many of the dilemmas will focus on what is in the best interest of patients who have never been able to express their wishes with regard to medical and end-of-life care and who should be empowered to exercise surrogate medical decision-making authority on their behalf. A case is presented that exemplifies the ethical and legal tensions surrounding surrogate medical decision making for acutely ill, never-competent, profoundly intellectually disabled patients.     

But murderers can have all the children they want: Surrogacy and public policy

No new ethical issue is created by reproductive technologies. The state should not intervene to suppress individual rights to take advantage of these technologies, including third party donations. Some individuals will view these technologies as the best available option for having and rearing children. The major values to be protected in public policy ought to be compassion, privacy and procreative rights.     

Pacemaker deactivation: withdrawal of support or active ending of life?

In spite of ethical analyses assimilating the palliative deactivation of pacemakers to commonly accepted withdrawings of life-sustaining therapy, many clinicians remain ethically uncomfortable with pacemaker deactivation at the end of life. Various reasons have been posited for this discomfort. Some cardiologists have suggested that reluctance to deactivate pacemakers may stem from a sense that the pacemaker has become part of the patient??s ??self.?? The authors suggest that Daniel Sulmasy is correct to contend that any such identification of the pacemaker is misguided. The authors argue that clinicians uncomfortable with pacemaker deactivation are nevertheless correct to see it as incompatible with the traditional medical ethics of withdrawal of support. Traditional medical ethics is presently taken by many to sanction pacemaker deactivation when such deactivation honors the patient??s right to refuse treatment. The authors suggest that the right to refuse treatment applies to treatments involving ongoing physician agency. This right cannot underwrite patient demands that physicians reverse the effects of treatments previously administered, in which ongoing physician agency is no longer implicated. The permanently indwelling pacemaker is best seen as such a treatment. As such, its deactivation in the pacemaker-dependent patient is best seen not as withdrawal of support but as active ending of life. That being the case, clinicians adhering to the usual ethical analysis of withdrawal of support are correct to be uncomfortable with pacemaker deactivation at the end of life.     

Practice Precedes Theory: Doing Bioethics “Naturally” Is There an Ethicist in the House?: On the Cutting Edge of Bioethics

Jonathan Moreno argues that a pragmatic approach is the best approach for bioethicists and health care practitioners to use when confronted with difficult ethical problems. There is no one formula to which to appeal in determining which course of action is right or wrong when making decisions about hastening or prolonging life, for example. Instead the best decision that can be expected under the circumstances emerges as the result of a slow process of consensus building, negotiation, and compromise. Decision makers' interpretive and reflective skills need to be strengthened to achieve this type of ethical decision.     

The Conception of Life in Synthetic Biology

The phrase ??synthetic biology?? is used to describe a set of different scientific and technological disciplines, which share the objective to design and produce new life forms. This essay addresses the following questions: What conception of life stands behind this ambitious objective? In what relation does this conception of life stand to that of traditional biology and biotechnology? And, could such a conception of life raise ethical concerns? Three different observations that provide useful indications for the conception of life in synthetic biology will be discussed in detail: 1. Synthetic biologists focus on different features of living organisms in order to design new life forms, 2. Synthetic biologists want to contribute to the understanding of life, and 3. Synthetic biologists want to modify life through a rational design, which implies the notions of utilising, minimising/optimising, varying and overcoming life. These observations indicate a tight connection between science and technology, a focus on selected aspects of life, a production-oriented approach to life, and a design-oriented understanding of life. It will be argued that through this conception of life synthetic biologists present life in a different light. This conception of life will be illustrated by the metaphor of a toolbox. According to the notion of life as a toolbox, the different features of living organisms are perceived as various rationally designed instruments that can be used for the production of the living organism itself or secondary products made by the organism. According to certain ethical positions this conception of life might raise ethical concerns related to the status of the organism, the motives of the scientists and the role of technology in our society.     

Nietzsche on Art and Freedom

There are passages in Nietzsche that can be read as contributions to the free will/determinism debate. When read in that way, they reveal a fairly amateurish metaphysician with little of real substance or novelty to contribute; and if these readings were apt or perspicuous, it seems to me, they would show that Nietzsche's thoughts about freedom were barely worth pausing over. They would simply confirm the impression—amply bolstered from other quarters—that Nietzsche was not at his best when addressing the staple questions of philosophy. But these readings sell Nietzsche short. He had next to no systematic interest in metaphysics, and his concern with the question of freedom was not motivated by metaphysical considerations. Rather—and as with all of Nietzsche's concerns—his motivations were ethical. He was interested, not in the relation of the human will to the causal order of nature, but in the relation between freedom and the good life, between the will and exemplary human living. Read from this perspective, Nietzsche's remarks about freedom actually add up to something. And what they add up to is one aspect of his attempt to understand life after the model of art. Beauty, for Kant, was an image of the moral. ¹ For Nietzsche, by contrast—and the contrast can be hard to spell out—art was an image of the ethical. ² My hope here is to begin to explain why Nietzsche might have thought that the issue of freedom was relevant to that. In sections 1–3, I attempt to show why Nietzsche is not best read as a participant in the standard free will/determinism debate; in sections 4–6, I try to spell out the ethical conception of freedom that he develops instead.