围手术期麻醉医师的伦理责任

随着医学模式的转变,麻醉医师应了解本专业特殊的伦理要求。本文通过对围手术期不同时间段的伦理要求进行分析,探讨了麻醉医师应遵守的医学伦理学职责,包括：术前查看病人,以最优化原则制定麻醉方案,坚持知情同意原则,杜绝术中知晓,执行保护性医疗制度,保证病人舒适自然的苏醒以及必要的心理抚慰与指导等。     

器官移植的伦理原则

器官移植的伦理原则１在器官移植中应坚持人道主义原则和功利主义原则,并使二者有机结合,达到辩证统一。２虽然科学研究与医疗事业是互相促进的,但临床器官移植医师应把恢复病人的健康视为首要目的,开展学术理论研究是第二位的。３严格遵守医学标准,审慎地选择...     

浅论生殖医学伦理委员会的功能

辅助生殖技术的开展为医学伦理带来了新的内容和挑战。我国卫生部于2001年2月20日发布的《人类辅助生殖技术管理办法》中规定,人类辅助生殖技术的应符合有利于患者的原则、知情同意的原则、保护后代的原则、社会公益原则、保密原则、严防商业化的原则和伦理监督的原则。开展辅助生殖技术的条件之一是医疗机构建立生殖医学伦理委员会。伦理委员会是教育性、咨询性、义务性及独立组织。生殖医学伦理委员会应依据上述原则对人类辅助生殖技术的全过程和有关研究进行监督,开展生殖医学伦理宣传教育,并对实施中遇到的伦理问题进行审查、咨询、论证和建议。     

婚检“检”破处女膜映射出的医学伦理问题

近年来婚检或妇检过程中“检”破未婚女性处女膜的现象屡屡发生,给未婚女性的身心带来巨大伤害,既侵犯了未婚女性的合法权益,又严重地损害了医学伦理声誉。医师在检查未婚妇女的生殖器官时除了要遵循普通的疾病诊断特别是体格检查过程中的伦理要求和妇科检查道德规范外,在婚检过程中还应当特别强调遵循自愿检查(知情同意)原则、尊重原则、不伤害(安全性)原则,履行谨慎检查、保护隐私等医学伦理义务,切实遵守婚前体格检查的技术规范,确保被检妇女的权益不受侵害。     

中美医师职业精神高层研讨会在上海举行

由哥伦比亚大学医学职业研究所（IMAP）和中华医学会医学伦理分会主办、上海医学伦理学会协办的“中美医师职业精神高层研讨会”,于2006年11月3日至4日在上海举行。来自美国、加拿大及国内学者30余人参加了会议。这次会议前,哥伦比亚大学等国外学者和北京大学医学部医学伦理学研究室及相关学校的学者先后在我国的北京、西安、济南、上海就医学的职业精神的情况进行了考察,为这次会议作了必要的准备。提交此次会议的30多篇论文,分别从医学职业精神的涵义、医患关系和谐化、利益冲突、行业管理和自律等四个方面进行了热烈的讨论。与会学者的发言一致认为,医学职业精神的核心,是医师对人类健康事业的忠诚,它是医师的社会责任和义务,医师的职业精神要求医师至始至终都要把病人的利益放在第一位;     

对我国《人体器官移植条例》的伦理审视

《人体器官移植条例》已经颁布实施,人体器官移植是一种公认的涉及敏感伦理问题的外科手术。通过分析《条例》是否充分体现了国际通行的生命/医学伦理原则,研究了人体器官移植进行进一步伦理规范的必要性,提出了人体器官移植应遵循的具体医学伦理原则。特别强调了其中的"公正"实体原则和"伦理审查"程序原则。     

对我国《人体器官移植条例》的伦理审视

《人体器官移植条例》已经颁布实施,人体器官移植是一种公认的涉及敏感伦理问题的外科手术.通过分析《条例》是否充分体现了国际通行的生命/医学伦理原则,研究了人体器官移植进行进一步伦理规范的必要性,提出了人体器官移植应遵循的具体医学伦理原则.特别强调了其中的"公正"实体原则和"伦理审查"程序原则.     

影像医学实习应加强伦理实践教育

目前,影像医学实习生的临床实践的主要问题是忽视医学伦理实践教育,这不利于影像医学实习生的培养、健康成长和全面发展。影像医学实习生临床实践教育的现实需要和影像医学专业基本特征的客观要求都证明,加强影像医学实习生的实践教育十分必要。影像医学实习生的医学伦理实践教育应重点加强和关注服务态度、尊重人格、医疗保密、知情同意、最优化原则、科学作风、做好防护避免伤害、保护医疗卫生资源、仪器设备维护保养九个方面的医学伦理问题。     

医务人员应如何迎接社交媒体时代的挑战——英国医学总会《医师使用社交媒体伦理指南》的分析与启示

中韩两国"手术室自拍门"事件凸显了医务人员规范使用社交媒体的必要性与紧迫性。通过对英国医学总会2013年发布的《医师使用社交媒体伦理指南》进行规范分析,强调医务人员应明确社交媒体优势弊端,应用时须坚持伦理准则与规范,秉持医学专业素养的重要性。启示我国医学相关专业协会应制定相关指南,指引医务人员规范使用社交媒体;医学伦理教育(教学)内容亟需纳入社交媒体使用伦理规范;社交媒体时代引发的新课题是医学伦理研究的题中之义。     

浅谈门诊手术中局部麻醉的彻底性

门诊手术没有麻醉师的介入,容易存在局部麻醉不彻底的情况。随着医学模式的转变,门诊手术中必须保证局部麻醉的彻底性。外科医师需要从人文关怀的角度出发,结合好几个具体环节,做到彻底的局部麻醉,才能赢得病人的终生信任。     

道德他律:我的道德重建的社会政治前提

在我的道德处于社会性解构之道德境遇中,道德他律是社会道德重建的基本方式。道德他律的存在主体是国家,实践主体是政府。政府要担当起道德他律的社会重任,其前提是政府要成为道德的政府并获得其道德的道德形象和引导力量。这要求政府必须建立在普遍人道、平等、公正的政治原则和政府道德优先的道德原则的基础上,严格遵循权力分散、制约、均衡的权力分配原则和小政府大服务的实践原则。     

Ontology and ethics in the foundation of medicine and the relevance of Levinas' view

The search for an ontological basis of medical practice is questioned from the viewpoint that ontologies are always related to the interpreting person in his situation, and that the definition of medicine includes a certain choice. This choice-character comes into greater play when ethical proposals are made. A foundation of medical ethics on an ontology of the healthy body or the factual medical practice is a naturalistic fallacy. Prior to an ontological basis, the ethical event of responsibility for the suffering and transcendent other (Levinas) is constitutive for medicine. This event with its dimension of infinity of the other can only be ontologized by a totalitarian act. A philosophy of medicine should start with the ‘heteronomy’ of the other.     

On Replacing the Ethical Principle of Autonomy With an Ethical Principle of Accordance

The author defines and critiques the ethical principle of autonomy. As a concept, autonomy is most aligned with paradigms of counseling that focus on the individual as a psychological entity with moral agency. It is less consistent with frameworks that focus on relationships philosophically and in practice. Autonomy is paradoxical, because it is a consensually defined principle imposed on counseling practice while denying counselors a choice in its application. The author suggests accordance as an alternative ethical principle. Accordance is consistent with relational paradigms of practice and the other relationship‐focused ethical principles in counseling. Accordance fully contextualizes individual responsibility and choice.     

Bearing Response-Ability: Theater, Ethics and Medical Education

This paper addresses a growing concern within the medical humanities community regarding the perceived need for a more empathically-focused medical curricula, and advocates for the use of creative pedagogical forms as a means to attend to issues of suffering and relationality. Drawing from the ethical philosophy of Emmanuel Levinas, I critique the notion of empathy on the basis that it erases difference and disregards otherness. Rather, I propose that the concept of empathy may be usefully replaced with that of ethical responsibility, which suggests a shared sense of humanity outside the boundaries of presumed knowledge of the other. To illustrate this argument, I theorize the importance of theater within medical education. Theater, I argue, may engender ethical responsibility in the Levinasian sense, and thus may allow learners to differently engage with the experience of the suffering other. As such, I examine Margaret Edson's widely used play Wit as a platform for such an ethical encounter to occur. Thus, rather than working to understand the value of theater in medical education in terms of knowledge and skill acquisition, I theorize that its primacy within medical curricula arises from its ethical/relational potential, or potential to engender new forms of inter-human relationality.     

Debriefing and accountability in deceptive research

Debriefing is a standard ethical requirement for human research involving the use of deception. Little systematic attention, however, has been devoted to explaining the ethical significance of debriefing and the specific ethical functions that it serves. In this article, we develop an account of debriefing as a tool of moral accountability for the prima facie wrong of deception. Specifically, we contend that debriefing should include a responsibility to promote transparency by explaining the deception and its rationale, to provide an apology to subjects for infringing the principle of respect for persons, and to offer subjects an opportunity to withdraw their data. We also present recommendations concerning the discussion of deception in scientific articles reporting the results of research using deception.     

Pharmaceutical companies and access to medicines – social integration and ethical CSR resolution of a global public choice problem

This article argues that effective corporate social responsibility (CSR) of multinational pharmaceutical companies in developing countries should reflect context, opportunity, proximity, time and impact in accordance with the social integration and ethical approaches to CSR. It proposes a CSR model expressed as CSR=COPTI+SI+E, which acknowledges access-to-medicines as a matter in the global public domain, a public choice problem and a moral responsibility issue for multinational pharmaceutical companies. This model recognises the globalisation of the principle of humanity in communities of place and communities of interest as highlighted by the Global Economic Ethic Manifesto 2009 as an integral part of the responsibilities of multinational pharmaceutical companies. The model reflects a global application of the concept of disadvantaged consumer already known to some national laws. The article suggests an access-to-medicines CSR framework for pharmaceutical companies which may include pricing, patents, testing and clinical trials, research and development, joint public private initiative and appropriate use of drugs.     

Principles of early stopping of randomized trials for efficacy: a critique of equipoise and an alternative nonexploitation ethical framework

Recent controversial decisions to terminate several large clinical trials have called attention to the need for developing a sound ethical framework to determine when trials should be stopped in light of emerging efficacy data. Currently, the fundamental rationale for stopping trials early is based on the principle that equipoise has been disturbed. We present an analysis of the ethical and practical problems with the "equipoise disturbed" position and describe an alternative ethical framework based on the principle of nonexploitation. This framework acknowledges the need for balancing the dual ethical obligations of clinical research, the protection of human subjects and the generation of new medical knowledge. Based on this framework, we put forward a proposal to make early stopping guidelines more stringent under specified conditions. The temporary withholding of apparent benefits in certain circumstances is justified by achieving a fair contract with the research participants, one that protects them from undue harm and exploitation while reducing the many uncertainties surrounding new investigational treatments that arise when trials are stopped prematurely.     

公共卫生的责任主体缺位是众多医学伦理问题产生的根源

我国的卫生、医疗服务系统近年来产生了大量严重的伦理问题,引起了国内外广泛的关注。通过对大量材料的归类、分析,找出我国众多严重伦理问题产生的主要根源是公共卫生责任主体的缺位。解决的主要措施是:加快卫生母法的建立;政府对“公共性”卫生服务责任到位,扭转卫生工作严重的市场化和趋利化倾向;彻底改变医疗费用的“后付制”和“第三方付费制”,实行政府正向投入;改变当前在疾病预防和初级卫生保健投入方面过于细化的分级财政体制;制止药品广告和虚假的医疗广告;加大控制政府公立医院建设的成本和降低医院运行费用的工作,严格收费价格纪律等。     

Returning to the Infinite—Kohut’s Empathy,Levinas’s Other,and the Ethical Imperative: Discussion of Articles by Doris Brothers and Joseph Lichtenberg

This discussion interweaves the ethics of Emanuel Levinas with the empathic sensibility of Heinz Kohut’s psychoanalytic vision as a unifying lens that brings into sharp focus the ethical message of the articles by Brothers and Lichtenberg. Drawing on Raanan Kulka’s ideas on the permanent oscillation between states of separateness (emergence) and transcendent ethical states of dissolving, the principle of always returning to the infinite state of absolute responsibility to the other is brought forth as a fundamental ethical imperative that captures the ethical/spiritual center of the two articles. Brothers’ account of promise-making and Lichtenberg’s autobiographical account of his activism are seen to be reflections of the latter ethical imperative.     

脐血干细胞移植中的伦理思考

现代干细胞移植技术飞速发展。脐血干细胞移植在伦理学上具有胚胎干细胞和骨髓干细胞移植治疗不可比拟的优势,但是其伦理学上的可接受性并不等于伦理问题的消失。在脐血干细胞移植研究过程中,应该遵循伦理道德观和科学理性的原则,健康发展,造福人类。