医学伦理学不可忽视的课题：利益伦理

当今是一个以利益为轴心的时代。利益伦理学是医学伦理学不可忽视的课题。将病人利益置于首位应当是现代医学伦理学的首要原则。欲望是无穷的,利益是有限的。任何利益都有自己的边界和限度。我们必须设置利益的道德界限,以回答当前医学伦理学面临的种种现实课题。     

医学伦理学不可忽视的课题:利益伦理

当今是一个以利益为轴心的时代.利益伦理学是医学伦理学不可忽视的课题.将病人利益置于首位应当是现代医学伦理学的首要原则.欲望是无穷的,利益是有限的.任何利益都有自己的边界和限度.我们必须设置利益的道德界限,以回答当前医学伦理学面临的种种现实课题.     

生命伦理中的利益限度分析

法律或道德律令的最终目的都是为了消解利益冲突问题,怎样解决利益冲突,也一直是现实生活中的关注焦点.寻求最佳的解决利益冲突的方式、方法,需要一个每个人都可以接受并能够认真遵守的行为法则,而这个法则的确立需要人们对冲突中所涉及的利益边界有一个深入地分析,即对矛盾冲突进行利益限度分析.目前对我国影响较大的生命伦理学原则有"二原则说"、"四原则说"、"五原则说"等[1]."五原则说"即生命价值原则、善良原则、公正原则、说实话原则和个人自由原则.这些原则不同程度地体现了利益限度原则,突出地表现为利益自主、利益互赢、人人有利的特征,此三者即为利益限度的整体形态.     

医学专业面临的危机：利益冲突——再论医学专业精神

医患间未能遵守利益限度和利益边界原则,使矛盾转化为冲突。当前我国面临的医患冲突与一些国家相比是全面而深刻的。体制与非体制原因相互交错,直接冲突与间接冲突相互影响,理性冲突向非理性冲突转化,群体性与个体性的不同表现,即发生与后发性的不同特点,是我国医患冲突演化的规律与特征。要正确对待第三方的介入。端正专业思想是理顺医患关系的治本之道。     

医学专业面临的危机:利益冲突——再论医学专业精神

医患间未能遵守利益限度和利益边界原则,使矛盾转化为冲突.当前我国面临的医患冲突与一些国家相比是全面而深刻的.体制与非体制原因相互交错,直接冲突与间接冲突相互影响,理性冲突向非理性冲突转化,群体性与个体性的不同表现,即发生与后发性的不同特点,是我国医患冲突演化的规律与特征.要正确对待第三方的介入.端正专业思想是理顺医患关系的治本之道.     

医疗行善与病人自主的冲突与解决——论"患者最佳利益"之实现

维护"患者的最佳利益"是当代医疗决策的伦理要求.但是,通过对"患者最佳利益"的综合分析发现,建立在尊重个-人权利基础之上的"患者最佳利益"将患者的个人决策置于医生的专业判断之上,呈现出与传统医学伦理观念相背离的状态.不过,"患者最佳利益"是有存在的可能性和实现的操作性的.基于患者的心智和理性状态的不同,提出不同的判断标准,并设想了与之配套的一些程序.     

临床决策的边界

探讨临床决策之边界,以期为临床医生合理决策提供参考。临床决策是日常医疗工作的核心内容,医生是临床决策的制定者和施行者。决策过程中,医生需综合考量多种因素,如病人的临床状况和真正需要解决的临床问题、法律法规、伦理和社会因素、诊疗规范和指南、经验总结、个案和基础研究、团队的技术能力、专业标准和临床预期等,这些因素组成了临床决策的基本边界,同时,这个边界会随着医学、文化、经济、社会的发展而变化。     

医药回扣是最大的医患利益冲突

分析医患利益冲突如何影响医生的临床决策,并在此基础上探讨如何处理医患利益冲突。医患利益冲突影响医生临床决策有两个环节,其一是影响其专业判断,其二是影响其医疗决定。医药回扣具备商业贿赂的典型特征。医药回扣是最大的医患利益冲突。     

医药回扣是最大的医患利益冲突

分析医患利益冲突如何影响医生的临床决策,并在此基础上探讨如何处理医患利益冲突.医患利益冲突影响医生临床决策有两个环节,其一是影响其专业判断,其二是影响其医疗决定.医药回扣具备商业贿赂的典型特征.医药回扣是最大的医患利益冲突.     

论医生的双重角色及其激励相容

在医患关系中,医生充当着双重角色,不仅作为患者的代理人或顾问为患者利益着想,同时也作为医疗服务的提供者为自己的利益着想。在这种双重角色下极易发生供者诱导需求,并进而导致过度医疗与医疗费用的上升。因此,有必要在支付机制、成本费用约束和外在监督等方面实现对医生的激励相容,以规范医疗行为,切实降低医疗费用。     

浅议生物医学研究中不同主体的利益冲突

作为医学伦理学研究的重要内容,生物医学研究中的利益冲突问题日益受到公众、研究机构和管理部门的关注。探讨生物医学活动中研究者、研究机构、学术期刊三种不同主体利益冲突的表现、危害及其特点,以期有针对性地促进人们对该领域利益冲突问题的认识。     

Medical journals' conflicts of interest in the publication of book reviews

The purpose of the study was to assess medical journals’ conflicts of interest in the publication of book reviews. We examined book reviews published in 1999, 2000, and 2001 (N=1,876) in five leading medical journals: Annals of Internal Medicine, British Medical Journal (BMJ), Journal of the American Medical Association (JAMA), Lancet, and New England Journal of Medicine. The main outcome measure was journal publication of reviews of books that had been published by the journal’s own publisher, that had been edited or authored by a lead editor of the journal, or that posed another conflict of interest. We also surveyed the editors-in-chief of the five journals about their policies on these conflicts of interests. During the study period, four of the five journals published 30 book reviews presenting a conflict of interest: nineteen by the BMJ, five by the Annals, four by JAMA, and two by the Lancet. These reviews represent 5.8%, 2.7%, 0.7%, and 0.7%, respectively, of all book reviews published by the journals. These four journals, respectively, published reviews of 11.9%, 25.0%, 0.9%, and 1.0% of all medical books published by the journals’ publishers. Only one of the 30 book reviews included a disclosure statement addressing the conflict of interest. None of the journals had a written policy pertaining to the conflicts of interest assessed in this study, although four reported having unwritten policies. We recommend that scientific journals and associations representing journal editors develop policies on conflicts of interest pertaining to book reviews. Disclosure: R.M. Davis was North American editor of the BMJ from 1998 to 2001, and is a member of the Board of Trustees of the American Medical Association, which publishes JAMA. The opinions expressed in this paper are those of the authors and do not reflect the official policy of any organization with which the authors have been affiliated.     

守护受试者的权益——对“药物研究与应用的伦理监督”

如何保障和守护临床试验研究中受试者的权益?这既是医生、患者(受试者)、工业界与公众注目的问题,也是医院伦理委员会工作面临并要解决的基本而至关重要的问题。从华西医院伦理委员会工作角度出发,分析了临床试验研究中的权益冲突和对受试者权益的科学、伦理与政策守护的要素,论述了如何保障受试者权益问题。     

Conflict of interest in Croatia: doctors with dual obligations

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the medical profession that address problems of conflict of interest. An earlier version of this paper entitled was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

工程中利益冲突问题研究

首先在详细分析工程中利益冲突已有定义的基础上,本文从不同角度提出了一种不同的定义。然后,分析了利益冲突的构成,并列举了利益冲突的情形。接着,分析了利益冲突的伦理问题,并提出解决方法。最后介绍了美国工程社团以及大型企业有关利益冲突的伦理章程和行为规范。     

后现代语境下医学语言的伦理解读

医学的现代性遗产和后现代世界的冲突在不断加剧,导致了对医学语言理解的困境和伦理意义的丧失。后现代主义极力寻求人类理解的解释性基础,使后现代医学语言的伦理选择成为可能。在后现代语境下,医学语言的伦理应该是摆脱现代性“文化霸权”的一种诠释学的谈话,是一种境遇伦理。     

制度伦理与社会转型期的医德建设

市场经济的发展,多元价值观的形成,各种伦理价值观念之间发生了冲突,医疗道德失范现象成为我国社会转型期的一个重要社会问题。制度伦理对道德建设起着基础性和根本性的作用,以制度伦理建设为契机,并辅以正确的激励手段等,可以让医务人员树立正确的道德理念,引导和强化医务人员的价值选择和行为规范,重塑良好医德医风。     

医学生之医学伦理素养教育剖辨

对医学生加强医学伦理素养教育是当前国内外医学教育的共识,但在教育的内容、方式和方法上却是各具特色.相对而言,我国医学院校对医学生的医学伦理素养教育尚处于不成熟的阶段,其表现就是教育过程中存在着诸多的问题、教学效果不甚理想.从医学伦理素养教育的现状入手,尝试分析我国医学伦理素养教育中的重点和难点问题.     

Conflit d’intérêts et déontologies : l’échec des déontologies existantes et l’improbable (?) succès de la loi

The increasing frequency with which health scandals have come to light since the 1980s has uncovered a great deal of unlawful behavior, both in the pharmaceutical industry and the medical profession, as well as in the world of “experts” (or researchers), along with journalists and specialist media companies. These types of behavior have accumulated and combined to inhibit any reaction from government, thus preventing health policy from playing its role. The State has its share of responsibility in this failure, for having been unable to conserve the impartiality and effectiveness of its administrative actions: it must acknowledge this, which is a whole other problem. However, in the case in point, it is obvious that those texts which must have been breached to allow these health scandals to occur are almost exclusively the result of professional self-regulation, with a wide range of diverse legal values: ethics for the health professions, journalistic ethics, charters between the pharmaceutical industry and media companies, alongside scientific ethical charters. These texts are the result of regulations generated by the professions themselves, drafted to counteract conflicts of interest. The sheer number of cases highlights the failure of these self-regulatory measures, leading to legislation targeting the problem, in particular that of December 29, 2011, which strengthened monitoring in terms of conflicts of interest and penalties against those placing themselves in a conflict of interest situation. Will this legislation, in direct response to the so-called Mediator^® case, be able to succeed where self-regulation failed, swept away as it was by financial considerations? The arbitrations that characterized the drafting of this legislation and the resulting complexity, which affects the decrees, seem to promise many difficulties, particularly due to the scarcity of resources the authorities have to enforce it.