对知情同意书和知情同意过程的探讨

在<医疗事故处理条例>实施中,存在着一种现象:重视一张由患者签字的知情同意书,轻待知情同意过程.签字的知情同意书不等于知情同意,知情同意书不等于"生死契约".知情同意的本义:对患者权利、尊严、人格和自由的尊重,只有在知情同意过程中获得.因此知情同意过程应该重要于知情同意书.医生严格履行好法定的告知和说明义务,尊重患者的知情同意权,就是尊重法律,也是医生保护自己的最好方式.     

知情同意原则的中国化:一种生命伦理学视角的转换

知情同意原则的中国化是我国生命伦理学中的一个理论难点.有学者主张可以在知情同意原则的实践上实现个人自决与家庭决策的并立共存,也有学者认为应当运用多元道德理论来对知情同意原则进行论证.然而,知情同意原则中国化的更为可行的方式是认识到“自主”理论下的知情同意原则的限度,并重新确立医学“行善”原则的核心地位.通过这种理论视角的转变,知情同意原则的中国化就不再是一个难解的问题.     

知情不同意社会心理因素分析——全国10城市4000名住院患者问卷调查研究报告之九

如何对待病人的知情不同意,是履行知情同意时必须正确对待的问题,也是临床医生经常面对的伦理难题.通过问卷调查,了解目前我国病人及家属知情不同意的现状,并对知情不同意社会心理因素进行分析,找出知情不同意的社会心理原因,从而为保护患者的利益,减少医患冲突提供参考依据.     

从中西文化差异审视知情同意

中西文化差异的核心是价值观的差异,西方文化强调个人主义,中国文化强调家庭主义.知情同意作为生命伦理学的重要原则,是西方个人主义文化的产物.移植到家庭本位的中国文化语境中,因价值观、行为方式和社会制度方面的差异,知情同意遇到了患者知情同意而家属知情不同意、家属知情同意而患者知情不同意的困境.对此,医方应做好协调沟通工作,一般情况应首先尊重患者意见.     

尊重自主权:如何面对患者的知情不同意——全国10城市4000名住院患者问卷调查研究报告之五

如何面对患者的知情不同意,是医师尊重病人自主权时必须正确对待的问题,也是医师履行职业责任不可回避的事实.通过问卷调查及深入访谈,对目前我国病人及家属知情不同意的现状,知情不同意的类型、原因以及医师面对病人的知情不同意时容易走进的误区,正确处理知情不同意的意义做了分析和讨论,以便为维护患者的利益,减少医惠冲突,完善医师专业精神提供参考依据.     

基因研究中的知情同意之惑

知情同意作为生命伦理的重要原则,在基因研究中同样占据重要的地位,由于基因研究中知情同意的异质性,在基因研究中面临着诸如如何理解其知情同意的异质性、群体知情同意、基因知情与基因隐私、利益冲突等问题.通过分析基因研究中知情同意的特殊性,综合国内外此领域的已有研究,运用理论联系实际的方法,得出结论认为,只有正确区分基因知情与基因隐私的权利主体,用伦理规范来解决利益冲突,在发展中不断完善知情同意,才能够取得科技与伦理的共赢.     

纸质与视频补充材料对手术知情同意体验的影响：以腹腔镜胆囊切除手术为例

知情同意书在医患沟通中起着间接传递信息的重要作用。以159名大学生为被试,通过操纵不同的知情同意方式,考察了纸质或视频补充信息对患者知情同意满意度、理解程度以及患者信息需求的满足程度影响。结果发现,接受纸质补充知情同意或视频补充知情同意的被试对知情同意过程的满意度、对手术信息的理解程度与知情同意信息需求的满足程度显著高于接受普通知情同意的被试。同时,纸质补充知情同意使得“治疗信息需求的满足程度”最高。这表明,纸质补充知情同意更能满足患者对治疗信息的需求。     

对知情同意书和知情同意过程的探讨

在《医疗事故处理条例》实施中,存在着一种现象:重视一张由患者签字的知情同意书,轻待知情同意过程。签字的知情同意书不等于知情同意,知情同意书不等于“生死契约”。知情同意的本义:对患者权利、尊严、人格和自由的尊重,只有在知情同意过程中获得。因此知情同意过程应该重要于知情同意书。医生严格履行好法定的告知和说明义务,尊重患者的知情同意权,就是尊重法律,也是医生保护自己的最好方式。     

知情同意在我国临床医疗中的实施

知情同意在我国至少已倡导与实践了20年,由伦理要求上升到法律准则无疑是一个跨越式的进步。当前,医院落实知情同意的实践滞后于患者要求,除了主观方面的原因外,客观上存在知情同意与保护性医疗,病人自主权与医生处置权、医学对疾病的已知与未知等诸多盾与难点。要使知情同意在我国临床医疗中真正落实尚有许多工作要做;提高医务人员尊重病人权利的意识;完善执行知情同意的方式与程序;细化与知情同意的实施原则;营造良好的社会氛围,探索非西方环境下知情同意实现途径。     

医学研究中对个体标本采集知情同意理解的调查研究

为了解患者对个体标本采集知情同意的现状,对患者进行问卷调查.根据性别、年龄及受教育程度分组,对知情同意结果、原因、理解程度进行分析.知情同意者1 691例,主要原因为尊重医生的意见;知情不同意者281例,主要原因为怀疑医生的正确性或无法理解知情同意内容.结果表明,医生在知情同意过程中起主导作用.     

The Return Of The Religious

Recents discussions of expansion in the European Union and the possibility of envisioning a Muslim country in it has exacerbated the deep-seated anxiety about Islam among the liberal and extreme right in Europe. This paper suggests that there are recurring elements in the discourse of European cultural identity and one of these elements is the representation of Islam in its alterity to European identity and civilization. Questioning the thesis of a radical break with the Christian past, this paper questions whether the European cultural identity which is being formed today signifies a break with a religious form of identification. The liberal and extreme right opposes Turkish membership on the grounds that the differences between ‘European values’ and ‘European culture and lifestyle’ and Turkey's culture are what makes the latter essentially and fundamentally external to the essence of Europe. Tracing the remnants of Christian discourse in the contemporary fashioning of European identity, this paper discusses how Christianity, with its secularized versions, which are now displaced to culture and lifestyle, still holds a privileged position as a unifying theme in Europe. It suggests that one of the tests that awaits Europe is whether it will be capable of articulating a new but democratic identity for Europe, one that is responsive to the differences of the other or whether it wants to continue to be European by way of its old methods of exclusion.     

The Red and The Real

It is often claimed that principles of individuation imply essential properties of the things individuated. For example, sets are individuated by their members, hence sets have their members essentially. But how does this inference work? First I discuss the form of such inferences, and conclude that the essentialist inference is not a purely formal matter: although there is a form which all principles of individuation have in common, it is not true that any statement of that form is a principle of individuation, and hence there is no valid inference based purely on that form. However, I argue that there is a viable version of the essentialist inference nonetheless. The resources for a proper reconstruction of this type of inference can be gathered from reflections upon the role principles of individuation play in the project of the ontologist: such principles turn out to carry a modal weight similar to that of definitions or conceptual truths. It follows that, no matter how austere the ontology, some portion of essentialist modality is inevitable.     

医学教育人文精神缺失的弊端及对策

人文精神本是医学学科的根本要旨之一,然而,目前医学教育中普遍存在着人文精神缺失的状况.从医学教育的宗旨、医学模式的转变、医学生的综合素质、医患关系方面剖析了人文精神缺失的弊端并提出了相应对策.     

The Activities of The Scandinavian Societies

Freud's concept of the death instinct has given rise to many different interpretations which have often been contradictory. It is in fact already possible to discern two diametrically opposite meanings of this concept in Freud's work from 1920—Beyond the Pleasure Principle—in which he first introduced the concept of the death instinct. In this paper, it is argued that both these meanings are relevant in describing psychical life, although only one of these meanings actually qualifies for the concept “death instinct”. Beyond the Pleasure Principle was written in order to try to understand some everyday, as well as clinical phenomena which could not be explained by the so-called pleasure principle. Freud postulated something beyond the pleasure principle, which initially seemed to have to do with binding energy. I will preserve this idea and attempt to develop it within the context of a phenomenological analysis of time. The temporalization of the subject involves a very basic affirmation of existence, in that the subject experiences something constant, something that can be said to possess the quality of a gestalt. I propose that that which is beyond the pleasure principle—this binding of energy—should be understood as the opposite of the idea of a primordial death instinct striving towards death. In this case, that which is beyond the pleasure principle reflects an original affirmation of existence, which could be said to correspond to Freud's first meaning of the death instinct. The second meaning—for which the name “death instinct” seems to be applicable—concerns the discharge of energy, which from a temporal point of view shows itself as a tendency to dissolution. The concept of the death instinct in its various meanings is discussed in connection with phenomenological reflections on time, which is a different approach from Freud's attempt to ground the death instinct in biology.     

The neglected bulimic: The nonpurger

For nearly 10 years bulimia has been recognized officially as a distinct eating disorder, and yet in that time only minimal attention has focused on the nonpurging subtype. The present investigation compared 21 DSM-III-R diagnosed nonpurging bulimics with 22 non-eating-disordered controls on three standardized questionnaires and during a unique assessment task. In this procedure subjects imagined that they were the character in a series of slides and audiotaped flooding scenes. The content of the stimuli ranged from food and weight cues to issues hypothesized to play a role in the development or maintenance of bulimia (e.g., rejection or loss of control fears). A MANOVA conducted on the three questionnaires was highly significant, with the Beck Depression Inventory and the Restraint Scale being responsible for the elevated bulimic scores. A repeated-measures ANOVA performed on the self-report ratings during the exposure task also achieved significance, as the bulimics reported higher anxiety reactions than controls to each experimental stimulus. Significant skin conductance reactions were detected when a group of only the most psychophysiologically responsive bulimics and controls were compared. The importance of continued comprehensive evaluations with DSM-III-R nonpurging bulimics was emphasized.This research was supported by grants both from the University of New Mexico's Research Allocation Committee and the Biomedical Research Support Grant committee. Portions of this paper were presented at the Association for the Advancement of Behavior Therapy annual conference, Boston, November 1987.     

The Logic of The Goldhagen Debate

Since Daniel J. Goldhagen's Hitler's Willing Executioners: Ordinary Germans and the Holocaustattempts to show that the Holocaust is explicable and can be understood largely in terms of a single cause, “eliminationist anti-Semitism”, it is not surprising that the book has generated an international debate. What is surprising is the magnitude and emotional intensity of the debate. This article argues that the deepest flaws in it Hitler's Willing Executioners,as well as the chasm of disagreement between Goldhagen's detractors and defenders, have as much to do with reasoning and concepts as with matters of fact. It concludes that Goldhagen's central argument is stronger than many of his critics claim, but that the inadequacy of his cognitive interpretation of anti-Semitism and his unexamined psychological assumptions weaken his attempt to explain the Holocaust. This revised version was published online in August 2006 with corrections to the Cover Date.