超越双螺旋:DNA对科学与社会文化的影响

50年前,DNA双螺旋结构的建立标志着生命科学一个崭新时代的到来。DNA双螺旋结构模型的建立不仅使生命科学及其相关领域发生了巨大变化,而且也深刻地影响到人类的社会生活与思想观念,甚至影响到社会文明的前景。今天,我们又站在一个历史的转折点上,中国科学家应当主动迎接生物技术世纪和知识经济时代的挑战,不仅在分子生物学的研究前沿作出自己的贡献,而且也应创造出更多的科学成果造福于人民。     

How Christian ethics became medical ethics: the case of Paul Ramsey.

Over the last century Christian ethics has moved from an attempt to Christianize the social order to a quandary over whether being Christian unduly biases how medical ethics is done. This movement can be viewed as the internal development of protestant liberalism to its logical conclusion, and Paul Ramsey can be taken as one of the last great representatives of that tradition. By reducing the Christian message to the 'ethical upshot' of neighbour love, Ramsey did not have the resources to show how Christian practice might make a difference for understanding or forming the practice of medicine. Instead, medicine became the practice that exemplified the moral commitments of Christian civilization, and the goal of the ethicist was to identify the values that were constitutive of medicine. Ramsey thus prepared the way for the Christian ethicist to become a medical ethicist with a difference, and the difference simply involved vague theological presumptions that do no serious intellectual work other than explaining, perhaps, the motivations of the ethicist.     

论现代医学视野中的伦理与现代伦理视野中的医学

医学与伦理的关系从古代、近代到现代,经过了一个浑然一体、相互分离和重新融合的否定之否定过程。通过对这一过程的简要考察和分析,着重阐述了现代医学视野中的伦理与现代伦理视野中的医学应当所具有的本质形相。在现代医学视野中,现代医学伦理是来自人类伦理遗产和对现实生命道德问题的伦理认识结果两方面的理论交汇。现代伦理应当是多层次的理论与实践系统,其中包括道德哲学层次的思考;生命伦理中的道德原则和规范的构建;关于生命道德规范长入现代医学的机制问题的思考;现代医学伦理的发展与相关学科的相互借鉴的研究。在现代伦理的视野中,现代医学的本质在于,现代“大医学”的概念已经取代了对医学的传统认识;医学作为现代社会文化构成部分的特质逐渐地被揭示出来;现代医学已经成为特定社会职业群体以科学技术为主体的重要社会活动。站在现代医学和现代伦理各自的立场认识和了解对方,对全面把握二者之间的关系和推进二者之间的有机结合具有重要意义。     

The anthropological tradition in the philosophy of medicine

The tradition of anthropological medicine in philosophy of medicine is analyzed in relation to the earlier interest in epistemological issues in medicine around the turn of the century as well as to the current interest in medical ethics. It is argued that there is a continuity between epistemological, anthropological and ethical approaches in philosophy of medicine. Three basic ideas of anthropologically-oriented medicine are discussed: the rejection of Cartesian dualism, the notion of medicine as science of the human person, and the necessity of a comprehensive understanding of disease. Next, it is discussed why the anthropological movement has been superseded by the increasing interest in medical ethics. It is concluded that the present-day moral issues cannot be interpreted and resolved without clarification of the underlying anthropological images.     

Turning the history of medical ethics from its head onto its feet: a critical commentary on Baker and McCullough

The paper provides a critical commentary on the article by Baker and McCullough on Medical Ethic's Appropriation of Moral Philosophy. The author argues that Baker and McCullough offer a more "pragmatic" approach to the history of medical ethics that has the potential to enrich the bioethics field with a greater historical grounding and sound methodology. Their approach can help us to come to a more nuanced understanding about the way in which medical ethics has connected, disconnected, and reconnected with philosophical ideas throughout the centuries. The author points out that Baker and McCullough's model can run the danger of overemphasizing the role of medical ethicists whilst marginalizing the influence of philosophers and of other historical actors and forces. He critically reviews the two case studies on which Baker and McCullough focus and concludes that scholars need to bear in mind the levels of uncertainty and ambivalence that accompany the process of transformation and dissemination of moral values in medicine and medical practice.     

The hyperreality of clinical ethics: A unitary theory and hermeneutics

Medical ethics nowadays is dominated by a conception of ethics as the application of moral theories and principles. This conception is criticized for its depreciation of the internal morality of medical practice and its narrow view of external morality. This view reflects both a lack of interest in the empirical realities of medicine and a neglect of the socio-cultural value-contexts of medical ethical issues, including the creative development of a broader philosophical framework for a practicable medical ethics. Several alternative approaches and conceptions have been proposed. The unified clinical ethics theory, developed by Graber and Thomasma, is an interesting attempt to synthesize these alternative approaches. It correctly identifies as the crucial problem the present disconnectedness of medical ethics from theoretical philosophy as well as the practice of medicine. In this paper, however, it is argued that the unitary theory should take more serious attention to the hermeneutic character of medicine as well as ethics. This implies that the unitary theory must in fact transform itself into aninterpretive clinical ethics theory. The theoretical characteristics and practical consequences of an interpretive theory of medical ethics are discussed in the present paper.     

A Student’s Perspective on Medical Ethics Education

Despite many efforts to increase ethics education in US medical schools, barriers continue to arise that impede the production of morally driven physicians who practice medicine with ideal empathy. Research has shown that, particularly during the clinical years, medical students lose the ability both to recognize ethical dilemmas and to approach such situations with compassionate reasoning. This article summarizes the current status of ethics education in US medical schools, described through the eyes of and alongside the story of a graduating medical student.     

Thinking critically in medicine and its ethics: relating applied science and applied ethics

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision-making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision-making.     

Sterilization, Catholic health care, and the legitimate autonomy of culture.

Disagreement over the legitimacy of direct sterilization continues within Catholic moral debate, with painful and at times confusing ramifications for Catholic healthcare systems. This paper argues that the medical profession should be construed as a key moral authority in this debate, on two grounds. First, the recent revival of neo-Aristotelianism in moral philosophy as applied to medical ethics has brought out the inherently moral dimensions of the history and current practice of medicine. Second, this recognition can be linked to Catholic morality through Vatican II's affirmation of the legitimate autonomy of culture, including the sciences. A partial precedent for understanding the moral authority of medicine can be found in the recent history of Catholic medical morality, and we further argue that a full contemporary recognition of that authority would weigh against an absolute prohibition of direct sterilizations. Institutionally, we propose the allowance of direct sterilizations in cases where the clinically perceived biomedical good of the patient is at stake.     

医学阐释学--医学哲学研究新视角

医学阐释学是哲学阐释学在医学领域的应用,是医学与哲学交叉的一个新领域.简述哲学阐释学的发展以及其主要观点,并集中讨论了医学阐释学研究的范畴,其中包括:人体的现象学、健康和病患的意义、医患关系、生命伦理学、医学的目的.指出医学阐释学对医学哲学、医学人文科学研究的影响.     

The ‘Magic Light’: A Discussion on Laser Ethics

Innovations in technology and science form novel fields that, although beneficial, introduce new bio-ethical issues. In their short history, lasers have greatly influenced our everyday lives, especially in medicine. This paper focuses particularly on medical and para-medical laser ethics and their origins, and presents the complex relationships within laser ethics through a three-dimensional matrix model. The term ‘laser’ and the myth of the ‘magic light’ can be identified as landmarks for laser related ethical issues. These ethical issues are divided into five major groups: (1) media, marketing, and advertising; (2) economic outcomes; (3) user training; (4) the user-patient/client relationship; and (5) other issues. In addition, issues arising from two of the most common applications of lasers, laser eye surgery and laser tattoo removal, are discussed. The aim of this paper is to demonstrate that the use of medical and para-medical lasers has so greatly influenced our lives that the scientific community must initiate an earnest discussion of medical laser ethics.     

The relevance of Heidegger’s philosophy of technology for biomedical ethics

Heidegger’s thoughts on modern technology have received much attention in many disciplines and fields, but, with a few exceptions, the influence has been sparse in biomedical ethics. The reason for this might be that Heidegger’s position has been misinterpreted as being generally hostile towards modern science and technology, and the fact that Heidegger himself never subjected medical technologies to scrutiny but was concerned rather with industrial technology and information technology. In this paper, Heidegger’s philosophy of modern technology is introduced and then brought to bear on medical technology. Its main relevance for biomedical ethics is found to be that the field needs to focus upon epistemological and ontological questions in the philosophy of medicine related to the structure and goal of medical practice. Heidegger’s philosophy can help us to see how the scientific attitude in medicine must always be balanced by and integrated into a phenomenological way of understanding the life-world concerns of patients. The difference between the scientific and the phenomenological method in medicine is articulated by Heidegger as two different ways of studying the human body: as biological organism and as lived body. Medicine needs to acknowledge the priority of the lived body in addressing health as a way of being-in-the-world and not as the absence of disease only. A critical development of Heidegger’s position can provide us with a criterion for distinguishing the uses of medical technologies that are compatible with such an endeavor from the technological projects that are not.     

精诚合一:医学哲学事业的永恒主题

医学哲学事业的价值在于发现并弘扬医学的基本精神。“精诚合一”是医学亘古不变的基本精神。当代医学哲学研究的任务是揭示医学的“精诚合一”特征及其深刻内涵,注重“精”与“诚”的有机结合,批判现实医疗活动和理论研究在“精”、“诚”问题上的片面,弘扬医学的基本精神。     

Health and Healing: Spiritual, Pharmaceutical, and Mechanical Medicine

Modern medical practice is identified as a relatively recent way of approaching human ill health in the wide scope of how people have addressed sickness throughout history and across a wide range of cultures. The ideological biases of medical or “allopathic” (disease as “other” or “outsider”) practice are identified and grafted onto other perspectives on how people not engaged in modern medicine have achieved healing and health. Alternative forms of healing and health open a consideration of ethnomedicine, many forms of which are unknown and, hence, untested by modern medical research. Ethnomedicine the world over and throughout human history has displayed unique spiritual (vitalism), pharmaceutical (herbs/drugs), and mechanical (manipulation/surgery) approaches to treating illness. The argument is that modern allopathic medicine would do well to consider such “world medicine” as having valuable alternative and complementary therapies, the use of which could enhance contemporary medical advice and practice.     

Casuistry and clinical ethics

For the last century, moral philosophy has stressed theory for the analysis of moral argument and concepts. In the last decade, interest in the ethical issues of health care has stimulated attention to cases and particular instances. This has revealed the gap between ethical theory and practice. This article reviews the history and method of casuistry which for many centuries provided an approach to practical ethics. Its strengths and weaknesses are noted and its potential for contemporary use explored.     

Mediate Auscultation, the Stethoscope, and the “Autopsy of the Living”: Medicine's Acoustic Culture

The practice of mediate auscultation—listening to the body through a stethoscope—was at the center of new articulations of medical thought and practice in the 19th century. During that period, the stethoscope became the hallmark of medical modernity. This article offers a detailed examination of the work of RTH Laennec and other important writings on the stethoscope in order to argue for the centrality of a distinctive orientation toward listening in modern medicine. The development of mediate auscultation applied medical and scientific reason to listening, just as a particular practice of hearing the body became integral to everyday functioning of medicine. Mediate auscultation was thus an artifact of a new approach to reason and the senses, one based in a scientific mindset and a logic of mediation.     

Religion and medicine: A theoretical overview

Recent scholarly studies in history, sociology, anthropology, religion, and psychosomatic medicine, coupled with clinical experience in the care of patients, call for a reassessment of the interrelationships between religion and medicine. Six major areas of interaction between these forms of human experience are identified and outlined. Investigations into these interlinkages not only offer challenging new opportunities for discovery but also hold promise for the development of new, more effective forms of medical care and healing. This new understanding of the interconnections between medicine and religion has many implications both for health care practitioners and for professionals with specialized training in religious studies.Has studied and taught in the areas of religion, American and Western history, and the history of medicine and medical ethics. He is the author of a number of publications on history, ethics, and the interrelationships between religion and medicine.     

The gastroenterologist and his endoscope: The embodiment of technology and the necessity for a medical ethics

The purpose of this essay is to argue for the necessity of an ethics of the practice of the specialist-technologist in medicine. In the first part I sketch three stages of medical ethics, each with a particular viewpoint regarding the technology of medicine. I focus on Brody's consideration of the “physician's power” as a example of contemporary medical ethics which explicitly excludes the specialist-technologist as a locus of development of medical ethics. Next, the philosophy of Heidegger is examined to suggest an approach to the problem, and, finally, some of Levinas' contributions regarding the “other” are introduced to suggest a preliminary approach to a medical ethics of the specialist-technologist.     

检验医学的医学伦理学思考

检验医学发展迅速,然而对其医学伦理学的思考却常被人忽视。本文对日常检验工作中存在的伦理学问题进行了初步探讨,从检验机构设置、检验项目管理、日常检验工作及检验与,临床的沟通等方面思考了当今检验医学领域医学伦理学的现况。加强检验医学的医学伦理学建设,真正体现出对患者的人文关怀。     

Between Same-Sex Marriages and the Large Hadron Collider : Making Sense of the Precautionary Principle

The Precautionary Principle is a guide to coping with scientific uncertainties in the assessment and management of risks. In recent years, it has moved to the forefront of debates in policy and applied ethics, becoming a key normative tool in policy discussions in such diverse areas as medical and scientific research, health and safety regulation, environmental regulation, product development, international trade, and even judicial review. The principle has attracted critics who claim that it is fundamentally incoherent, too vague to guide policy, and makes demands that are logically and scientifically impossible. In this paper we will answer these criticisms by formulating guidelines for its application that ensure its coherence as a useful normative guide in applied and policy ethics debates. We will also provide analyses of cases that demonstrate how our version of the principle functions in practice.