多点执业中医疗纠纷的隐患与预防

预防多点执业中的医疗纠纷,须对医师多点执业的工作时间与工作地点进行限定,并实行首诊负责制,严格交接班制,建立多点执业档案,规范多点执业医院的执业范围,制定多点执业医师准入条件以杜绝草台班子,多点执业医师应与接受医院就医疗纠纷的法律责任分担签订合同.     

上海全科医生签约执业的实践反思与制度建构

为完善全科医生签约执业的制度规范,通过对上海全科医生签约执业的实践反思,认为区别对待全科医生与家庭医生违背全科医生制度设计理念,应从专业、机构、职责和签约四方面明确全科医生内涵;全科医生是基本医疗卫生服务主要提供者,具有签约主体资格;基于全科医生团队服务方式的独特性,基本公共卫生服务属于全科医生的签约职责,范围具有法定性;只有实现基本医疗卫生服务法治化,基本医疗服务内涵方可明确,外延可采取列举与概括相结合方式予以限定。     

《执业医师法》关于医师执业规则的伦理基础

《中华人民共和国执业医师法》是我国第一部规范医师执业活动的法律,它是我国在长期的社会主义医德培养和教育的基础上,以加强医师队伍建设、提高医师职业道德和业务素质、保护人民健康为宗旨,将医师队伍建设和管理工作纳入法制的轨道。因此,长期的、多层次的、多角度的医德教育,为这部法律的制定及实施奠定了扎实的基础。一医生是一种特殊的职业,其执业行为直接关系到患者的生命和健康,关系到千家万户的悲欢离合,因此,在医学活动之始,就有了对医生这一职业进行约束之说。我们可以看到,无论是古代的《黄帝内经》、《希波克拉底誓…     

医师区域注册制度的可行性实证研究——基于法经济学的观察

区域注册制度与知情报备制度赋予医师多点执业的自我决定权,理论上是助推医师多点执业的利好新政。但实证研究表明,在区域注册制度激励机制下,仍有近一半的医师并不打算积极开展第二执业,医师多点执业可能再次遇冷。从法经济学角度观察,其实质是医师在医疗侵权责任高风险的制度条件下,基于经济人理论及预期效用理论所致的消极防御性医疗,具有制度性、内生性及隐蔽性的特点。就医师多点执业配套制度改革而言,首推完善医疗侵权责任制度,是促进医师多点执业的内在制度逻辑所需,也是医师多点执业核心主体医师群体的首盼。     

论保密义务与诚信原则

尊重患者隐私,保守执业秘密,是医师的道德义务,也是法律义务,保密义务的理论基础在于诚实信用原则.为此,医疗活动中应引入体现伦理道德要求的诚信理念,从道德和法律两方面规范医师的行为,并且建立以法律规范为主的规制模式.     

伦理审查委员会的法律地位初探

伦理审查委员会(IRB)的法律地位是一个崭新的课题.通过解读我国现行的伦理审查规范,对我国IRB伦理审查活动的合法性、伦理审查结果的法律效力、IRB及研究人员的法律责任等关乎IRB法律地位的问题进行了探讨.考察了美国和瑞典的伦理审查法规,提出应该提高我国伦理审查规范的法律位阶,推行注册制度的建议.     

医院数字化管理在临床决策中的作用

医院数字化建设是管理行为中的重要手段,借助这一工具,医疗决策的制定和执行将更加科学和规范,但同时医院数字化管理在法律和具体操作上对临床决策的管理还有一定的影响。讨论医院数字化在医疗决策中的合法性、安全性及对临床决策基本原则的作用。     

医患预期效价差:一项理论的分析框架

医患预期效价差受患者感知水平、医疗资源供需矛盾、医护人员执业行为、医疗执业标准和规范、信息不对称、法律责任等众多因素的影响。医患预期效价差的扩大会带来医患关系的紧张,严重影响正常医疗秩序,给社会稳定带来隐患。医患预期效价差的弥合需要全社会的共同努力。政府应加大对医疗卫生的投入,加强医疗卫生知识宣传,并不断完善医疗责任认定。医疗机构应建立健全规章制度和医疗质量控制制度,不断提高医护人员执业水平和诊疗效果。患者需要增强对医学医患知识的学习,并采取合法的方式来维护权益。     

医师多点执业合理结构模式初探

从阐述"社区首诊制"、"双向转诊制"和"分级诊疗"的概念入手,基于"三诊制"的角度分析"医师多点执业"可能引发的诸如扰乱"三诊制"秩序、浪费专家精力、增加医疗风险及转嫁医疗费用等问题,同时结合国内外"医师多点执业"模式,参照医师分级制度,探索"医师多点执业"合理结构模式及职能,提出合理选择多点执业机构、强三诊、倡医联体、促补偿等多源方案构建"医师多点执业"的路径选择,为推行"医师多点执业"提供参考依据。     

论医师多点执业中医方的法律风险与防控

医师多点执业中医方的法律风险包括医师和医院的法律风险两个层面。其中,多点执业医师面临着被界定为"非法行医"以及增加诉累的法律风险;第一执业机构的法律风险包括不正当竞争风险、职务发明创造及职务作品的归属风险等;第二、三执业机构主要有医疗纠纷频发和多点执业医师违约的法律风险。法律风险的宏观防控措施包括坚持多点执业的公益性,整治走穴等;微观防控措施包括建立"首诊负责制"等具体化的管理制度,增设针对第一执业机构的审慎注意义务和损益补偿机制,区分中医、口腔和临床类多点执业医师的准入资格等。     

Transnational Governance Arrangements: Legitimate Alternatives to Regulating Nanotechnologies?

In recent years, the development and the use of engineered nanomaterials have generated many debates on whether these materials should be part of the new or existing regulatory frameworks. The uncertainty, lack of scientific knowledge and rapid expansion of products containing nanomaterials have added even more to the regulatory dilemma with policy makers and public/private actors contenting periods of both under and over regulation. Responding to these regulatory challenges, as well as to the global reach of nanotechnology research and industrial needs, governance arrangements beyond the state have addressed the challenge head-on. This article focuses on the governance arrangements of the International Organization for Standardization (ISO), which has led to the development of numerous “horizontal anticipatory standards” with an important role in setting the foundation for science, technology and market development. During the course of its operation ISO has broadened its scope to address not only technical issues related to the concept and the size of nanomaterials but also broader aspects of the technology, including health, environment and safety issues. The increasing relevance of the ISO to regulate economic relations and achieve certain public policy goals has given rise to many concerns about its legitimacy. The important questions are whether these governance arrangements may be deemed as being legitimate and where this legitimacy is derived from? What are the main sources of legitimacy at the transnational level and how we can apply them to analyse nanotechnology standardization? This article provides concise answers to these questions. It focuses at the normative concepts of democratic and scientific legitimacy and explores the institutional structures and processes by which nanotechnology standards are established.     

A Heideggerian Defense of Therapeutic Cloning

Debates about the legitimacy of embryonic stem-cell research have largely focused on the type of ethical value that should be accorded to the human embryo in␣vitro. In this paper, I try to show that, to broaden the scope of these debates, one needs to articulate an ontology that does not limit itself to biological accounts, but that instead focuses on the embryo’s place in a totality of relevance surrounding and guiding a human practice. Instead of attempting to substantiate the ethical value of the embryo exclusively by pointing out that it has potentiality for personhood, one should examine the types of practices in which the embryo occurs and focus on the ends inherent to these practices. With this emphasis on context, it becomes apparent that the embryo’s ethical significance can only be understood by elucidating the attitudes that are established towards it in the course of specific activities. The distinction between fertilized embryos and cloned embryos proves to be important in this contextual analysis, since, from the point of view of practice, the two types of embryos appear to belong to different human practices: (assisted) procreation and medical research, respectively. In my arguments, I highlight the concepts of practice, technology, and nature, as they have been analyzed in the phenomenological tradition, particularly by Martin Heidegger. I come to the conclusion that therapeutic cloning should be allowed, provided that it turns out to be a project that benefits medical science in its aim to battle diseases. Important precautions have to be taken, however, in order to safeguard the practice of procreation from becoming perverted by the aims and attitudes of medical science when the two practices intersect. The threat in question needs to be taken seriously, since it concerns the structure and goal of practices which are central to our very self understanding as human beings.     

Global Governance and Civil Society. Some Reflections on NGO Legitimacy

Today civil society groups are important actors on the international stage. Nongovernmental organizations (NGOs) have taken roles that traditionally have been the sole province of states or intergovernmental institutions. NGOs are not bound to act in the public interest. Neither are their actions justified by formal democratic procedures, as is the case with states. Therefore, questioning the legitimacy of their actions is a crucial thing to do. This article presents the results of empirical research on the legitimacy of internationally operating NGOs (INGOs). From the interview data seven types of legitimacy are distinguished. These do not give us a comprehensive categorisation of sources of legitimacy; rather they provide tools to counterbalance existing views of legitimacy. The aim is to develop concepts for evaluating the legitimacy of INGO activities which are grounded in theory as well as in practice. Before analysing the empirical results concerning NGO legitimacy, some views on civil society will be discussed with a focus on the problem of legitimacy.     

Science Policy and Concomitant Research in Synthetic Biology—Some Critical Thoughts

In science policy, public controversy around synthetic biology has often been presented as a major risk because it could deter innovation. The following inter-related strategies for avoiding contestation have been observed: (1) There have been attempts to close down debates by alluding to the importance and legitimacy of reliance on scientific evidence as input to regulatory processes. (2) Scientific policy advice has stressed sufficiency of existing regulation, economic risks of additional regulation and/or suggestions for monitoring that are limited in scope. (3) Initiatives for self-governance have narrowed the scope of topics for consideration. (4) Engagement with humanities, social sciences and arts has been co-opted for legitimisation and science communication. Although such agendas are of course not ubiquitous, in this paper, I criticise that instrumentally motivated engagement has been supported not only by the scientific community but also by policy institutions and funding bodies. I argue that it is good that this now seems to fuel controversy in the academic and policy realms. As synthetic biology is not the only technoscientific field to see such dynamics, this is also part of the broader context of debate about the governance of science, especially the concept of “responsible research and innovation” (RRI) currently promoted in the EU.     

用批判性思维方法解决烧伤护理实践中的问题

批判性思维是护理界越来越注重培养并予运用的思维方法。在烧伤护理实践中用批判性思维方法解决临床护理实际问题,护理人员应正确理解批判性思维的概念并培养批判性思维能力、应具备良好的职业道德和敬业精神,最终能将批判性思维正确运用于护理程序的每一个步骤中。     

How to Regulate a Practice: The Case of Cosmetic Surgery

How should a practice, subservient to a public good, be regulated in order to guarantee fair access without encouraging improper claims? In the first place, a clear understanding of the goal of the practice is indispensable for knowing what criteria the regulation must contain. As to the purely formal aspect, the regulation of any practice must include both general rules and particular instances. Finally, to resolve conflicts, committees in which different kinds of expertise are represented should be installed. These three theses are illustrated by the Dutch regulation for cosmetic surgery.     

单题项测量：质疑、回应及建议

研究者关于单题项测量的争论已久。支持者认为单题项测量具有时间和效率上的优势, 而反对者则认为单题项测量的信效度均无法得到保障。通过定性和定量的回顾, 归纳了单题项测量的优缺点, 剖析了以往研究对单题项测量的种种质疑并逐一进行回应。通过系统梳理, 发现单题项测量具有可以接受的信度和效度水平, 且多题项测量的效标关联效度并没有显著优于单题项测量。最后, 指出了单题项测量开发和使用过程中应该注意的事项。尽管多题项测量仍是当前研究界的主流测量方法, 但未来研究者应当更加客观地看待单题项测量。学界应当充分理解单题项测量潜在的优点和适用范围, 从而使单题项测量在管理心理学和社会科学研究中发挥其应有的作用。     

Standardisation in the Field of Nanotechnology: Some Issues of Legitimacy

Nanotechnology will allegedly have a revolutionary impact in a wide range of fields, but has also created novel concerns about health, safety and the environment (HSE). Nanotechnology regulation has nevertheless lagged behind nanotechnology development. In 2004 the International Organization for Standardization established a technical committee for producing nanotechnology standards for terminology, measurements, HSE issues and product specifications. These standards are meant to play a role in nanotechnology development, as well as in national and international nanotechnology regulation, and will therefore have consequences for consumers, workers and the environment. This paper gives an overview of the work in the technical committee on nanotechnology and discusses some challenges with regard to legitimacy in such work. The paper focuses particularly on stakeholder involvement and the potential problems of scientific robustness when standardising in such early stages of the scientific development. The intention of the paper is to raise some important issues rather than to draw strong conclusions. However, the paper will be concluded with some suggestions for improving legitimacy in the TC 229 and a call for increased public awareness about standardisation in the field of nanotechnology.     

A Model for the Role of Defined Spirituality in South African Specialist Psychiatric Practice and Training

The current bio-psycho-social approach in South African psychiatry refers to Engel’s extended model of health care. It forms the basis of the existing collaboration between medicine, nursing, psychology, occupational therapy and social work. Psychiatry also has to bridge the multi-cultural, multi-religious and spiritual diverse reality of everyday practice. It has become important to establish how, within accepted boundaries, spirituality should be incorporated into the model for practice. Referring to methods described for nursing theory development, a defined core concept was used to construct a model. It may contribute to the discourse on spirituality in local psychiatry, health and mental health.     

知情同意中患方权利人的排序

知情同意是重要的病人权利之一,患方知情同意权的排序,直接关系到病人的利益,是一个不容忽视的伦理问题,也是一个必须解决的实践问题,对知情同意的内容,患方权利人的范围,资格和排序从医学伦理学角度进行初步分析,同时探讨了在特殊情况下知情同意权的伦理悖论和操作上的两难问题,我们认为,在医疗行业快速市场化的今天,尽快建立病人权利法规,对包括知情同意权在内的病人权利作出法律规定,已经是十分必要和十分迫切了。