试论刘少奇《论共产党员的修养》对传统道德修养理论的继承与超越——纪念刘少奇诞辰110周年

在中国近代的道德转型中,许多学者对建立共产主义道德的理论体系、批判封建旧道德、驳斥西方资产阶级道德等重要工作都做出了重要贡献。刘少奇对共产党员道德修养的论述,是其中重要的组成部分。他将共产党员的道德修养的必要性植根于中国革命实践,从历史发展和人性可变的角度论证道德修养的可能性,并在加强理论学习的基础之上强调道德修养的实践途径与方法,反映了在这一转型过程中中国共产党人对传统伦理道德的批判、继承与超越。     

知情同意在中国不适用吗——“文化差异论”的认知错误

知情同意是在当代生命伦理学中最有影响的概念,在大多数西方国家它已成为医疗实践和涉及人体的医学科学研究的一个基本的伦理要求。不少西方和中国学者认为,由于中西文化显著而根本的差异,知情同意不适宜于中国。指出了“文化差异论”的三个认知错误,即,文化差异论是建立在对中国文化和医学道德、西方文化以及知情同意的一系列误解之上的。基于文化的差异而拒绝知情同意在中国的适用性和必要性,显然不能成立。     

The origins and evolution of bioethics: some personal reflections

Bioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on a perceived "dehumanization" of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human "values" into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third -- and present -- period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise -- e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

Medical ethics in France: The latest great political debate

The American term Bioethics has been adopted over the last ten years and the development of Bioethics committees on the American model testifies this influence, even before the official appointment of a National Committee in 1983. This phenomenon acknowledged as the “emergence of French bioethics” is in fact the final outcome of a long-lasting crisis in the medical profession, in quest for a new style of ethics, breaking with the traditional professional ethics (French Déontologie, through the Ordre des Médecins). Among other factors of conceptual and institutional change, the increase of biomedical research comes first: a major consequence is the sharing of moral responsibilities in decision-making with outsider scientists and finally the involvement of the whole population as potential moral subjects. The designation of these events as the emergence of French bioethics is hardly appropriate for an account of this dramatic shift in ethical norms and roles in medicine. This paper attempts to review the intellectual roots of the recent evolution and to summarize present and prospective trends.     

Global ethics and principlism

This article examines the special relation between common morality and particular moralities in the four-principles approach and its use for global ethics. It is argued that the special dialectical relation between common morality and particular moralities is the key to bridging the gap between ethical universalism and relativism. The four-principles approach is a good model for a global bioethics by virtue of its ability to mediate successfully between universal demands and cultural diversity. The principle of autonomy (i.e., the idea of individual informed consent), however, does need to be revised so as to make it compatible with alternatives such as family- or community-informed consent. The upshot is that the contribution of the four-principles approach to global ethics lies in the so-called dialectical process and its power to deal with cross-cultural issues against the background of universal demands by joining them together.     

A draft model aggregated code of ethics for bioethicists

Bioethicists function in an environment in which their peers--healthcare executives, lawyers, nurses, physicians--assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists.     

Medical ethics in Latin America: a new interest and commitment.

Recent visits to five Latin American nations indicate that some medical professionals are eager to increase the role of bioethics in their countries. Conversations with key figures there point up similarities and differences among Latin nations, and between Latin countries and the United States, in their approaches to ethics. Opportunities exist for U.S. bioethicists to help get bioethics teaching and research off the ground in Latin America.     

A Draft Model Aggregated Code of Ethics for Bioethicists

Bioethicists function in an environment in which their peers—healthcare executives, lawyers, nurses, physicians—assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists.     

Medical Ethics Education: A Survey of Opinion of Medical Students in a Nigerian University

In Nigeria, medical education remains focused on the traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition. In order to ascertain the adequacy of this method of moral formations, we studied the opinions of medical students in a Nigerian university towards medical ethics training. Self administered semi-structured questionnaires were completed by final year medical students of the College of Medicine, University of Ibadan, Nigeria. There were 82 (64.1%) male and 44 (34.4%) female respondents. The median age was 26 years. Most students (80.5%) responded that they did not receive enough training in medical ethics. The ethics instructions they received did not sufficiently prepare them for the ethical challenges they came across as medical students. Though inadequate, the few hours of lecture and discussion on human values and professional etiquette which they received positively influenced their moral reasoning. They identified end-of-life issues, dealing with financial issues and handling socio-cultural beliefs of patients and relations as some challenges that medical doctors are ill-prepared for by their current training. Most, 85.9% believed that formal medical ethics education would be worthwhile as it would enhance the making of complete and better doctors. They recommended incorporating bioethics as a course in the medical school curriculum. Nigerian medical students encounter ethical challenges for which they have not been adequately trained to resolve. They recommended formal medical ethics training in their curriculum and a uniform bioethics programme in the country.     

What is bioethics without Christianity?

The author uses the essays in this issue as a springboard for making three points. First, he argues that most, if not all, current institutional versions of Christianity have failed to provide a meaningful framework for the spiritual life. Second, he argues that there is no ethics other than Judeo-Christian ethics and that there can be no bioethics other than Judeo-Christian bioethics. Finally, he argues that the overriding issue we face is not whether to address bioethical issues from a Christian perspective or from a non-Christian perspective, but rather whether we shall address biological and medical issues from an ethical or a scientific-technological perspective.     

Medical Ethics,Bioethics and Research Ethics Education Perspectives in South East Europe in Graduate Medical Education

Ethics has an established place within the medical curriculum. However notable differences exist in the programme characteristics of different schools of medicine. This paper addresses the main differences in the curricula of medical schools in South East Europe regarding education in medical ethics and bioethics, with a special emphasis on research ethics, and proposes a model curriculum which incorporates significant topics in all three fields. Teaching curricula of Medical Schools in Bulgaria, Bosnia and Herzegovina, Croatia, Serbia, Macedonia and Montenegro were acquired and a total of 14 were analyzed. Teaching hours for medical ethics and/or bioethics and year of study in which the course is taught were also analyzed. The average number of teaching hours in medical ethics and bioethics is 27.1 h per year. The highest national average number of teaching hours was in Croatia (47.5 h per year), and the lowest was in Serbia (14.8). In the countries of the European Union the mean number of hours given to ethics teaching throughout the complete curriculum was 44. In South East Europe, the maximum number of teaching hours is 60, while the minimum number is 10 teaching hours. Research ethics topics also show a considerable variance within the regional medical schools. Approaches to teaching research ethics vary, even within the same country. The proposed model for education in this area is based on the United Nations Educational, Scientific and Cultural Organization Bioethics Core Curriculum. The model curriculum consists of topics in medical ethics, bioethics and research ethics, as a single course, over 30 teaching hours.     

Laying medicine open: understanding major turning points in the history of medical ethics

At different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenonmenon of laying medicine open has sometimes resulted in major turning points in the history of medical ethics. In this paper, I examine two examples of when the laying open of medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724-1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician's fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.     

Institutional identity, integrity, and conscience

Bioethics has focused on the areas of individual ethical choices -- patient care -- or public policy and law. There are however, important arenas for ethical choices that have been overlooked. Health care is populated with intermediate arenas such as hospitals, nursing homes, hospices, and health care systems. This essay argues that bioethics needs to develop a language and concepts for institutional ethics. A first step in this direction is to think about institutional conscience.     

Training in clinical ethics consultation: the Washington Hospital Center course

How can one be trained to enter the evolving field of clinical ethics consultation? The classroom is not the proper place to teach clinical ethics consultation; it is best done in a clinical setting. The author maps the elements that might be included in an apprenticeship, and sets out propositions for debate regarding the training needed for clinical ethics consultants and directors of clinical ethics consultation services. I was invited to be an observer of the first Intensive Course in Clinical Ethics at the Washington Hospital Center (WHC). I had no input into the planning. Having been present at a meeting of the Clinical Ethics Consultation Affinity Group of the American Society of Bioethics and Humanities (ASBH) when the issue of a lack of training programs was discussed, I was acutely aware of the need. Knowing how popular the various four-day intensive courses in bioethics have been, held at Georgetown University first, and then in Seattle and locations in the Midwest, it seemed time to have a four-day intensive course that was devoted to clinical ethics. The differences between bioethics and clinical ethics is substantial and largely unappreciated by those in bioethics. So when the WHC team agreed to take on the task of offering an intensive in clinical ethics, it was an important step for the field.     

The social individual in clinical ethics

Except for several provocative final sentences, Sigrid Fry-Revere's "A Libertarian Critique of H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics" is not a libertarian so much as it is a philosophical critique. Engelhardt's work has been widely reviewed, and its arguments have been discussed in Fry-Revere's article and elsewhere. Although it would be impractical in this context to undertake the development of a full-scale, philosophical alternative to libertarianism in bioethics, some recent work in philosophy and clinical ethics bears strongly on the challenge that Engelhardt's work represents. In this commentary I will focus on the implications of a certain alternative philosophy -- and by comparison the limitations of Engelhardt's libertarianism -- for one important aspect of clinical ethics: our understanding of the nature of individuality, with special reference to the situation of the patient. I write as an admiring critic of Engelhardt's work, from which I have learned and drawn inspiration....     

On a communitarian approach to bioethics

A communitarian approach to bioethics adds a core value to a field that is often more concerned with considerations of individual autonomy. Some interpretations of liberalism put the needs of the patient over those of the community; authoritarian communitarianism privileges the needs of society over those of the patient. Responsive communitarianism’s main starting point is that we face two conflicting core values, autonomy and the common good, and that neither should be a priori privileged, and that we have principles and procedures that can be used to work out this conflict but not to eliminate it. This discussion uses the debate in the US over funding for entitlements as a case study to apply the values of communitarian bioethics.     

Encountering diversity: Medical ethics and pluralism

An emerging issue in medical ethics is how to respond to the growing religious and ethnic diversity seen in American hospitals. This fictionalized account of a clinical case uses narrative ethics to explore decisions at the end of life in a pluralistic society. The author maintains that it is the rights secured for patients and their families by secular bioethics and its inherent respect for pluralism that allow for cultural and religious differences.     

案例教学的医学伦理学再造

我国医学伦理学采用案例教学法已经有二十余年的历史了。在此期间,案例教学得到了一定的发展,却也受到了诸多因素的限制。当前,中国医学伦理学的案例教学朝哪里去、怎么去等一系列新的问题摆在我们面前,这些问题必须依赖于加强我国医学伦理学软件环境的建设并对案例教学进行医学伦理学的再造方能加以解决。