Ethics issues in security hospitals

The term 'security hospital' is used for a variety of facilities including forensic hospitals and prison hospitals, which, because of their mission, the nature of their work, and the populations they serve-or because of the authority under which they operate-place the staff at considerable risk of ethical violations related to either clinical care or to forensic activities. The problem of divided loyalties is of special concern in security hospitals. Ethics principles particularly at risk are confidentiality and informed consent. Where there are cultural disparities between the staff and the patients, differences in background, socioeconomic class, education, and other types of diversity, cultural awareness is required and must be reflected in appropriate treatment and evaluation. To counteract the risks of ethical violations, a security hospital should create an ethical climate and develop means to anticipate, prevent, and deal with ethical violations. These might include detailed and specific policies and procedures, programs of orientation, education, consultation, and liaison as well as its own ethics committee.     

Ethics education and value prioritization among members of U.S. hospital ethics committees

Calls for ethics education for members of hospital ethics committees presume that the effects and benefits of such education are well-established. This is not the case. A review of the literature reveals that studies consistently have failed to uncover any significant effect of ethics education on the moral reasoning, moral competency, and/or moral development of medical professionals. The present paper discuss this negative result and describes the author's national study of the value priorities of members of hospital ethics committees. This study discovered correlations between moral decision making and factors like age and type of institution where the committee operates. The results of this study also resemble those of previous studies in finding no correlation between ethics education and moral decision making. The author concludes that there is a need for more research on the effects of nonmoral personal, societal, and institutional factors on the moral reasoning of members of hospital ethics committees. Further, in the absence of any firm empirical basis, calls for ethics education for medical professionals and ethics committee members should be rethought.     

Legal briefing: Healthcare ethics committees

This issue's "Legal Briefing" column covers recent legal developments involving institutional healthcare ethics committees. This topic has been the subject of recent articles in JCE. Healthcare ethics committees have also recently been the subject of significant public policy attention. Disturbingly, Bobby Schindler and others have described ethics committees as "death panels." But most of the recent attention has been positive. Over the past several months, legislatures and courts have expanded the use of ethics committees and clarified their roles concerning both end-of-life treatment and other issues. These developments are usefully grouped into the following eight categories: 1. Existence and availability. 2. Membership and composition. 3. Operating procedures. 4. Advisory roles. 5. Decision-making and gate-keeping roles. 6. Confidentiality. 7. Immunity. 8. Litigation and court cases.     

传统伦理学的价值伦理学转向

传统伦理学的价值伦理学转向,一是基于研究重心由“应当”问题转换为“德行之所以然”的问题,二是基于研究范式上由目的论、德性论、义务论等转换为价值论。作为传统伦理学的集大成者,康德伦理学一方面因其浓烈的价值论色彩而成为舍勒和N．哈特曼价值伦理学的前奏,另一方面因其“实质”内容缺失而致的形式主义又为后者的拓展提供了空间。舍勒,尤其是N．哈特曼的实质价值伦理学正是在康德伦理学的理论平台上得以建立的。     

A national study of ethics committees

Conceived as a solution to clinical dilemmas, and now required by organizations for hospital accreditation, ethics committees have been subject only to small-scale studies. The wide use of ethics committees and the diverse roles they have played compel study. In 1999 the University of Pennsylvania Ethics Committee Research Group (ECRG) completed the first national survey of the presence, composition, and activities of U.S. healthcare ethics committees (HECs). Ethics committees are relatively young, on average seven years in operation. Eighty-six percent of ethics committees report that they played a role in ongoing clinical decision making through clinical ethics consultation. All are engaged in developing institutional clinical policy. Although 4.5% of HECs write policy on managed care, 50% of HEC chairs feel inadequately prepared to address managed care. The power and activity of ethics committees parallels the composition of those committees and the relationship of members to their institutions. The role of ethics committees across the nation in making policies about clinical care is greater than was known, and ethics committees will likely continue to play an important role in the debate and resolution of clinical cases and clinical policies.     

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。     

A new role for psychologists--hospital ethics committees

Over the past decade psychology has begun to appreciate that it represents more than "merely mental health care" and has become increasingly involved in the generic health care arena. The participation of psychologists in Hospital Ethics Committees (HECs) is presented as a professional activity for which psychologists are particularly well suited. The clinical mission of HECs, the historical importance of ethical considerations to psychology, and the field's specific training and psycho-social expertise suggest valuable contributions that psychologists can make in this particular area. Further, as psychology actively increases its participation in HECs, other professional disciplines outside of the mental health field will systematically have the opportunity to become more familiar with psychology and its clinical and research expertise.     

Research ethics committees: a regional approach

Guidelines for Institutional Review Boards (IRBs) or research ethics committees exist at national and international levels. These guidelines are based on ethical principles and establish an internationally acceptable standard for the review and conduct of medical research. Having attained a multinational consensus about what these fundamental guidelines should be, IRBs are left to interpret the guidelines and devise their own means of implementing them. Individual and community values bear on the interpretation of the guidelines so different IRBs attain different levels of effectiveness. In the Caribbean and Pan American regions there are few IRBs. Obstacles to the establishment and function of IRBs are exacerbated in developing regions like these by differences in language, literacy, and local value systems; education, administrative expertise, facilities, and access to information are also limited. A regional IRB network might facilitate more uniform ethical review in developing countries, and simplify IRB procedures. This revised version was published online in August 2006 with corrections to the Cover Date.     

Children in hospitals

Institutional hospital rules are often deleterious to the emotional well-being of the infant or child and the family. Consumers and concerned professionals can organize advocacy coalition organizations to study institutional policies, advocate and create change, and monitor practices.     

Virtue Ethics and Confucian Ethics

This essay focuses on the unity of several virtues in pre-Qin Confucians. Confucius maintains the proper application and coherence of such virtues as benevolence, wisdom, trustworthiness, straightforwardness, courage, and firmness. Further, Confucius takes benevolence and nobility as characteristic of human being. Particular attention is paid to the distinction and relationship between virtuous characters and virtuous actions.     

Feminist Ethics and Religious Ethics

This focus issue is a conversation at and about the interface of feminist ethics and religious ethics, in order to show what these multifaceted fields of intellectual endeavor and practical import have to say to each other, to teach and to learn. The seven essays approach that dialogue from a variety of angles and traditions, reflecting the fecundity of both fields and the wide‐ranging concerns of colleagues in religious ethics who share commitments and methods with feminist ethics.     

语言伦理与媒体伦理

语言与媒体的联系表明语言伦理与媒体伦理具有内在联系;语言与媒体的差异表明语言伦理与媒体伦理之间又存在着巨大区别,从而使得前者构成了自然语言的伦理问题,后者构成了媒体语言的伦理问题。不要说谎(即说真话)既是自然语言伦理也是媒体语言伦理的基本要求,但是,由于媒体语言与自然语言的不对称,以及媒体语言已经成为公共领域的主导语言,所以,媒体语言之不要说谎的重要性远非自然语言不要说谎的重要性所能比拟。应用伦理学应该通过政府主管部门、媒体自律协会和全体社会公众三条监督途径,来解决媒体伦理问题,确保媒体遵循不要说谎的基本道德要求。其中,利用现代网络技术把自然语言提升为媒体语言,完善全体社会公众的监督途径尤为重要。