从医学伦理学到生命伦理学--新西兰生命伦理学的历史与社会学研究之二

1从医学伦理学到生命伦理学:知情同意的重要性 卡特莱特调查代表着新西兰医学伦理学史上最具深远意义的转折点.它不仅暗示了一个传统医学伦理学时代(主要着力于医生个体从职业立场出发而应有的礼仪)走向尾声,还宣布着一个新的生命伦理学时代(有着更宽泛的并以患者为中心的观点)的到来.     

突发公共卫生事件中志愿者行动的伦理支持

在突发公共卫生事件下,志愿者行动有着天然的伦理支持。从伦理的外在维度来说,政策支持、组织力量和伦理精神为志愿者提供了强有力的行动保障。从内在维度来说,疫情环境下的志愿者行动是其自身的伦理使然。伦理观是行动论的先导,志愿者自身的道义伦理观、效果伦理观和美德伦理观是志愿者行动的道德保障和精神表达。疫情时代志愿队伍的发展需要伦理价值观的引导,才能为突发公共卫生事件中的志愿者行为指引方向,进而为社会秩序的维护提供道德支持。

     

Ethics and Changing Mental Health Care: Concerns and Recommendations for Practice

Recent developments in health care delivery in the United States have left many professionals baffled by the continuing changes in practice sparked by the relatively new managed care environment. Psychologists who practice in medical settings are struggling to balance the seemingly competing needs to deliver quality care to clients and patients, while meeting the demands of third-party payers and trying to remain true to their ethical responsibilities. Critical elements of managed care, which many suggest compromise the ethical provision of quality care, include utilization review, financial incentives, and threats to confidentiality. Recommendations are proposed so that mental health professionals may be proactive in protecting their ethical responsibilities in this changing environment.     

生命伦理学:权力与不公正--在第六届国际生命伦理学大会的致辞

在现代生命伦理学的讨论中,主要关注的是改造医患关系中的权力关系。通过强调人权和对个人尊严的尊重,对脆弱人群授予权利已经达到。然而,在卫生保健中,权力的不平衡依然普遍存在。这在相当程度上与对社会不公正的关注不够有关。那种权力的不平衡加之新的权力形式的发展,例如,通过新的遗传生物技术,产生了对日益增长的社会不公的恐惧与忧虑。由此,扩展与公共卫生有关的伦理学讨论将受到关注。政治哲学研究也需要变为改造国际权力关系和改善人口健康。     

突发公共卫生事件中民众对专家系统的信任研究

风险社会充满不确定性,社会风险因素不断增加,突发公共卫生事件中民众与专家系统的信任关系存在“有限”信任取代完全依赖、盲从式跟风、信任缺失等问题。从风险传播视角出发,分析民众与专家系统信任关系存在问题的原因主要包括：专家与普通民众之间的认知落差、媒体不当报道消解专家公信力、对话机制缺失影响专家观点传播效果,并在此基础上提出落实公众参与交流机制、规范新闻媒体报道、优化专家风险话语表达等修复和调整民众对专家系统信任关系的有效策略。

     

The Ethics of Virtual Reality Technology: Social Hazards and Public Policy Recommendations

This article explores four major areas of moral concern regarding virtual reality (VR) technologies. First, VR poses potential mental health risks, including Depersonalization/Derealization Disorder. Second, VR technology raises serious concerns related to personal neglect of users’ own actual bodies and real physical environments. Third, VR technologies may be used to record personal data which could be deployed in ways that threaten personal privacy and present a danger related to manipulation of users’ beliefs, emotions, and behaviors. Finally, there are other moral and social risks associated with the way VR blurs the distinction between the real and illusory. These concerns regarding VR naturally raise questions about public policy. The article makes several recommendations for legal regulations of VR that together address each of the above concerns. It is argued that these regulations would not seriously threaten personal liberty but rather would protect and enhance the autonomy of VR consumers.     

Ethics Education: Recommendations for an Evolving Discipline

This article describes results of a national questionnaire completed by counselor education program professors regarding their teaching of ethics. The questionnaire asked professors about 5 aspects of ethics education: materials used, instructional methods used, content taught, methods of evaluation used, and professors' goals for the ethics education of their students. Questionnaire results and demographic data about professors and programs are used to describe perceptions and practices of counselor educators who teach ethics.     

Ethics for Mental Health Influencers: MFTs as Public Social Media Personalities

The increase in social media usage contributes to a greater number of Marriage and Family Therapists (MFTs) using social media to grow their professional outreach and to increase awareness about mental health by engaging with online audiences. Although existing literature has discussed how MFTs can make ethical use of personal social media in and around their therapeutic role, no literature at this time has explored the potential ethical issues faced by MFTs seeking to build public presence on social media as a “mental health influencer.” The present paper intends to provide a definition of mental health influencers (MHIs) and reviews ethical concerns relevant to MFTs acting as MHIs. Particular consideration is given to ethical dilemmas and conflicts-of-interest which may emerge via parasocial relationships developed through social media influencing, as well as how the boundaries and the limitations of an MFT’s professional scope can be tested when presenting as a personable, public figure over digital platforms. A framework for conceptualizing ethical issues for MHI-MFTs is offered, with a selection of prescient issues being examined within the scope of existing ethical standards set forth by the American Association of Marriage and Family Therapy’s (AAMFT) Code of Ethics. Reflections are offered about what questions and guidelines should be observed by MFTs in order to avoid unethical use of social media as an MHI, followed by a brief discussion about future considerations which should be considered by MHIs.

     

遭遇公共健康的生命伦理学

由于传统的生命伦理学是建基于个人主义的价值观之上,它强调个人权利的优先性,而在公共健康实践中却经常会为了全体人口的健康对个人的自由、隐私等权利进行干预或限制。公共健康对公共善而非个人权利的强调对传统的生命伦理学构成了挑战。公共健康的这一挑战促使生命伦理学向多元化的方向发展。     

Decisions about life and death: Assessing the Law Reform Commission and the Presidential Commission Reports

This paper compares and critically comments upon certain aspects of the Canadian Law Reform Commission Report,Euthanasia, Aiding Suicide and Cessation of Treatment, and the United States Presidential Commission Report,Deciding to Forego Life-Sustaining Treatment. It focuses on their positions on euthanasia and on the general principles, values, and procedures that ought to govern practices of foregoing life-sustaining treatment. The paper first comments on the recent debate over the moral relevance of the killing/letting die distinction, since this issue appears crucial in assessing the rationality of the current, absolute prohibitions of direct killing in medical contexts, embodied both in law and in codes of ethics. This issue bears upon a question in the closing section—whether the withdrawal of foods and fluids is ever morally permissible.     

流行病学实践与研究相关的伦理学视角与思考

随着社会的发展,公共卫生领域的伦理学问题不断显露,有必要对其重新审视。探讨了目前在公共卫生领域流行病学实践与研究中存在和涉及到的一些伦理问题,有传染病报告、隔离、免疫规划、艾滋病防治、传染病应急机制、流行病学调查和试验研究等,并就公共卫生领域中的伦理实践原则进行了概括。     

论公共卫生决策的伦理模式

公共卫生决策的伦理问题是公共卫生伦理研究的一个核心问题。近年来我国公共卫生领域出现了大量严重的伦理问题,其主要根源在于公共卫生决策的伦理缺失。强调指出公共卫生伦理决策应当树立科学健康观,并以此为基础,从转变政府职能、强化公共卫生信息系统和加大政府投入等方面详细论述了公共卫生伦理决策的一种新模式。