Ethics Remediation,Rehabilitation, and Recommitment to Medical Professionalism: A Programmatic Approach

This article recounts the development of the Professional/Problem-Based Ethics (ProBE) Program, the original physicians’ professional ethics remediation course. Since 1992, more than 1,200 healthcare professionals of many disciplines have been mandated to attend ProBE by licensing boards and other oversight entities. Using a small-group, interprofessional setting, the ProBE Program assists participants to discover and articulate ethical underpinnings violated by their misconduct; appreciate professional responsibilities that are societal, regulatory, and ethical; and recommit to professional ideals. The authors describe the rationale for developing ProBE, its curriculum, participant demographics, and infractions and reconsider medical professionalism in light of two decades of ProBE.     

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.     

临床护理人员的护理伦理知信行素养调查研究——以某三甲医院为例

为了解临床护理人员的护理伦理知识、信念、行为等素养的现状、存在的主要问题及其主要影响因素,问卷调查了某三级甲等医院的1147名护理人员,同时对16名资深护理人员和护理工作管理者进行深入访谈。调查结果显示,尽管多数护理人员在工作实践中能正确践行护理伦理行为,但护理人员的护理伦理知识欠缺,护理伦理教育有待加强;部分护理人员的基本护理（医学）伦理理念尚未建立;“重技术轻人文”的护理理念仍然是影响护理伦理践行的主要因素。临床护理人员普遍有接受有关护理伦理知识和技能培训的需求和愿望。

     

Professional Boundary Ethics Attitudes and Awareness Among Nurses and Physicians in a University Hospital in the Kingdom of Saudi Arabia

This study sought to gauge ethical attitudes about professional boundary issues of physicians and nurses in the Kingdom of Saudi Arabia. Respondents scored 10 relevant boundary vignettes as to their ethical acceptability. The group as a whole proved “aware/ ethically conservative,” but with the physicians' score falling on the “less ethically conservative” part of the spectrum compared to nurses. The degree of ethicality was more related to profession than to gender, with nurses being more “ethical” than physicians.     

A Code of Ethics for Health Care Ethics Consultants: Journey to the Present and Implications for the Field

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here.     

公共卫生人才调查及培养的思考

对江苏省部分市、区、县级疾病预防控制中心和卫生监督所的公共卫生队伍现状、人才需求进行了调查分析,为我国公共卫生教育提供了科学的依据。认为江苏省公共卫生系统现有人员素质有待进一步提高,医学高等院校应该加强公共卫生人才的培养。     

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。     

宗教心理-鬼神心理疾病—濒死体验的诊断与预后

濒死体验是科学现象而不是灵学现象,有初步问卷和最终量表可供筛查和诊断;是心理疾病而不是精神病。美国精神病学学会《精神疾病诊断与统计手册》标定为“宗教—鬼神问题”。除非获得适当的心理治疗与社会心理康复,患者预后不良。     

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。     

Obligations In Medical Crises: Treatment and Protocols

This article adduces several lines of argument to try to analyze the need for certain sorts of interventions in medical crises. The recent Ebola crisis is taken as exemplary, and other similarly serious medical situations requiring intervention, such as the endemic presence of Valley fever in parts of California, are alluded to. The overall contention is that our duties in medical crises may be somewhat stronger than previously constructed by analysts. The work of Kuhse and Singer is cited, and the article concludes that there are special moral obligations to respond to international medical emergencies when they arise.     

新公共卫生与后医学时代

现代社会出现的超重、肥胖、吸烟、吸毒、不安全性行为等社会压力和社会环境导致的各种退行性疾病和新传染病(艾滋病等)新公共卫生问题,主要靠非卫生部门的努力,即由政府主导、社会各部门和群众参与,按生物心理社会医学模式,用健康教育和健康促进战略,深入社区,对人们的行为进行干预,医生与服务对象(健康人、亚健康人、病人)共同努力才能取胜。医务人员需转变观念、更新服务模式,为提高全民健康素质,全面建设小康社会,自觉地促进此历史性的变革。     

医学伦理学和生命伦理学的学科使命之辨

从古典医德学发展到生命伦理学,催生医学伦理学和生命伦理学两门学科。欧美对于医学伦理学本质解读的经典路径和中国医学伦理学的阐释方式,不能完全反映医学伦理学的全貌,为此需要以动态有机的方式理解医学伦理学范畴。这种理解表明：医学伦理学的学科使命聚焦医学职业道德,是德性伦理和规范伦理的融合,是质料伦理和形式伦理的统一。生命伦理学本质上是为生命科学的运用提供道德正当性论证,将关怀类生命和人类未来生存作为其学科使命。生命伦理学的跨学科建制及其解决范式依托寻求论证和程序合理性,它是对医学职业道德瓶颈的突围,又反哺"医学职业道德规范"的制定和执行。     

美德复兴的历程与医学美德的复苏

美德伦理的复兴是20世纪伦理学研究的重要转向和理论图景,国外美德伦理研究以麦金太尔为代表,迈克尔•斯洛特的情感主义美德伦理学最具代表性,国内在译介国外研究的基础上提出美德与规范的互补。在医学领域也开始复兴美德伦理,内因在于美德伴随医学的产生,比规范伦理有更悠久的历史,外因在于扭转社会的去道德化倾向,美德伦理与规范伦理同样重要,甚至某些情况下更重要。但在美德伦理的复兴过程中,也面临着内在与外在的阻力,美德伦理复兴任重而道远。

     

Prescriptions: Autonomy,Humanism and the Purpose of Health Technology

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems.     

“学界热”与“行业冷”：医学伦理学落地医疗实践之思

医学伦理学是医学人文教育的基础阵地,中国过去40年医学伦理学科建设有成绩也有不足。当前医学伦理学落地医疗实践成为问题的焦点。从伦理学界的热点问题出发,描述热中有冷、冷热交加的伦理现象：应用伦理热、科研伦理热、医学伦理热,分析现象背后的原因可能是伦理观念与意识不足,理论与实践脱节及实践深度与广度不够。以此为基点寻生根之径,知的层面要自上而下多层保障;行的层面要理论联系实践,要深化内化转化;最终达到知行合一,入脑入心入行,加速医学伦理学落地生根。

     

Healing Without Waging War: Beyond Military Metaphors in Medicine and HIV Cure Research

Military metaphors are pervasive in biomedicine, including HIV research. Rooted in the mind set that regards pathogens as enemies to be defeated, terms such as “shock and kill” have become widely accepted idioms within HIV cure research. Such language and symbolism must be critically examined as they may be especially problematic when used to express scientific ideas within emerging health-related fields. In this article, philosophical analysis and an interdisciplinary literature review utilizing key texts from sociology, anthropology, history, and Chinese and African studies were conducted to investigate the current proliferation of military metaphors. We found the use of these metaphors to be ironic, unfortunate, and unnecessary. To overcome military metaphors we propose to (1) give them less aggressive meanings, and/or (2) replace them with more peaceful metaphors. Building on previous authors' work, we argue for the increased use of “journey” (and related) metaphors as meaningful, cross-culturally appropriate alternatives to military metaphors.     

公共卫生的特征及其伦理学问题

公共卫生主要关注全体人口的健康,而不是个体的健康。通过对公共卫生的定义,对公共卫生实践与临床医疗实践的区别的阐述,提出公共卫生伦理学概念上的大致范围。指出在公共卫生中最为关键的因素是政府的作用,政府采取强制措施消除造成公众健康威胁因素的权力和义务。     

Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records

Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool (ECQAT). ECQAT enables raters to assess the quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation (ethics question, consultation-specific information, ethical analysis, and conclusions and/or recommendations), established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT, the resulting product, and recommended future testing and potential uses for the tool.     

Rehabilitating Self-Sacrifice: Care Ethics and the Politics of Resistance

ABSTRACT

How should feminists view acts of self-sacrifice performed by women? According to a long-standing critique of care ethics such acts ought to be viewed with scepticism. Care ethics, it is claimed, celebrates acts of self-sacrifice on the part of carers and in doing so encourages women to choose caring for others over their own self-development. In doing so, care ethics frustrates attempts to liberate women from the oppression of patriarchy. Care ethicists have responded to this critique by noting limits on the level, form, or scope of self-sacrifice that work to restrict its role in their theories. While we do not here take issue with the initial feminist critiques of self-sacrifice, we suspect that the strategies offered by Care ethicists in response are importantly flawed. Specifically, these responses undervalue the positive roles that self-sacrifice can play in fighting patriarchal oppression. As a result, in attempting to restrict an oppressive norm, these responses risk foreclosing on valuable means of resistance. Our aim is to explore these positive roles for self-sacrifice and thereby rehabilitate its standing with feminists.