医学伦理学与生命伦理学的联系与区别

医学伦理学和生命伦理学有共同的哲学伦理学和医学的学科基因。二者都遵守共同的伦理原理和原则,但是它们实施原理原则的方法和路径却有区别。医学伦理学构建了常态下的医德原则和规范体系。在经常的医疗卫生活动中医务人员会"以义导利"。当医务人员的选择面临价值冲突时,会按照伦理学原则提出的价值顺位安排医疗卫生行为的优先顺位。生命伦理学面对的常常是高科技带来的道德冲突,没有现成的价值顺位可以套用。在生命伦理学的许多具体案例中,人们只能通过协商讨论来寻求方案,达成共识。二者都是哲学伦理学和医学的子集,两者之间有交集,但是侧重不同。     

全球生命伦理学:共识的瓦解(上)——对全球性道德的探求:生命伦理学,文化战争和道德多样性

探究道德差异的核心问题以及哪种道德意见被我们采纳,比如为了建立医疗保健伦理模式与决策方法比较传统与后传统、家族本位与个人本位之间的关系。考虑到以道德多元化定义当代人类处境,关于卫生保健政策和生命法则的反思是明智的。这个反思强调了俗世伦理学的道德多元化和为对自由和责任进行俗世化思考的结论之间分歧的意义。     

Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure

Clinical ethics consultations (CECs) are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient “closure” for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as “bioethics mediation.”     

基因研究中的知情同意之惑

知情同意作为生命伦理的重要原则,在基因研究中同样占据重要的地位,由于基因研究中知情同意的异质性,在基因研究中面临着诸如如何理解其知情同意的异质性、群体知情同意、基因知情与基因隐私、利益冲突等问题.通过分析基因研究中知情同意的特殊性,综合国内外此领域的已有研究,运用理论联系实际的方法,得出结论认为,只有正确区分基因知情与基因隐私的权利主体,用伦理规范来解决利益冲突,在发展中不断完善知情同意,才能够取得科技与伦理的共赢.     

Islamic Bioethics and Animal Research: The Case of Iran

Despite growing interest in Islamic bioethics, little work has been done on research ethics in Islam, and even less on animal research ethics. This essay explores religious and scientific insights into the lives of animals used as research subjects, particularly in Iran. The inner lives of animals and their relationship to their Creator as relayed by the Qur'an, ethological research on animal minds, and neuroethical reflection on painience (the ability to feel and process pain as noxious [injurious] and explicitly hurtful) are brought together to question the current, relatively unrestricted use of research animals in Iran. The essay concludes that Islamic sources and the desire of Iranian clinicians to treat laboratory animals in line with them could poise Muslims to take the lead in developing alternatives to animal research. Further, recent suggestions that human and animal research guidelines and protections should be brought closer together are examined in light of these findings.     

现时代的生命伦理问题

结合现时代临床,提出医疗要回归“初心”,“初心”就是“人命贵”,这是医学伦理起点,也是医学的最高宗旨;而要贯彻“初心”,又应讲究医疗科技和医学人文及伦理之间形成合力。分析认为：现时代医学伦理可能以“生态伦理”更为合适;应区分重大疫情、急性抢救、慢性病纠治等不同情况,考虑“合力”所涉及的不同方面之轻重缓急;并针对生命伦理的有利原则,指出“有利”只是动机及出发点,还需深入思考,确立动机的基线和起点;就基线而言,要搞清楚是本然“有利”,还是科学“有利”,并做出一定区分;应在科学“有利”和本然“有利”之间保持适度的张力与平衡。

     

The Professional Status of Bioethics Consultation

Theoretical Medicine and Bioethics - Is bioethics consultation a profession? Withfew exceptions, the arguments andcounterarguments about whether healthcareethics consultation is a profession...     

德性伦理与规范伦理在生命伦理中的契合

在生命伦理领域中,规范伦理与德性伦理都曾发挥重要作用,然而,德性伦理没有受到人们足够的重视,重新厘定传统德性伦理的现代价值显得尤为重要。初步探究在生命伦理迅速发展的情况下,德性伦理与规范伦理相结合的模式。     

Not Just “Study Drugs” for the Rich: Stimulants as Moral Tools for Creating Opportunities for Socially Disadvantaged Students

An argument in the cognitive enhancement literature is that using stimulants in populations of healthy but socially disadvantaged individuals mistakenly attributes pathology to nonpathological individuals who experience social inequalities. As the argument goes, using stimulants as cognitive-enhancing drugs to solve the social problem of poorly educated students in inadequate schools misattributes the problem as an individual medical problem, when it is really a collective sociopolitical problem. I challenge this argument on the grounds that not all types of enhancement have to be explained in medical terms, but rather at least one conception of enhancement can be explained in social terms—opportunity maintenance. Therefore, I propose that as a moral requirement we ought to explore whether stimulants could be a means of remedying underprivileged children's experiences of social inequalities that are borne from inadequate schools for the sake of increasing their chances for opportunities and well-being.     

Moral philosophy's moral risk

Commonsense moral thinking holds that people have doxastic, contemplative, and expressive duties, that is, duties to or not to believe, seriously consider, and express certain ideas. This paper argues that moral and political philosophers face a high risk of violating any such duties, both because of the sensitivity and difficult of the subject matter, and because of various pernicious biases and influences philosophers face. We argue this leads to a dilemma, which we will not try to solve. Either philosophers should reduce their risk by avoiding sensitive issues where they are likely to violate such duties or, for one reason or another, philosophers are to some degree exempt from such duties when doing their work. Either horn of the dilemma, we argue, has unpalatable implications.     

Ethics in Psychology and Law: An International Perspective

Some psychologists working in the psychology and law (psycholegal) field feel that the profession does not provide them with adequate ethical guidance even though the field is arguably one of the oldest and best established applied fields of psychology. The uncertainty psychologists experience most likely stems from working with colleagues whose professional ethics differs from their own while providing services to demanding people and the many moral questions associated with the administration of law. I believe psychology’s ethics does, however, provide adequate moral guidance. It has a sound historical basis, has face validity and emphasizes those social moral principles that allow psychologists to best serve individuals and society. Psychologists may nevertheless be confronted with conflicting demands because there are other norm systems that also regulate their behavior as researchers and practitioners, and they, like all people, are influenced by their conscience. Ultimately, psychologists working in the psycholegal field will be best served if they have good knowledge of, and have internalized, the ethical principles of psychology.     

Virtue Ethics, Theory, and Warrant

Are there good grounds for thinking that the moral values of action are to be derived from those of character? This ‘virtue ethical’ claim is sometimes thought of as a kind of normative ethical theory; sometimes as form of opposition to any such theory. However, the best case to be made for it supports neither of these claims. Rather, it leads us to a distinctive view in moral epistemology: the view that my warrant for a particular moral judgement derives from my warrant for believing that I am a good moral judge. This view seems to confront a regress-problem. For the belief that I am a good moral judge is itself a particular moral judgement. So it seems that, on this view, I need to derive my warrant for believing that I am a good moral judge from my warrant for believing that I am a good judge of moral judges; and so on. I show how this worry can be met, and trace the implications of the resulting view for warranted moral judgement.     

Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment.     

Ethnography and Subjectivity in Comparative Religious Ethics

The ethnographic turn in religious studies has responded to important developments, such as the rejection of value neutrality and the need to better address the lived experience of individuals and communities. In this essay, I affirm the value of ethnography as a method in comparative religious ethics, but distinguish between two ways of framing ethnography in relation to ethics. The first way insists on the hard limits of translating values across cultures, and tends to marginalize or dismiss normative inquiry. The second way allows for the interpretation of practices of ethical justification in diverse cultural contexts. I argue that this second category of ethnography is more congenial to the work of comparative religious ethicists, since an integral part of ethical inquiry involves reflecting on, and making arguments about, social norms and practices.     

The design and use of the Bioethics Consultation Form

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.     

Fetal Risks,Relative Risks,and Relatives' Risks

Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used—often spuriously—to advance arguments against activities, such as home birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states.     

Christian Bioethics in a Western Europe after Christendom

Europe has taken on a new, post-Christian, if not a somewhatanti-Christian character. The tension between Western Europe'sever more secular present and its substantial Christian pastlies at the heart of Western Europe's current struggle to articulatea coherent cultural and moral identity. The result is that WesternEuropean mainline churches are themselves in the midst of anidentity crisis, thus compounding Western Europe's identitycrisis. Christian bioethics in Europe exists against the backdropof these profound cultural cross currents that define the Europeancondition, engender conflicts regarding the meaning of beingWestern European and being Christian, and bring the public significanceand role of Western European bioethics, especially Western EuropeanChristian bioethics, into question. The dominant culture ofthe public forum is post-Christian and post-traditional, althoughtraditional Christianity still asserts its voice. Denis Müllerin his paper has clarified the choice between a traditional-fundamentalistChristian Bioethics and a revisionist, progressive ChristianBioethics.     

Rational Choice and Moral Decision Making in Research

University psychology and sociology researchers rated the likelihood they would engage in misconduct as described in 9 research scenarios, while also making moral judgments and rating the likelihood of discovery and sanctions. Multiple regression revealed significant effects across various scenarios for moral judgment as well as shame and embarrassment on reducing misconduct. The effects on misconduct of the perceived probability of sanctions were conditioned on moral judgments in some scenarios. The results have implications for how universities address the prevention, detection, and sanctioning of research misconduct.     

当代医学伦理学的四种研究进路及其反思

当代中国医学伦理学尚未形成统一的学科范式,但主要有四种研究进路：应用伦理学进路、经验主义进路、道德教育进路和生命伦理学进路。这四种进路在学术界占据着主导地位,构成了医学伦理学的基本知识图景。但是任何未经反思的知识前提都是不可靠的,需要从本体论、知识论和价值论的层面对它们进行认真的反思,以构建更加科学和系统的理论体系。在本体论上,需要考虑伦理学概念的本质属性及其与医学实践的联系。在知识论上,需要质疑伦理理论和具体应用之间的适用性和相关性。在价值论上,需要考虑伦理学研究和实践中所涉及的价值取向。