我国公共卫生中的伦理学问题

在公共卫生研究中重点探讨了伦理审查、研究对象选择、知情同意、保护研究对象隐私、对研究对象的适当补偿等方面的伦理学问题;在公共卫生实践中重点探讨了传染病防治、疾病监测、计划免疫、疾病筛查及卫生资源配置领域中的伦理学问题.重视这些问题并参照一定的伦理学原则将有助于解决问题,更好地促进公共卫生事业的发展,促进人群健康.     

公共卫生伦理学——第8届世界生命伦理学大会学术内容介绍（之一）

公共卫生伦理学是一个新的领域。随着突发传染病的全球流行,公共卫生问题也日益突出。但与临床伦理学和研究伦理学相比,公共卫生伦理学还是一个未被充分开垦的新领域。本次大会探讨这方面问题的会议有:公共卫生伦理学和突发传染病的控制;突发健康问题的经验和教训:从SARS到禽流     

公共卫生伦理学——第8届世界生命伦理学大会学术内容介绍(之一)

公共卫生伦理学是一个新的领域.随着突发传染病的全球流行,公共卫生问题也日益突出.但与临床伦理学和研究伦理学相比,公共卫生伦理学还是一个未被充分开垦的新领域.本次大会探讨这方面问题的会议有:公共卫生伦理学和突发传染病的控制;突发健康问题的经验和教训:从SARS到禽流感;全球流行的禽流感的伦理问题;中国面临的突发公共卫生问题;新的突发性传染病的伦理学;公共卫生的伦理问题.因此公共卫生伦理的学术内容比较丰富.现分别介绍如下.     

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。     

公共卫生伦理学的结构和若干基本论题

讨论了作为生命伦理学学科分支的《公共卫生伦理学》的结构及其基本论题,阐述了公共卫生的伦理基础、公共卫生伦理学的基本原则、公共卫生与个人自由之间的关系等对公共卫生各领域均具有普遍意义的基本伦理问题。指出公共卫生是建立公正社会和实现社会正义的必备要素,应该以公共卫生实践中的伦理问题而不是以哪个理论作为其逻辑出发点;公共卫生工作之所以能得到伦理辩护,缘于健康是人民安康的基本层面,而人民的安康是建立公正社会的基本内容;公共卫生伦理学的基本原则应包括效用、公正、尊重、共济、相称;最后讨论公共卫生限制个人自由在伦理学上可辩护的条件。     

厘清伦理学的对象与定义

厘清伦理学的对象与定义是构建伦理学理论体系的首要问题。以往对伦理学研究对象的说法大致可以归并为德性、道德价值、道德行为、道德规范、道德语言、自由、幸福、人生问题和道德这九种。经逐一分析可知,前八种界说难以成立。第九种界说将伦理学的对象直接聚焦于道德是值得肯定的,可由此给出的伦理学定义还是不够准确与周延。虽然道德是伦理学的基本对象,但并不是伦理学的全部对象。能将伦理学全部对象一网打尽的概念只有道德问题,因而伦理学就是系统研究各种道德问题的学问。     

关于召开第二届全国生命伦理学学术会议

为了在第一届全国生命伦理学学术会议的基础上,进一步对生命科学和生物技术伦理、涉及人和动物的生物医学研究伦理、公共卫生和卫生政策伦理以及生命伦理学的哲学和文化层面等研究成果进行检阅,探讨在这些领域以及临床工作中出现的伦理问题。以推动我国生命伦理学学术研究的发展及其在实践中的应用,     

经济体制改革与企业道德建设

在传统学术领域,社会主义企业只是经济学尤其是工业经济学研究的对象。随着经济体制改革的不断深入,企业逐渐成为人们普遍关心的理论“热点”。企业不仅仅是经济学研究的对象,而且也为哲学、法学、社会学、心理学、伦理学等学科所关注。随之,产生了企业管理哲学、企业法学、企业社会学、企业心理学、企业伦理学的重要研究课题。本文试图从伦理学方面探讨企业在经济体制改革中的道德建设问题,以求教于同志们。     

自觉开辟文化伦理学的研究方向

自古以来,人类就有对文化生活、文化现象和文化发展的伦理评价及研究活动。当代中国文化建设的新高潮也推动、呼唤着文化伦理学的诞生!可是,在我国应用伦理学的分支性研究中,却缺少了文化伦理学的研究方向和自觉意识。因此,本文对研究文化伦理学的背景、问题和意义;文化伦理学的属性、对象和任务,研究文化伦理学的基本方法和体系结构等问题,谈了一些初步认识。     

公共卫生监测中的伦理问题及其借鉴意义

公共卫生监测作为公共卫生实践的重要组成部分,在具体实施过程中存在着一系列伦理问题,通过介绍有关监测的各类伦理问题,包括个人利益(和权利)与集体利益之间可能的冲突,知情同意的问题,网络数据的收集和保存中的伦理问题,死者数据利用问题等,揭示了公共卫生监测伦理学与临床伦理学的差异,以帮助评估公共卫生监测的伦理可接受性。随着监测项目日益增多且伦理要求越来越高,世界卫生组织公布了《世界卫生组织公共卫生监测的伦理指南》,希望通过总结和梳理这些问题为相关的伦理培训提供信息,为伦理委员会提供参考,并提高从业人员的认识。     

"Show me" bioethics and politics

Missouri, the "Show Me State," has become the epicenter of several important national public policy debates, including abortion rights, the right to choose and refuse medical treatment, and, most recently, early stem cell research. In this environment, the Center for Practical Bioethics (formerly, Midwest Bioethics Center) emerged and grew. The Center's role in these "cultural wars" is not to advocate for a particular position but to provide well researched and objective information, perspective, and advocacy for the ethical justification of policy positions; and to serve as a neutral convener and provider of a public forum for discussion. In this article, the Center's work on early stem cell research is a case study through which to argue that not only the Center, but also the field of bioethics has a critical role in the politics of public health policy.     

Developing an informational tool for ethical engagement in medical tourism

Background

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.

Methods

The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.

Results

The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service.

     

“Show Me” Bioethics and Politics

Missouri, the “Show Me State,” has become the epicenter of several important national public policy debates, including abortion rights, the right to choose and refuse medical treatment, and, most recently, early stem cell research. In this environment, the Center for Practical Bioethics (formerly, Midwest Bioethics Center) emerged and grew. The Center's role in these “cultural wars” is not to advocate for a particular position but to provide well researched and objective information, perspective, and advocacy for the ethical justification of policy positions; and to serve as a neutral convener and provider of a public forum for discussion. In this article, the Center's work on early stem cell research is a case study through which to argue that not only the Center, but also the field of bioethics has a critical role in the politics of public health policy.     

公共卫生的责任主体缺位是众多医学伦理问题产生的根源

我国的卫生、医疗服务系统近年来产生了大量严重的伦理问题,引起了国内外广泛的关注。通过对大量材料的归类、分析,找出我国众多严重伦理问题产生的主要根源是公共卫生责任主体的缺位。解决的主要措施是:加快卫生母法的建立;政府对“公共性”卫生服务责任到位,扭转卫生工作严重的市场化和趋利化倾向;彻底改变医疗费用的“后付制”和“第三方付费制”,实行政府正向投入;改变当前在疾病预防和初级卫生保健投入方面过于细化的分级财政体制;制止药品广告和虚假的医疗广告;加大控制政府公立医院建设的成本和降低医院运行费用的工作,严格收费价格纪律等。     

The Rise of Citizen Science in Health and Biomedical Research

Citizen science models of public participation in scientific research represent a growing area of opportunity for health and biomedical research, as well as new impetus for more collaborative forms of engagement in large-scale research. However, this also surfaces a variety of ethical issues that both fall outside of and build upon the standard human subjects concerns in bioethics. This article provides background on citizen science, examples of current projects in the field, and discussion of established and emerging ethical issues for citizen science in health and biomedical research.     

Human Rights,Cultural Pluralism,and International Health Research

In the field of bioethics, scholars have begun to consider carefully the impact of structural issues on global population health, including socioeconomic and political factors influencing the disproportionate burden of disease throughout the world. Human rights and social justice are key considerations for both population health and biomedical research. In this paper, I will briefly explore approaches to human rights in bioethics and review guidelines for ethical conduct in international health research, focusing specifically on health research conducted in resource-poor settings. I will demonstrate the potential for addressing human rights considerations in international health research with special attention to the importance of collaborative partnerships, capacity building, and respect for cultural traditions. Strengthening professional knowledge about international research ethics increases awareness of ethical concerns associated with study design and informed consent among researchers working in resource-poor settings. But this is not enough. Technological and financial resources are also necessary to build capacity for local communities to ensure that research results are integrated into existing health systems. Problematic issues surrounding the application of ethical guidelines in resource-poor settings are embedded in social history, cultural context, and the global political economy. Resolving the moral complexities requires a commitment to engaged dialogue and action among investigators, funding agencies, policy makers, governmental institutions, and private industry.     

Trotter G: The Ethics of Coercion in Mass Casualty Medicine The Johns Hopkins University Press; 2007

Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters.     

Preventive behaviour and health status among the elderly

Abstract

The research describes the range of preventive health behaviours undertaken by the elderly, investigates the dimensionality of preventive health behaviour, and explores the relationship between preventive health behaviour, self-assessed and medically assessed health status. Previous research has relied mainly on self-reports of health status. Data from medical examinations and interviews with 115 elderly individuals (aged 65–75) indicated that most elderly persons performed some intentional preventive health practices, as well as a broad range of normative preventive health practices. Particular clusters of preventive health behaviour emerged when the data were subjected to cluster analysis. A short index consisting of five personal preventive health behaviours found in other studies to have a protective effect on long-term health was found to have a low to moderate correlation with the medical and self-assessments of health status employed in the study. These findings indicate particular types of preventive health behaviour of importance for health promotion programmes with the elderly.     

抗菌药物使用中的伦理辨析

抗菌药物合理使用是人与微生物伦理关系的要求,是社会资源优化使用的重要内容并普惠与民。抗菌药物合理使用恰是良好医患关系注释。医疗政策、医院管理对抗菌药物合理使用影响不可替代,医生应主动介入且有社会广泛参与的伦理讨论对抗菌药物合理使用意义重大。