死后生殖问题的生命伦理学思考

生物科学和医疗技术的发展使死后生殖成为可能,但是,面对世界不同地域所发生的死后生殖案例,伦理和法律的争议层出不穷.试图从生命伦理学的基本原则入手,以尊重人、行善以及公平原则为基点,结合相关问卷调查结果,探讨争议的焦点及成因,希望可以引发各个层面对相关问题的关注和讨论.     

“无主胚胎”的处理方式及其伦理争论

随着辅助生殖技术的不断发展,越来越多暂时不需要进行移植的胚胎存放在生殖医学中心.然而,由于各种伦理争议及社会舆论压力,生殖中心往往会困惑于“无主胚胎”的处理.2013年6月,美国生殖医学协会伦理委员会对“无主胚胎”进行了确切的定义并给出了处理意见和指导原则,结合我国实际国情,从“无主胚胎”定义、“无主胚胎”现状、“无主胚胎”的处理方式及伦理争议、对生殖中心的建议四个方面进行阐述,以求为生殖中心在“无主胚胎”处理方面提供相应帮助.     

浅论生殖医学伦理委员会的功能

辅助生殖技术的开展为医学伦理带来了新的内容和挑战。我国卫生部于2001年2月20日发布的《人类辅助生殖技术管理办法》中规定,人类辅助生殖技术的应符合有利于患者的原则、知情同意的原则、保护后代的原则、社会公益原则、保密原则、严防商业化的原则和伦理监督的原则。开展辅助生殖技术的条件之一是医疗机构建立生殖医学伦理委员会。伦理委员会是教育性、咨询性、义务性及独立组织。生殖医学伦理委员会应依据上述原则对人类辅助生殖技术的全过程和有关研究进行监督,开展生殖医学伦理宣传教育,并对实施中遇到的伦理问题进行审查、咨询、论证和建议。     

医务人员对辅助生殖技术伦理认知的调查

为了解医务人员对辅助生殖技术伦理知识的认知情况及对待争议问题的观点,对已开展多年辅助生殖技术的上海市第一妇婴保健院的所有医务人员进行有关辅助生殖技术伦理认知的问卷调查。问卷包括配子和胚胎的处理、捐献问题、子代问题及有关新技术的问题。结果显示,医务人员对其中一些争议问题态度相对宽松,但对这些问题的认知情况仍然不足,在伦理知识方面需要更多培训普及。     

医务人员对辅助生殖技术伦理认知的调查

为了解医务人员对辅助生殖技术伦理知识的认知情况及对待争议问题的观点,对已开展多年辅助生殖技术的上海市第一妇婴保健院的所有医务人员进行有关辅助生殖技术伦理认知的问卷调查.问卷包括配子和胚胎的处理、捐献问题、子代问题及有关新技术的问题.结果显示,医务人员对其中一些争议问题态度相对宽松,但对这些问题的认知情况仍然不足,在伦理知识方面需要更多培训普及.     

ART伦理委员会构建与作用的探讨

辅助生殖技术(Assisted Reproduction Technique,ART)的飞速发展给社会带来了复杂的伦理难题。实践证明,只有发挥伦理委员会作为一个工作机构的职能,在医患人群中加强ART技术基本原理及相关伦理原则的宣传教育,才能促使医患人群都能够自觉遵守优良的医学伦理道德规范,保证人类辅助生殖技术的健康发展。     

ART伦理委员会构建与作用的探讨

辅助生殖技术(Assisted Reproduction Technique,ART)的飞速发展给社会带来了复杂的伦理难题.实践证明,只有发挥伦理委员会作为一个工作机构的职能,在医患人群中加强ART技术基本原理及相关伦理原则的宣传教育,才能促使医患人群都能够自觉遵守优良的医学伦理道德规范,保证人类辅助生殖技术的健康发展.     

从合作生殖的视角对代孕生殖含义的伦理辨析

代孕生殖技术已有三十多年的历史,一直备受争议。代孕生殖的技术概念包括完全代孕和部分代孕两类。基于遗传学联系、情感联系和伤害风险的考量,只有不孕夫妻提供精卵、代孕女性孕育分娩的完全代孕在实践中可行。同时,基于合作生殖的视角,虽然代孕生殖可能引发人们对传统婚姻伦理和亲情伦理的种种论争,但是通过完全代孕技术帮助不孕夫妻的代孕女性不是破坏婚姻关系的所谓"第三者",代孕女性"生而不养"的事实亦不应被斥责为不道德。     

人工生殖技术伦理的多学科渊源及启示

随着人工生殖技术的飞速发展,其导致的伦理和法律问题层出不穷。目前迫切需要制定一套能够适应中国现实和发展的人工生殖技术伦理原则,以指导立法、引导社会舆论,并最终促进该技术的健康发展。通过人工生殖技术伦理的哲学、历史传统、宗教、社会制度等多学科渊源的考察,给正确、有效的伦理原则的确立提供启示。     

台湾人工生殖技术管制之回顾与前瞻

台湾地区人工生殖技术的管制先后经历了道德管制和行政管制两个阶段,目前正积极总结各阶段管制模式的成败得失,努力构造《人工生殖法》的原则和框架,以提高人工生殖技术管制的合法性和有效性。     

Donation after circulatory death: burying the dead donor rule

Despite continuing controversies regarding the vital status of both brain-dead donors and individuals who undergo donation after circulatory death (DCD), respecting the dead donor rule (DDR) remains the standard moral framework for organ procurement. The DDR increases organ supply without jeopardizing trust in transplantation systems, reassuring society that donors will not experience harm during organ procurement. While the assumption that individuals cannot be harmed once they are dead is reasonable in the case of brain-dead protocols, we argue that the DDR is not an acceptable strategy to protect donors from harm in DCD protocols. We propose a threefold alternative to justify organ procurement practices: (1) ensuring that donors are sufficiently protected from harm; (2) ensuring that they are respected through informed consent; and (3) ensuring that society is fully informed of the inherently debatable nature of any criterion to declare death.     

恐惧管理理论的争议及其对死亡心理研究的启示

死亡心理是人类面临死亡及相关事件时所产生的认知、情感和行为意向的复杂心理状态。目前, 研究死亡心理较为全面和科学的理论是恐惧管理理论(Terror Management Theory, 简称TMT)。但该理论存在以下争议: (1)在死亡的基本认知方面, 恐惧管理理论呈现出不一致的研究结果, 如死亡是否与不确定性无关, 死亡是否导致恐惧情绪, 寻求个体生存是否为人类的核心议题; (2)在社会文化层面, 恐惧管理理论提出者的文化背景对待死亡的普遍态度是呈否认的, 但是跨文化的研究显示其他文化背景对待死亡的态度却呈现出接纳或蔑视; (3)在恐惧管理理论的研究结果方面, 呈现出较多的矛盾性, 表明研究中有重要的调节因子未被涉及。基于此, 死亡心理可能的研究方向拟从认知、行为和社会三个层面进行梳理。未来死亡心理研究需秉承科学与文化并重的原则, 并结合死亡心理的内容与过程, 关注群体面对死亡时的心理规律, 开展死亡心理影响下的身心健康干预研究。     

Joseph Sandler's Contributions to The Concept of Countertransference

A few months before Joe Sandler's death, he participated in an American Psychoanalytic Association panel that focused on the Controversial Discussions that occurred in the British Psychoanalytic Society from 1941 to 1945. Our plan was to revisit the controversies in the context of British psychoanalysis some 50 years later. As we designed the panel, I suggested that we have one Kleinian panelist, one contemporary Freudian panelist, and a third panelist representing the Independents.     

Neuroscience and Brain Death Controversies: The Elephant in the Room

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President’s Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.     

Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder

Use of complementary and alternative medicine (CAM) for treatment of attention-deficit hyperactivity disorder (ADHD) has become widespread in both referral and primary care populations. We review the purported mechanism of action and available evidence for selected CAM therapies for ADHD. Enduring controversies, such as elimination of artificial food additives, colors, and/or preservatives; the effect of sugar on behavior in children; and the use of EEG biofeedback, have been well studied but lack support as effective sole treatments for ADHD. The initial evidence for some emerging CAM therapies, such as essential fatty acid supplementation, yoga, massage, homeopathy, and green outdoor spaces, suggests potential benefits as part of an overall ADHD treatment plan. More rigorously designed studies are needed to evaluate their effectiveness as single therapy for ADHD.     

Controversies and existence claims in chemistry: The theory of resonance

Controversies, i.e., multiple theory confrontations, may have a strong impact on the development of science. By an analysis of the so-called “resonance controversy” in chemistry the view that controversies and their resolution differ considerably from the process of theory succession is defended. It is argued that controversies are symptomatic of foundational problems, produce theory-scattering or domain-splitting, and induce ontological shifts. An explication is given of the role of existence claims and the applicability of Ockham's Razor in the resolution of controversies. The requirement of a realistic interpretation of theories at all times, as defended by some philosophers, is criticised.     

In the Name of Psychoanalysis: Persistent Controversies and Evolution in Psychoanalysis: A Review of Impossible Training: A Relational View of Psychoanalytic Education by Emanuel Berman

In his book Impossible Training, Emanuel Berman stresses the historical roots of current standards of psychoanalytic training and demonstrates the persistence of controversies that have been present in psychoanalysis and psychoanalytic training from their inception. This perspective, of psychoanalysis and psychoanalytic education as evolving, encourages candidates and practitioners to be participants and creative voices in an evolving field rather than rote followers learning a trade. The author proposes ways that the transference of educators to the younger generation of psychoanalysts can facilitate or interfere with the training of candidates. Berman is applauded for shedding light on current controversies in psychoanalytic education by showing their roots in historical controversies. However, the author points out Berman's tendency to overvalue his side of the controversy rather than embrace controversy itself as in the best interest of the evolution and development of the field.     

Stopping nutrition and hydration technologies: a conflict between traditional Catholic ethics and church authority.

This article focuses on the troubling effects of the secular values of individual freedom and autonomy and their impact on laws regarding suicide and euthanasia. The author argues that in an increasingly secularized culture, death and dying are losing their meaning and are not thought of within a moral framework. The debate regarding the provision of artificial nutrition and hydration is critically considered in light of the history of Catholic morality as well as within the modern healthcare context, and finally with new insight from the recent statements made by the late pope. Drane argues that the pope's insistence on providing artificial nutrition and hydration despite irreversible persistent vegetative states in unconvincing.     

Distinct Psychological Characteristics Predict Resilience and Recovery Throughout Widowhood

The dual-process model proposes that early and later bereavement involves different types of stressors and adaptation processes (Stroebe & Schut, 1999, 2010). It is thus possible that different factors facilitate adaptation during the early months versus subsequent years following widowhood. Elevated depressive symptoms, though prevalent after widowhood, may indicate problematic adaptation, as they are associated with poor long-term physical and mental health outcomes. We predicted that neutral death acceptance would be associated with less increase in depression during early widowhood (when confronted with loss-oriented stressors), whereas perceived control would predict depressive symptom decline during later widowhood (when adapting to controllable restoration-oriented stressors). Older adults (N = 265) reported on neutral death acceptance, perceived control, and depression before widowhood and on depression 0.5, 1.5, and 4.0 years after the death of their spouse. Bilinear spline growth modeling revealed that, on average, depressive symptoms increased from before to 0.5 years after spouse death and fell from 0.5 to 4.0 years after spouse death. Neutral death acceptance predicted a smaller increase in depression from before to 0.5 years after spouse death, as well as a smaller subsequent decrease in depression from 0.5 to 4.0 years after spouse death. Perceived control predicted a larger decrease in depression from 0.5 to 4.0 years after spouse death. Neutral death acceptance and perceived control had unique associations with resilience and recovery throughout early and later widowhood. These variables may be fruitful targets in interventions for depression throughout the full course of widowhood.