论中国多元化医疗公正的选择

生命伦理学面对的最大的道德困惑是公正问题,其中最为尖锐的问题是生命权利与医疗公正.公正原则在实际医疗领域运用中存在着种种误区.公正观的多元化是现代社会包括现代医疗的必然结果,体现在医疗公正方面合理的伦理选择就在于在不同的医疗境遇中,使用不同的公正原则,从而选择现实的生命伦理学道路.     

Money and distorted ethical judgments about research: ethical assessment of the TeGenero TGN1412 trial

The recent TeGenero phase I trial of a novel monoclonal antibody in healthy volunteers produced a drastic inflammatory reaction in participants receiving the experimental agent. Commentators on the ethics of the research have focused considerable attention on the role of financial considerations: the for-profit status of the biotechnology company and Contract Research Organization responsible respectively for sponsoring and conducting the trial and the amount of monetary compensation to participants. We argue that these financial considerations are largely irrelevant and distort ethical appraisal of this tragic research. Except for administering the antibody to all 6 participants nearly simultaneously, the trial appears to fulfill all of the critical ethical requirements for clinical research--social value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for enrolled participants.     

The Ethical Standard of Care

The recent TeGenero phase I trial of a novel monoclonal antibody in healthy volunteers produced a drastic inflammatory reaction in participants receiving the experimental agent. Commentators on the ethics of the research have focused considerable attention on the role of financial considerations: the for-profit status of the biotechnology company and Contract Research Organization responsible respectively for sponsoring and conducting the trial and the amount of monetary compensation to participants. We argue that these financial considerations are largely irrelevant and distort ethical appraisal of this tragic research. Except for administering the antibody to all 6 participants nearly simultaneously, the trial appears to fulfill all of the critical ethical requirements for clinical research—social value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for enrolled participants.     

Ethics in Research

Summary

This article presents an overview of the history of efforts to protect human subjects in research. It discusses the establishment of international, national, organizational, and institutional procedures designed to protect human participants. The article provides a detailed summary of the principal ethical codes for research and their origins. It includes discussions of the most frequently encountered ethical issues ranging from the initial decision to undertake the project, through the selection and application of the various research procedures, to the analysis and interpretation of the data.     

Ethical aspects of research into the etiology of autism

Advances in understanding autism and other developmental neuropsychiatric disorders will come from an integration of various research strategies including phenomenologic, functional neuroimaging, and pharmacologic methods, as well as epidemiologic approaches aimed at identifying genetic and environmental risk factors. The highly heritable nature of autism makes it scientifically valuable to involve parents and siblings as research participants. However, many studies on autism pose ethical challenges because they do not offer the prospect of direct benefit to subjects. In this article, we present an in-depth ethical analysis of current nontherapeutic research strategies that are common in autism research. The ethical analysis applies a proposed ethical framework for evaluating clinical research focusing on seven ethical requirements: (1) social or scientific value, (2) scientific validity, (3) fair subject selection, (4) favorable risk-benefit ratio, (5) independent review, (6) informed consent, and (7) respect for potential and enrolled research participants.     

In Defense of Imperative Inference

“Surrender; therefore, surrender or fight” is apparently an argument corresponding to an inference from an imperative to an imperative. Several philosophers, however (Williams 1963; Wedeking 1970; Harrison 1991; Hansen 2008), have denied that imperative inferences exist, arguing that (1) no such inferences occur in everyday life, (2) imperatives cannot be premises or conclusions of inferences because it makes no sense to say, for example, “since surrender” or “it follows that surrender or fight”, and (3) distinct imperatives have conflicting permissive presuppositions (“surrender or fight” permits you to fight without surrendering, but “surrender” does not), so issuing distinct imperatives amounts to changing one’s mind and thus cannot be construed as making an inference. In response I argue inter alia that, on a reasonable understanding of ‘inference’, some everyday-life inferences do have imperatives as premises and conclusions, and that issuing imperatives with conflicting permissive presuppositions does not amount to changing one’s mind.     

Ethical issues in considering 'religious impairment' in diagnosis

There are several ethical implications of clinician assessment of clinically significant religious impairment (CSRI). This paper draws upon the American Psychological Association's (APA's) Code of Ethics (1992) to review relevant ethical principles and standards. It then presents a continuum of responses to the relationship between psychology and religion: (1) religion as harmful, (2) benign neglect of religion, (3) formal: problem-focused, (4) formal: domain-focused, and (5) religion as paradigmatic alternative. This continuum is followed by a discussion of three clinical vignettes and an examination of the potential ethical tensions for each model. The conclusions drawn from this review are that the formal: domain-focused model presents a rationale for inclusion of CSRI in assessment and is the most promising among alternative models for avoiding professional obsolescence, expanding alternatives for clients and clinicians, and enhancing ethical practice and professionalism.     

The University and the Moral Imperative of Fair Trade Coffee

This paper examines the relationship between the university and fair trade coffee campaigns in North America. In recent years, fair trade coffee sales internationally have increased substantially but have still not grown large enough to meet the needs of fair trade producers in the South. In consequence, fair trade activists have sought to expand the market by pressuring public institutions to adopt fair trade purchasing policies. In North America, the university has emerged as a central focus of fair trade coffee campaigns. Thus far, university administrators have been reluctant to support fair trade. This paper explores this reluctance and asserts that the university has a moral responsibility to support fair trade. However, it also argues that the potential exists for administrators to employ fair trade as an ethical fig leaf to mask the growing corporatization of the university under the weight of neoliberal reforms. This has become a common strategy of many neoliberal institutions in the North. Contrary to the assumptions of much of the emerging literature, it cannot be assumed that the impact of fair trade will necessarily be beneficial in the North unless activists work to ensure fair trade does not become employed as an ethical fig leaf.     

Risk and Trust in Public Health: A Cautionary Tale

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm.     

How a Group Goal May Reduce Social Matching in Group Performance: Shifts in Standards for Determining a Fair Contribution of Effort

Abstract

The authors investigated whether the presence of a specific group goal would reduce social matching (i.e., matching one's own performance to the performance expected from others) by serving as an alternative standard. As predicted, when there was no specific goal, the participants matched their own performance to the performance expected from other group members. When there was a specific group goal, the women no longer engaged in social matching, although that effect did not emerge among the men. Instead, the women's mean personal performance was close to the performance level representing an equal share of the group goal. Moreover, the participants' perceptions of a fair contribution mediated the performance of the men and the women, both in the presence and in the absence of a goal.     

Modest seductiveness: Reconciling modesty and vanity by reverse assimilation and double resistance

We study conflicting notions of modesty and vanity in the Arab Gulf region by focusing on contemporary female adornment practices and the tensions underlying them. The standard of modest traditional dress that women are expected to adhere to in Gulf countries is intended to conceal their sexuality and promote public virtue. Nevertheless, emerging bodily adornment practices in the region serve the contradictory purposes of emphasizing female sexuality and celebrating fashion. By using insights from observations and depth interviews with young Qatari and Emirati women, we explore the dynamics underlying the conflicting imperatives of modesty and vanity and examine how they reconcile these contradictions in constructing their identities as women, Muslims, Qataris, and Emiratis. We find that the concepts of reverse assimilation and double resistance are most useful in understanding responses to these conflicting imperatives among young Gulf women. Copyright © 2012 John Wiley & Sons, Ltd.     

Postmodernism's Self-Nullifying Reading of Nietzsche

In his very rich and insightful book, Kant's Theory of Freedom, Henry Allison argues that in the first Critique Kant's reason for rejecting Humean compatibilism in favor of an incompatibilist conception of practical freedom stems, not from a specific concern to ground morality, as many have supposed, but from his general conception of rational agency, which Allison explicates in terms of the idea of practical spontaneity. Practically spontaneous rational agency is subject to imperatives and therefore distinct from Humean agency. But it is not necessarily subject to the categorical imperative and hence is distinct from fully spontaneous (transcendentally free) moral agency. A conception thus emerges of an agent with limited spontaneity, subject to hypothetical but not categorical imperatives. A doubt may be raised, however, as to whether Kant's view can accommodate this conception of limited practical spontaneity. Reflection on Kant's notion of a hypothetical imperative suggests that the idea of limited spontaneity is in danger of either collapsing into the Humean picture or else turning out to be equivalent to the conception of full spontaneity appropriate to moral agency. There is thus reason to suppose that, for Kant, we would not be bound by imperatives at all if we were not bound by the categorical imperative.     

Enacting Actuarial Fairness in Insurance: From Fair Discrimination to Behaviour-based Fairness

ABSTRACT

In line with developments in the personalisation of risk, the idea that insurance products should above all be ‘fair’ to the policyholders is increasingly voiced by commentators. The performativity thesis in Science and Technology Studies usually used to study economic markets can be used to investigate different enactments of ‘actuarial fairness’ in insurance practice. Actuarial fairness functions as a technical economic concept and was coined by the neoclassical micro-economist Kenneth Arrow (1921–2017). Faced with anti-discrimination legislation, the insurance industry has, since the 1980s, advanced the principle of actuarial fairness to legitimise their medico-actuarial technologies to discriminate between risk groups. In the absence of this actuarial fairness, it is assumed that dynamics of adverse selection—derived from neoclassical assumptions about economic actors— will result in the bankruptcy of insurance providers. The paradigmatic case of Fairzekering, a showcase of contemporary behaviour-based personalisation in car insurance, demonstrates an important shift in how actuarial fairness is enacted through behaviour-based calculative devices. Here, policyholders are enacted as being personally in control of their driving style while an interactive discount-infrastructure is set up to provide real-time feedback to incentivize policyholders towards ‘good behaviour.’ This enactment of behaviour-based fairness simultaneously implies a shift in the enactment of the economic actors involved, constitutive of the making of new economic ideas in behavioural economics.     

Chapter 4. The Intervention Process

Abstract

The qualitative research methods used by the author to study one parent-child activity group are shared. This qualitative research study documented what the participants of a parent-child activity group on a child psychiatric inpatient unit reported about their experiences with each other and how these participants interacted with each other in the group over the course of eight months. The group was studied through     

For the Good of the Group? Balancing Individual and Collective Risks and Benefits in Community Psychology Research

Balancing risks and benefits is a necessary ethical task for social science researchers. Community psychologists must often consider risks and benefits not just for individual participants, but also for the group, system, or society that those individuals inhabit. Little ethical guidance currently exists for how to navigate this ethical challenge across these multiple levels. In this article, we use a case example of social network research incorporating multiple levels of analysis to identify common risks and benefits and understand their relationship to each other. We conclude by discussing distinctive ethical considerations revealed by this case example.     

Burnout and its relations with basic psychological needs and motivation among athletes: A systematic review and meta-analysis

ObjectivesThe present study is a review on studies about the relationships between the three basic psychological needs/motivational regulations (i.e., amotivation, controlled regulation, extrinsic autonomous regulation, and intrinsic motivation) and burnout.DesignA systematic review and meta-analysis.MethodStudies were identified through five electronic databases and manual search using combinations of three groups of keywords. Three inclusion criteria were then used to screen the searched articles.ResultsEighteen studies met the inclusion criteria and these studies varied considerably in terms of their study characteristics (e.g., characteristics of participants, study designs, and outcome measures). The results also showed that the three basic psychological needs, intrinsic motivation, extrinsic autonomous regulation, and amotivation had small to large effects on predicting global burnout and its three dimensions. However, controlled regulation showed no or weak correlations with the burnout subscales.ConclusionsSelf-determination theory was generally supported in explaining athlete burnout.     

Principles of early stopping of randomized trials for efficacy: a critique of equipoise and an alternative nonexploitation ethical framework

Recent controversial decisions to terminate several large clinical trials have called attention to the need for developing a sound ethical framework to determine when trials should be stopped in light of emerging efficacy data. Currently, the fundamental rationale for stopping trials early is based on the principle that equipoise has been disturbed. We present an analysis of the ethical and practical problems with the "equipoise disturbed" position and describe an alternative ethical framework based on the principle of nonexploitation. This framework acknowledges the need for balancing the dual ethical obligations of clinical research, the protection of human subjects and the generation of new medical knowledge. Based on this framework, we put forward a proposal to make early stopping guidelines more stringent under specified conditions. The temporary withholding of apparent benefits in certain circumstances is justified by achieving a fair contract with the research participants, one that protects them from undue harm and exploitation while reducing the many uncertainties surrounding new investigational treatments that arise when trials are stopped prematurely.     

Informed Consent Procedure for Clinical Trials in Emergency Settings: The Polish Perspective

Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients’ to give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants. Whereas the Declaration of Helsinki, Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow waivers from participants’ consent or deferred consent for emergency research, the regulations of most European Community countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting regulations on a waiver from a participant’s consent in emergency research exist and the regulations on surrogate consent of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should become a large part of important public health priorities.     

5～6岁儿童公平分配玩具行为的心理机制

采用实验法和结构访谈法,考察66名5～6岁儿童在幼儿园游戏活动中公平分配玩具行为的心理机制.结果发现:(1)根据在幼儿园分配玩具的过程中的表现,可以把儿童分为三类:公平型儿童、不公平型和不稳定型,每类儿童的自我评价各不相同;(2)对自己做出的公平行为能做出准确的自我评价,而且对假想的不公平行为也能做出正确的自我评价,这是形成稳定的公平行为的重要心理机制,自我概念、自我形象在道德准则的内化过程中起着重要作用.