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.     

中国公共健康伦理学的理论自觉与范式转换

理论自觉不仅直接关乎中国特色公共健康伦理学的理论构建,也直接关乎中国公共健康伦理学的持续发展和现实功能的发挥。中国公共健康伦理学的理论自觉包括对学科关系、中西关系、古今关系以及理论与实践关系的自觉等四个基本维度;其问题域或基本理论结构包括本体论层面的基本问题、对象问题和范畴问题,认识论层面的视角和向度问题以及价值论层面的发展取向、价值追求和学者的价值选择问题。范式意识的自觉是中国公共健康伦理学理论自觉的方法论标志。当前,中国公共健康伦理学研究范式应该实现从西方范式向马克思主义范式、从个体论或整体论向个体论与整体论相结合的范式、从职业伦理或实践伦理向职业伦理与实践伦理相结合的范式转换。     

伦理治理:医疗卫生机构的角色和责任

在推进"健康中国"战略的大环境下,医疗卫生机构承担着服务全民健康的重大职责。然而,当前医疗卫生实践面临着诸多伦理问题,其中一个关键原因在于医疗卫生机构尚缺乏相应的伦理规约。从"机构伦理"的视角出发,探讨医疗卫生机构的伦理治理。在从理论角度梳理医疗卫生机构面临的伦理问题和挑战的基础上,探讨医疗卫生机构同时作为"治理主体"和"治理对象"应当承担的道德责任,以期为探讨医疗卫生机构伦理提供一个可能的视角。     

整合型医疗卫生服务体系研究与实践——医疗卫生服务共同体(X+X)试运营两年

以区域医疗信息交互平台为技术支撑,建立区域医疗卫生服务的协作体系及专家团队,对区域医疗卫生服务的综合功能进行可行性研究.整合型医疗卫生服务体系的建立,提高了服务效率、控制了医疗开支、改善了医疗安全和医疗质量、促进了不同医疗机构医务人员的协调合作.同时有利于缓解"看病难、看病贵"的问题、有利于三级甲等医院专注于疑难病症的治疗和研究,有助于一、二级医院提高患者信任度及全科医生业务水平.     

超越义务论的伦理观——生命伦理学的几种范式

作为研究生命科学和医学道德行为的新兴学科,生命伦理学通过一个确定的形而上学的原则或者伦理规范来指导现实。生命伦理学的原则规范体系源自于人类道德哲学的思潮,义务论是对生命伦理学有着重大影响的思想来源,至今在医疗实践中承担着道德规范的作用。当代医学科学技术的巨大发展所引发的生命、生殖、医患关系等难题,对传统的伦理观提出了挑战。在理性多元化的今天,生命伦理学不可能依赖一种普适的道德规范来指导人们的实践,而只能在探索过程中寻找适应不同文化背景和指导生命科学发展进路的伦理范式。     

论我国公共伦理研究的三个向度及其基本范式

我国学界关于公共伦理的研究存在三个既相互区别又相互联系的研究向度,即公共管理伦理的向度、市民社会伦理的向度、政治伦理的向度,与之相应的基本理论范式是公共利益范式、公共领域范式以及公共性范式.厘清三个向度及其基本理论范式之间的区别和联系,是公共伦理学研究的基础理论问题.     

医疗人工智能的伦理风险及应对策略

医疗人工智能的迅猛发展带给医疗卫生领域更多发展契机的同时,也带来了一系列伦理风险和挑战。从人的道德主体性地位、责任认定、隐私权保护和医生主体性地位四个方面探讨了医疗人工智能带来的伦理风险。提出要实现医疗人工智能健康、有序地发展,需要采取重构责任伦理,强化特殊监管;加强隐私和数据保护,保障公众安全;坚定医生主体地位,优化诊疗质量等应对策略,以趋利避害,更好地促进人类健康和医疗卫生水平的提高。     

微观、中观和宏观工程伦理问题——五谈工程伦理学

伦理学中存在着微观、中观和宏观三种不同"层次"或"尺度"的伦理问题.从微观、中观和宏观的相互联系、相互作用中认识和分析伦理问题有可能成为一种新的伦理学研究范式.伦理学研究者应该善于识别"三观"伦理问题,强化从"三观"互动中分析伦理问题的意识和能力.在工程伦理学中,工程共同体成员--工程师、投资者、管理者、工人、其他利益相关者--的"个体伦理"是微观伦理问题,有关企业、组织、制度、行业、项目等等的伦理问题是中观伦理问题,而宏观伦理则是指国家和全球尺度的伦理问题.微观、中观和宏观伦理问题既有性质、层次、范围上的区别,同时又相互渗透、相互纠缠、密切联系、相互作用.     

彰伦理内涵显军事特色——全军第六次医学伦理学专业学术会议纪要

为贯彻落实“全军医学科学技术大会暨第九届医学科学技术委员会全体会议”精神,推进军队医学伦理学学科发展,“全军第六次医学伦理学专业学术会议暨医院伦理审查管理与标准操作规程培训班”于2011年11月11日～14日在上海第二军医大学隆重召开.第二军医大学王延军副校长、中华医学会医学伦理学分会主任委员李义庭教授、全军医学伦理学专业委员会主任委员杨放教授以及来自全军35个医疗教研机构和15个地方医疗单位的120余位代表出席了会议.     

欢迎参加“中美医学人文高峰论坛暨科研伦理素质、医学伦理学教学能力第二期培训班”

正为了更好地推动中美医学人文交流,促进我国科研伦理和医学伦理学教学的研究与发展,东南大学人文学院及生命伦理学研究中心、医学与哲学杂志社、江苏省卫生法学会及江苏省医学伦理学专业委员会主办,中华医学会医学伦理学分会协办,拟于2018年10月26日～28日在南京召开"中美医学人文高峰论坛暨科研伦理素质、医学伦理学教学能力第二期培训班"。会议将邀请:Michael J.Zigmond,Beth A.Fischer     

支付与报复：成本形式对第三方惩罚的影响

第三方惩罚不仅对惩罚成本的数量敏感,也对成本形式敏感。在保持成本数量相等的情况下,不同形式的惩罚成本会对第三方惩罚的频率产生不同影响。相较支付形式,当惩罚成本采取报复形式时,被试的第三方惩罚频率显著下降。进一步的实验表明,惩罚频率的变化并非因为不同的成本形式所隐含的风险水平有所差异,而是因为被试对不同的成本形式赋予了不同的主观价值。进一步探索更多形式的惩罚成本是未来研究的重要方向。     

Adjustments of task-set control processes: Effect of task switch frequency on task-mixing and task-switching costs

The present study tested the hypothesis that task-switch frequency triggers adjustments of task-set control processes. A mixed-task condition where task switches are frequent should promote flexibility—thus improving task-switch performance—whereas a condition where task repetitions are more expected should favour stability—thus improving task-repeat performance. In two experiments, participants performed single-task and mixed-task blocks. In mixed-task blocks, tasks varied randomly on a trial-by-trial basis. For half of the mixed-task blocks, the frequency with which the task changed was 25%, for the other half, it was 50%. Overall, depending on the task-switch frequency, performance on both task-repeat and task-switch trials was modified. Switch cost was reduced and task-repeat performance was altered by the increase in switch probability. This study demonstrates context-sensitive adjustments of task-set control processes. These results further support the view that mixing cost reflects sustained and endogenous components of cognitive control.     

任务切换机制研究的理论争议与整合

任务切换是执行控制的一种重要功能。切换代价是量化执行控制持续时间的指标。并广泛应用于各个研究领域。但是切换代价在多大程度上体现了执行控制的作用,仍然还存在争论．当前主要存在任务设置重构、任务设置惯性和联结竞争三种理论。本文首先介绍了三种理论的基本观点和实验证据,以及对任务切换加工机制的分析;其次阐明了对三种理论进行整合的相关研究;最后分析了进一步研究的方向。     

Positive affect facilitates task switching in the dimensional change card sort task: Implications for the shifting aspect of executive function

Using the modified Dimensional Change Card Sort task, we examined the influence of positive affect on task switching by inspecting various markers for the costs, including restart cost, switch cost and mixing cost. Given that the executive-control processes that underlie switching performance—i.e., inhibition or shifting—are distinct from the component processes that underlie non-switching performance—i.e., stimulus evaluation, resource allocation or response execution—we hypothesised that if positive affect facilitates task switching via executive-control processes, rather than via component processes, positive affect would reduce both switch and restart costs, but not mixing cost, because both switch and restart costs rely on executive processes, while mixing cost imposes only minimal demands on executive processes. We found beneficial effects of positive affect on both restart and switch costs, but not on mixing costs. These results suggest that positive affect improves switching abilities via executive processes rather than via component processes.     

社区卫生服务中心手术功能的经济学研究

社区卫生服务中心是否应当保留或设置手术功能。调研南京市社区卫生服务中心手术功能科室的成本—效益和费用,及医院和社区卫生服务中心费用的不同。大多数中心设置外科手术功能,能维持成本;3甲医院、综合医院单病种手术平均住院费用明显高于社区卫生服务中心。社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。     

汉-英双语者图片命名任务中的语码切换代价

在图片命名范式下探讨了汉-英双语者汉、英两种语言之间的语码切换代价及影响切换代价不对称性的因素.实验一中发现了汉-英双语者的语码切换代价,但语码切换代价并未表现出不对称性;在加入时间间隔（ISI）变量后,短ISI条件下,汉-英双语者的语码切换代价表现出了不对称性,表现为从第二语言到第一语言的切换代价更大;而长ISI条件下,汉-英双语者的语码切换代价是对称的.这表明,图片命名任务中可出现语码切换代价,且ISI是影响语码切换代价不对称性的重要因素,支持并丰富了对优势语言的抑制说.     

The role of probability of success estimates in the sunk cost effect

The sunk cost effect is manifested in a tendency to continue an endeavor once an investment has been made. Arkes and Blumer (1985) showed that a sunk cost increases one's estimated probability that the endeavor will succeed [p(s)]. Is this p(s) increase a cause of the sunk cost effect, a consequence of the effect, or both? In Experiment 1 participants read a scenario in which a sunk cost was or was not present. Half of each group read what the precise p(s) of the project would be, thereby discouraging p(s) inflation. Nevertheless these participants manifested the sunk cost effect, suggesting p(s) inflation is not necessary for the effect to occur. In Experiment 2 participants gave p(s) estimates before or after the investment decision. The latter group manifested higher p(s), suggesting that the inflated estimate is a consequence of the decision to invest. Copyright © 2000 John Wiley & Sons, Ltd.     

Impaired task switching performance in children with dyslexia but not in children with autism

Problems with cognitive control in both autism and dyslexia have already been reported in different studies. The present study specifically examined task-switching performance in children with autism and dyslexia. For this purpose, a multiple-trial paradigm was used with cues for colour- and shape-matching tasks presented before a run of trials. The cue could imply a task switch (when the cue changed the task) or a task repetition (when the cue did not change the task). Both reaction times and error rates were measured for switching, restarting, and general task performance. Participants were children with autism (24) and with dyslexia (25) and healthy controls (27) with normal IQ and ages from 12 to 18 years. The main finding was that while similar switching performance was observed between children with autism and the healthy controls, children with dyslexia showed a significant switch-specific delay relative to both healthy controls and children with autism. Furthermore, no deficit in restarting performance was observed for any of the two patient groups. Finally, additional evidence is provided for a more general deficit in information processing in dyslexia. Our data suggest that children with autism are able to switch between tasks in a similar way as do normally developing children as long as the tasks are unambiguously specified. Furthermore, the data imply switch-specific deficits in dyslexia additionally to the deficits in general information processing already reported in the literature. The implications of our data are further discussed in relation to the interpretation of the Wisconsin Card Sorting Test.     

Sunk Cost and Commitment to Dates Arranged Online

The influence of prior, irretrievable, investment (sunk cost) on commitment to a date arranged online was investigated. Participants were recruited from an undergraduate population. There were 145 participants (86 female) with a mean age of 19.42 years. Participants took part in a computer simulation of the process of arranging a date online. Participants invested one of five amounts of sunk cost into this process. Participants were then presented with the choice of attending the date arranged online or attending a (superior) blind date. Participants chose how much time that they wanted to commit to the (inferior) date arranged online. Results revealed a significant sunk cost effect (p = 0.003). The implications of the sunk cost effect having an influence over human relationships are discussed.     

THE USE OF WRIST WEIGHTS TO REDUCE SELF-INJURY MAINTAINED BY SENSORY REINFORCEMENT

The participant in this study was a boy with a long history of self-injurious face slapping. Following a functional analysis indicating that face slapping was maintained by sensory consequences, the participant was given soft wrist weights to wear for progressively longer periods. Data on the frequency of face slapping were collected 5 min before the weights were put on, while the weights were on, and 5 min after the weights were removed. At all other times a protective helmet was placed on the participant's head for 30 min contingent on face slaps. When weights were worn for 30 min each day, face slapping decreased during 5-min observation periods before and after wearing the weights. The use of protective headgear was eliminated by the end of the study. Face slapping did not occur during a follow-up check conducted 5 months after completion of the study.