政府与个人的责任——中国当代医疗改革的责任伦理学剖析

卫生改革的重点必须放在政府部门;公共卫生,预防与初级医疗保健是人类生存的需要,带有鲜明的公益性和福利性。应由政府投资为主筹集资源,以国家投资为主体负担费用,这个层次的卫生服务产品,属非商品经济部分,并不以赢利为目的,不能引进市场经济,个人对健康负有重要责任,包括：选择医疗保健,决定花费数额,生活方式和卫生习惯的养成,主动接受健康教育,抵抗压力,支持国家与地区的卫生保健政策;个人对自身健康负责是一种道德责任,健商（health quotient)这一重要概念,具有伦理价值和普遍的医学人类学意义;个人对健康负责是一种社会风尚。     

Do the bishops have it right on health care reform?

The National Conference of Catholic Bishops has argued for significant government involvement in health care in order to assure respect for what they regard as the right to health care. Critics charge that the bishops are wrong because health care is not a right. In this article, it is argued that these critics are correct in their claim that health care is not a right. However, it is also argued that the premise that health care is not a right does not imply that the market is the most equitable and just system for providing health care. Natural law arguments in the tradition of Roman Catholic social teaching lead to the conclusion that a just and prosperous society has a moral obligation to provide health care even if there is no such right. Further, there are strong moral grounds for concluding that the bishops are correct in their claim that health care ought not to be considered a market commodity. It is argued that if health care ought not to be considered a commodity, then national health insurance is the best available alternative for fulfilling the social obligation to distribute health care resources justly and fairly at this time in American history. The bishops' case for government involvement can be made on the strength of the Catholic tradition in theological argumentation, independent of the claim that health care is a right.     

健康动机的研究进展与展望

健康动机是人们想要健康的愿望, 是影响人们健康行为的一个决定因素。本文回顾了有关健康动机的理论、测量和实证方面的研究。比较值得推崇的健康动机的动力过程理论认为健康动机是一个内在的动力过程, 并把健康动机对健康行为的作用分为四个阶段: 产生健康愿望、制定计划、采取行动和对行动的坚持。对健康动机的测量主要有一般测量和具体测量两类。实证研究表明健康动机能促进个体的健康行为并由此提高其健康水平。     

生命伦理与制度伦理冲突的终结--"非典"事件的伦理学审读

SARS事件可以为生命伦理与制度伦理历史冲突的终结提供佐证;公民享有的健康权必须平等。应大力矫正医疗与预防的关系,必须重视发展公共卫生事业;应重新思考中国的卫生事业改革,中国医疗改革不能实行市场化,卫生经济伦理学的研究证明,中国的卫生制度改革重点在农村,“适者生存”的原则不适用于卫生事业。创构灾疫伦理学是生命伦理学的一项使命。     

Le droit à la protection de la santé dans l’alinéa 11 du Préambule de 1946 : les impacts en termes de solidarité

The right to health protection is recognized as a constitutional objective. This includes guaranteeing an equal access to health care without any discrimination. The implementation of this right is a difficult task due to geographical and socioeconomic inequalities. In many situations, the public health sector is experiencing financial crises. The problems concerning health access seem to be mounting and could jeopardise the principle of solidarity which is the foundation of the health system.     

医疗保健是权利还是特权

分析了医疗保健是权利还是特权的问题,美国和中国的医疗保健供给体制在医疗保健的概念上被界定为医疗市场的一种商品。虽然作为商品的医疗保健的性质已被讨论,但更具社会责任感的论证应是强调医疗保健是一种权利。社会表示对其成员健康的关不的主要方式主要是通过国家健康保险而体现的,从这个角度出发回顾了美国和中国的医疗保健情况。     

The liberty principle and universal health care

A universal entitlement to health care can be grounded in the liberty principle. A detailed examination of Rawls's discussion of health care in Justice as Fairness shows that Rawls himself recognized that illness is a threat to the basic liberties, yet failed to recognize the implications of this fact for health resource allocation. The problem is that one cannot know how to allocate health care dollars until one knows which basic liberties one seeks to protect, and yet one cannot know which basic liberties to protect until one knows how health care dollars will be allocated. The solution is to design the list of basic liberties and the health care system in tandem so as to fit each other, such that every citizen is guaranteed a set of basic liberties and access to the health services needed to secure them.     

Health as a value: methodological and theoretical considerations

The concept of value placed on health is very important in several different theoretical approaches to the study of health behavior. In practice, however, health value is generally assumed to be universally high rather than being directly measured. If this assumption is incorrect, then theories that include health value have rarely been adequately tested. This paper presents a short 4-item Likert scale designed to measure the value placed on health. Norms from the utilization of this scale in five different samples are presented. Health value is found to increase with age among girls, but the increase apparently stops by late adolescence, before full adult levels of health value are achieved. Middle-aged women place a higher value on health than do middle-aged men, although no comparable sex difference appears in a sample of undergraduates. Consistent with theoretical predictions, both health locus of control beliefs and beliefs in the efficacy of certain preventive health behaviors correlate more highly with the performance of those same behaviors 5 to 9 months later among respondents who place a high value of health relative to those who do not value health so highly. However, this interaction is found only when it can be safely assumed that health is the primary value underlying the behavior. The importance of considering a variety of values in addition to health as possible motivators of preventive health behavior is stressed.     

Health, fortune, and moral authority in medicine.

The Christian conviction about Divine Providence encourages a novel account of the moral content of health and authority in the health care context. While health can be understood as the disposition of a living body to be able to proceed in the world well, as a species of freedom it is informed by the particular projects and concerns that Christians hold deepest. This is due to the fact that health acquires content, and thus becomes desirable as a particular type of good, only in relation to judgments about the good life. Aquinas' reflections concerning the good of health and its partial slavery to fortune reveal a Christian past that dwelt on the intrinsic and instrumental good of health. A rich Christian tradition in which health as intrinsically good, a good of the body, is ordained to the interests of right Christian virtue. Each of these factors affects the character of the health to be pursued and the authority of the physician as determining the ends and means of medicine.     

卫生政策走向与公共健康及其伦理思考

政府通过决策决定卫生政策,卫生政策对于公共健康具有导向和引领作用。卫生政策走向直接影响公共健康,决定公共健康的发展方向。卫生政策与公共健康的关系是因果关系,前者决定后者。卫生政策需要有伦理学基础和伦理学专家的伦理论证,坚持公正、公平、公益的原则。     

The Future of the Church as a Primary Health Place

ABSTRACT

There is a critical need for change in America's Health System, and religious organizations can facilitate not only the redefining of what health is but also the shaping of what the primary health services of the future should look like, function as, and be. The vision presented here is that the local parish or some extension of it be seen by the average citizen as a primary health place. The model proposed is that faith based living in community become the core health concept, defining what it means to be human and healthy become the core teaching, and that healing such that no illness need dominate become the goal. Within that context, health information, education, prayer, care, and support for most chronic illness, lifestyle change, and end of life concerns would begin at one's community of faith and only within that context to specially trained persons. This health system will compliment the sophisticated and complex acute medical care system that now exists.     

重庆市直辖以来卫生资源配置公平性研究

采用基尼系数方法从人口和地理分布两个方面定量分析重庆市卫生资源配置的公平性。重庆市主要卫生资源中,护士的基尼系数最高;重庆市的三个经济区域中,都市发达经济圈的基尼系数最高;资源按地理配置的公平性要差于按人口配置。重庆市护理人员严重不足且分布不公平,资源地理配置的公平性有待改善。     

Biomedical Ethics in the Year 2000:

The elderly are disproportionate consumers of health care resources. The major burden for these health care costs is being borne by the public. As more and more of our elderly live longer and consume even more of these finite resources, access to these resources will be restricted and they will be placed at ever increasing levels of risk. The history, current status, and future "projections" for elderly health and health care access are presented.     

Women’s Health Promotion in the Rural Church: A Canadian Perspective

The rural church may be an effective health resource for rural Canadian women who have compromised access to health resources. The purpose of this paper is to explore the relevance of the Christian church and faith community nurses in promoting the health of rural Canadian women in the evolving rural context. The findings from an extensive literature search reveal that religion and spirituality often influence the health beliefs, behaviors, and decisions of rural Canadian women. The church and faith community nurses may therefore be a significant health resource for rural Canadian women, although this phenomenon has been significantly understudied.     

诠释与转换：积极心理健康及其当代理解

积极心理健康是积极心理学理论系统的一个重要组成部分,也是积极心理学理论本身在心理健康领域的一种应用。积极心理健康以积极为核心观念,以人的积极品质为研究对象,注重人的个体差异的研究思路,引领和推动传统心理健康从关注人的消极品质转向人的积极潜力,从而使心理健康的主题既符合时代潮流又具有深厚的思想底蕴。     

Relationships between locus of control,health value,and preventive health behaviors among women

This study examines the relationships between locus of control expectancies, rated health value, and reported participation in preventive health behaviors among a healthy sample of undergraduate women. The prediction that participation in preventive health behaviors would be a joint function of an internal health-related locus of control belief and holding health in high value was not supported. Instead, individuals who valued their health reported participating in a greater number of health-enhancing behaviors compared to those who valued their health less. Respondents' scores on a health value scale in combination with their rated health status proved to be better predictors of health behaviors than their locus of control beliefs. Limitations of locus of control research with young, healthy individuals are discussed and further investigation into the utility and validity of health value scales is recommended.     

Psychologie communautaire et recherche : l’exemple du projet EMILIA

The development of community psychology has also had significant implications in the area of evaluation and research methodology. The empowerment principle, that is, giving users the means to control their health and to make their own health decisions, has important implications for the choice of evaluation strategies for both individual therapeutic acts as well as for public health programmes. If the user's potential expertise in the health area is to be fully acknowledged, how is this to be done with regard to research? How can users become not only actors of their own health, but also play an active role in research and health evaluation? The article gives an overview of research strategies based on community psychology principles, with a particular emphasis on action research and participative-action research. The example of a multisite European project on empowering mental-health service users to access life-long learning and employment, currently underway in Paris, is presented to illustrate these community research methods.     

现代公共卫生的概念特征及发展方向研究

现代公共卫生本质上是组织社会共同努力,预防疾病、促进健康的广泛的社会公共事业和人类健康相关的科学与实践活动,其理论观念、目标任务和工作模式等在传统公共卫生的基础上已发生了一系列重大变化.以健康为中心、与经济社会协调发展是现代公共卫生作的重要的发展方向.     

Neuroeconomics,health psychology,and the interdisciplinary study of preventative health behavior

The goal of this article is to introduce readers to theories, tools, and evidence from the field of neuroeconomics and to describe how health psychology and neuroeconomics can be mutually informative in the study of preventative health behaviors. Preventative health behavior here refers to both individual actions that impact one's health (e.g., exercise) and broader behavioral patterns, such as those captured in personality constructs. Although neuroeconomic researchers have begun to incorporate health‐relevant behaviors into their studies, the full potential of this research to inform preventative health models is as yet unrealized. What is needed to “translate up” is the unification of rich theoretical content from health psychology with investigations by neuroeconomic researchers of the decision‐making process during health‐relevant choices. We identify choice as a central, shared feature across models of preventative health behavior that can serve as an inroad for neuroeconomics to contribute to existing models and highlight commonalities that might not otherwise be apparent. A central premise of our argument is that, because health decisions are nearly always multiply determined, a more precise and mechanistic understanding of how choices are made is an important but understudied topic in health psychology. A partnership between health psychologists and neuroeconomic researchers can yield valuable insights into how preventative health choice is made and to identify targets and methods for intervention.     

Mental Health in Information Work

Abstract

The attention paid to problems related to mental health of employees in organizations is growing. Although the stress literature is huge and varied, most of the empirical studies are done in traditional work environments in which information technology and computers are of little importance. The recent increasing use of information technology has created a growing number of information processing work environments. The work in those work environments is typically done with data and can be characterized as “mental” work. The general hypothesis in this paper is that people doing mental work relate the perception of their work to mental health. More specifically, this paper describes the relationship between work-related factors and mental health among employees in a typical information processing environment: an insurance company. First, we discuss the concept of mental health. Next, we summarize the results of a number of studies on the determinants of mental health in information work. The results of our study indicate that work and health perception has a greater impact on mental health than work characteristics, personality, and activities outside work. Work perception, health perception, and mental health can be considered as one factor, although there are minor differences between subgroups in the population. In the discussion we try to integrate the findings into a general model of mental health related to work.