原则主义在医学伦理学领域的出场逻辑

原则主义在医学伦理学中出场逻辑的前提是伦理学中居于核心地位的道德原则及其作用。传统规范伦理道德原则始终是解决现实道德问题的出发点和落脚点,医学伦理学也不例外;然而医学伦理学不仅只是承认和应用道德原则,而且筛选出一些原则作为基本原则,然后将这些基本原则建构成原则主义的基本立场和观点,用来解决医疗卫生领域中出现的道德难题。原则主义在医学伦理学中的出场和应用确实解决了一些医疗卫生领域中的道德难题,推动了医学伦理学的新发展。但原则主义并没有像其提出者所设想的那样完美地解决所有道德难题,它本身也存在着理论上的缺陷,而且很多情况下,在实践上不仅不能解决道德困境,而且引起新的道德困境,因此需要得到进一步的修改和完善。

     

Critiques of Casuistry and Why They Are Mistaken

Casuistic methods of reasoning in medical ethics have been criticized by a number of authors. At least five main objections to casuistry have been put forward: (1) it requires a uniformity of views that is not present in contemporary pluralistic society; (2) it cannot achieve consensus on controversial issues; (3) it is unable to examine critically intuitions about cases; (4) it yields different conclusions about cases when alternative paradigms are chosen; and (5) it cannot articulate the grounds of its conclusions. Two main versions of casuistry have been put forward, and the responses to these objections depend in part on which version one is defending. Jonsen has advocated a version modeled on the approach to casuistry used by moral theologians in the 15th and 16th century, involving comparison of the case at hand with a single paradigm and a lineup of cases. The present author has advocated another version, drawn from experience with cases in clinical ethics, which involves comparing the case at hand with two or more paradigms. Four of the five objections are unsuccessful when directed against Jonsen'sapproach, and all of them are unsuccessful when directed against the approach involving comparison with two or more paradigms.     

原则主义的理论进路、伦理争论及其启示

原则主义作为全球生命伦理学最有影响力的理论进路,是对生命伦理学作为一门学科问题的回答,也是经典哲学理论在该领域中脆弱性的必然结果。然而,自产生伊始,原则主义就深陷批评和质疑的漩涡之中,包含原则一致性、常识道德问题、道德地位和方法论等。对这些争论的回应和批评性意见的包容、选择性吸纳,使原则主义释放出强大的理论生命力。原则主义本质上是对于生命伦理学的思考,对于我们参与全球生命伦理学发展提供中国话语给予深刻启示。

     

案例研究与决疑法：当代医学伦理学的经验主义方法论反思

当代医学伦理学至今没有形成较为成熟稳定的研究方法,方法论的“革命”往往意味着科学的革命、学科范式的转型和知识谱系的变革。案例研究与决疑法是医学伦理学常见的两种经验主义方法。这两种方法的广泛运用,是当代医学伦理学对于规范伦理学中“原则主义”的一种实践“反叛”与深度批评。对这两种方法的基本逻辑、实践特征、优点和弊端进行详细分析,深入探讨医学伦理学的学科方法论,通过对方法学的反思,表明当代医学伦理学的方法论在原则与例外、普遍与特殊之间“徘徊”不定,进一步推进对医学伦理学学科建设的理解与反思。

     

Ethics and Imagination

Cognitive semantics has made important empirical findings about human conceptualization. In this paper some findings concerning moral concepts are analyzed and their implications for medical ethics discussed. The key idea is that morality has to do with metaphors and imagination rather than with well-defined concepts and deduction. It is argued that normative medical ethics to be psychologically realistic should take these findings seriously. This means that an imaginative casuistry is to be preferred compared to principlism and to other forms of casuistry. Furthermore, the metaphorical character of central principles in medical ethics such as autonomy, utility, justice, and integrity is indicated. Such principles are interpreted as rules of thumb summarizing the collective wisdom concerning prototype cases.     

Humanitarian Intervention, Altruism, and the Limits of Casuistry

This essay argues that the ethics of humanitarian intervention cannot be readily subsumed by the ethics of just war without due attention to matters of political and moral motivation. In the modern era, a just war draws directly from self-benefitting motives in wars of self-defense, or indirectly in wars that enforce international law or promote the global common good. Humanitarian interventions, in contrast, are intuitively admirable insofar as they are other-regarding. That difference poses a challenge to the casuistry of humanitarian intervention because it makes it difficult to reason by analogy from the case of war to the case of humanitarian intervention. The author develops this point in dialogue with Michael Walzer, the U.S. Catholic bishops, and President Clinton. He concludes by showing how a casuistry of intervention is possible, developing a motivational rationale that draws on the Golden Rule.     

The Independence of Practical Ethics

After criticizing three common conceptions of therelationship between practical ethics and ethical theory, analternative modeled on Aristotle's conception of the relationshipbetween rhetoric and philosophical ethics is explored. Thisaccount is unique in that it neither denigrates the project ofsearching for an adequate comprehensive ethical theory norsubordinates practical ethics to that project. Because the purpose of practical ethics, on this view, is tosecure the cooperation of other persons in a way that respectstheir status as free and equal, it seeks to influence thejudgments of others by providing them with reasons that areaccessible to their own understanding. On this account, theindependence of practical ethics is rooted in an appreciation ofthe constraints that non-ideal circumstances place on the rolethat the philosophically refined premises of moral theory canplay in such public deliberations. Practical and philosophicalethics are united, not by shared theoretical frameworks orprinciples, but by the need to exercise intelligently the sameintellectual and affective capacities. They are separated, notby the particularity or generality of their starting points, butby their responsiveness to the practical problem of facilitatingsound normative deliberations among persons as we find them,under non-ideal circumstances.     

Intuition and The Junctures of Judgment in Decision Procedures for Clinical Ethics

Moral decision procedures such as principlism or casuistry require intuition at certain junctures, as when a principle seems indeterminate, or principles conflict, or we wonder which paradigm case is most relevantly similar to the instant case. However, intuitions are widely thought to lack epistemic justification, and many ethicists urge that such decision procedures dispense with intuition in favor of forms of reasoning that provide discursive justification. I argue that discursive justification does not eliminate or minimize the need for intuition, or constrain our intuitions. However, this is not a problem, for intuitions can be justified in easy or obvious cases, and decision procedures should be understood as heuristic devices for reaching judgments about harder cases that approximate the justified intuitions we would have about cases under ideal conditions, where hard cases become easy. Similarly, the forms of reasoning which provide discursive justification help decision procedures perform this heuristic function not by avoiding intuition, but by making such heuristics more accurate. Nonetheless, it is possible to demand too much justification; many clinical ethicists lack the time and philosophical training to reach the more elaborate levels of discursive justification. We should keep moral decision procedures simple and user-friendly so that they will provide what justification can be achieved under clinical conditions, rather than trying to maximize our epistemic justification out of an overstated concern about intuition.     

New Directions in Ethics: Naturalisms, Reasons and Virtue

This paper discusses three topics in contemporary British ethical philosophy: naturalisms, moral reasons, and virtue. Most contemporary philosophers agree that 'ethics is natural' - in Section 1 I examine the different senses that can be given to this idea, from reductive naturalism to supernaturalism, seeking to show the problems some face and the problems others solve. Drawing on the work of John McDowell in particular, I conclude that an anti-supernatural non-reductive naturalism plausibly sets the limits on what we can do in ethics. Moral reasons are widely discussed - in Section 2 I describe some of the criteria that used to distinguish moral practical reasons, and note possibilities and problems. Drawing on the work of Elizabeth Anscombe in particular, I suggest that an inclusive, minimalist account of moral reasons may be most fruitful. There has been a revival of philosophical interest in virtue ethics, which I take to be linked to the emergence of non-reductive naturalisms - in Section 3 I describe three points where virtue ethics has an especially significant contribution to make: learning, motivational self-sufficiency, and the question of whether virtues can be reasons. The naturalism of Section 1 constrains the accounts of moral reasons considered in Section 2, and depends upon an account of virtue as learned second nature, discussed in Section 3.     

The Innocuous Legacy of Christian Ethics in Comparative Religious Ethics

I argue that even if the influence of Christian ethics on comparative religious ethics (CRE) is inevitable, it need not be problematic. The legacy would only be worrisome if it stacked the deck in favor of Christian ethics or predisposed comparative ethicists to conform to the methods or thematic concerns of Christian ethics. Following Gadamer, I suggest that the ideal of presuppositionless objectivity is an illusion that applies to not only those who emerge from a Christian cultural context but in every global context. Given the specific historical and cultural contexts of the emergence of CRE, the residue of Christian ethics in CRE is understandable and expected. Thus, the legacy of Christian ethics in CRE will only be problematic to the extent that the potential dangers of Christian hegemony remain hidden, which does not seem to be the case in the contemporary academic context.     

期刊在医学伦理批件复核中的问题及防范

涉及医学伦理的文章在发表过程中,期刊要求作者提供相应伦理审批材料,并对材料进行审核。但在实际工作中发现存在很多作者无法提供伦理批件、研究超出伦理批件范围、使用其他研究的伦理批件进行冒名顶替、伦理审查批件不规范等情况。究其原因,主要是研究者缺乏伦理意识、在研究开始前并未申请伦理审查、目前国内伦理审查机构水平不一。因此,期刊应通过出版伦理建设来加强学术规范、科研诚信和医学科研伦理建设,提高研究者伦理意识;编辑在工作中要加强伦理审查力度,并且不断学习,提高自身医学伦理素养。

     

医疗机构伦理的内涵、意义及挑战

为推动国家卫生保健政策的落实,解决医务人员面临执业困境的现实问题,对医疗机构伦理的内涵、意义及其面临的挑战展开讨论。医疗机构伦理概念的提出来自于企业伦理经营的启发,其特征表现为实践性、中介性、导向性。医疗机构伦理的意义在于,这是医疗机构对社会的公开承诺,是医疗机构及医务人员行为道德的风向标,是医务人员团结的凝结剂,是执行卫生保健政策的铺路石。同时,应正视医疗机构伦理面临的挑战,包括医学市场化冲击人道主义的行善宗旨、医疗机构人文关怀日渐衰落、治病与致病的矛盾日益显现、医学公平性与可及性受到威胁。     

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。     

当代中国医德建设与相对主义医学伦理学

当代西方相对主义医学伦理学有许多建树,但也有其致命性的缺陷,这就是否定医学道德的客观绝对性和普遍性医学伦理准则。在引进、介绍了这种学说之后,需要下功夫同它进行对话,即以医德绝对性与相对性辩证统一的原理,对这种学说进行追问,从中借鉴有益的经验和教训,以顺利全面地推进我国当代的医学道德建设。     

加强医学伦理审查体系建设的医学人道主义反思

好的伦理治理需要好的伦理审查、好的伦理组织和好的伦理委员。伦理审查是对涉及人的研究的科学性与伦理性进行审查,其中存在技术话语与伦理话语两套体系,分别代表着医学人道主义的两个方面。其中后者居于主导地位,二者应当统一于伦理话语。伦理审查的认知基础、价值观念、问题分析、问题处理和评价反思均应体现人道主义的要求。风险和受益的计算同样如此。伦理审查活动是人道主义的实践过程,需要体现科技发展与维护人的尊严融合的伦理治理理念;形成科技创新与人文关怀融合的伦理审查机制;建立科学精神与人文精神融合的伦理教育体系。

     

Case method and casuistry: The problem of bias

Case methods of reasoning are persuasive, but we need to address problems of bias in order to use them to reach morally justifiable conclusions. A bias is an unwarranted inclination or a special perspective that disposes us to mistaken or one-sided judgments. The potential for bias arises at each stage of a case method of reasoning including in describing, framing, selecting and comparing of cases and paradigms. A problem of bias occurs because to identify the relevant features for such purposes, we must use general views about what is relevant; but some of our general views are biased, both in the sense of being unwarranted inclinations and in the sense that they are one of many viable perspectives. This reliance upon general views to determine relevancy creates additional difficulties for defenders who maintain that case methods of moral reasoning are not only useful, but more basic, reliable or prior to other forms of moral reasoning. If we cannot identify the case's relevant features and issues independently of our general views or biases, we need further explanation about why a case method or casuistry should be viewed as prior to or more basic or reliable than other forms of moral reasoning. Problems of bias also arise for other methods of reasoning. In medical science, case reviews are regarded as an unreliable way to form generalizations, and methods such as clinical trials are used to address bias.     

Xunzi: A Paradigm of Rationalistic Virtue Ethics in Early Confucianism

Against the background of modern academic study, this article consciously uses Aristotle’s virtue ethics as a tool to theoretically analyze Xunzi’s ethical philosophy. This article tries to briefly analyze the basic structure of Xunzi’s moral philosophy and to reveal its unique rationalist theoretical character by exploring the following three topics: “the understanding of human beings,” “the establishment of a moral foundation,” and “the accomplishment of virtue in practice.” From the perspective of comparative philosophy, this article can also be viewed as a model for bringing about communication and synthesis between two philosophical traditions, namely Confucian ethics and Western virtue ethics.     

现代医学伦理学原则的冲突及其原因分析

现代医学伦理学追求的是在基本原则指导下建构一个程序规则,让各种理论和价值观获得平等对话和合作的机会。但由于方法本身的缺陷及现代性伦理的内在矛盾,它并没有实现这一目的。我们必须充分尊重中国文化传统和社会现实,谨慎而合理的利用西方医学伦理资源。     

东西方医学伦理思维之共通性

从中国古代医者的行医事迹、著作来探寻中国的医者是否在行医过程当中勤守医者的本份,也即类似原则思维的表现。虽然中国古代并没有"医学伦理"这个名词,但从历代具有代表性之医者身上发现,其实在中国古代医者的行医事迹当中,就表现出类似的医学伦理情操。因之,医学伦理原则是俱普世价值的,也即世界上有所谓的共同道德存在。     

军事医学伦理学研究现状及进展

结合国内外相关文献,从军事医学伦理学的产生及其发展、军事医学伦理学的研究范畴及其发展、对军事医学伦理学的发展展望等方面进行总结分析。重点研究了军医职业带来的军事伦理学困境、军人战斗行为后的心理创伤和精神健康问题、对待战俘的军事医学伦理学问题、生物技术应用于军事的医学伦理问题、海外事务中军事医学伦理规范的建立、新军事革命对军事医学伦理学的需要等方面。未来,军事医学伦理学的发展必定是站在全球视野的合作与共赢,需要构建符合国际伦理需求的军事医学伦理规范,不断丰富和完善我国军事医学伦理学体系。