第五讲 灵敏度分析在临床决策中的应用

通常情况下,在临床上由于病人病情的复杂性,医生在处理病人时要承受一定的风险,此时医生所做出的决策就是风险性型决策。风险型决策之所以有风险,是因为决策所依据的主要参数中,存在不确定性（即概率性）的参数,如果这些参数发生一点变化,或估计时不够准确,有一点出入又会产生怎样的结果呢？这时决策方案还如以前一样稳定吗？因此,应该对决策方案的稳定性进行分析和估计。这时所作的分析和估计就是灵敏度分析。     

第二讲如何构建不确定条件下的临床决策

在第一讲我们提到决策有三种类型:一是确定型决策,二是风险型决策,三是不确定型决策.对于确定型和风险型决策,其每种自然状态发生的可能性是确定的或是可以预计的,可以利用文献资料获得的,其结果是确定的或需要承担一定风险的.而临床实践中由于病人个体体质的不同,病情的变化,医生对病情的掌握程度,医学技术的发展等诸多不确定性的因素,往往决策者无法获悉各种可能出现的结果的概率,只能凭主观直觉进行决策,这时就需要采用决策程序来构建不确定条件下的临床决策.在不确定条件下的临床决策最直观,而且最常用的方式就是采用决策树.     

医生是否应该让患者参与医疗决策

美国法院要求医生在确定治疗方案时必须得到患者的知情同意.而近来伦理学家提出,尊重患者的自主权不仅要使其知情,还应让病人在医疗决策中发挥作用.然而有调查结果显示,事实上病人在参与医疗决策时起到的作用微乎其微.尽管医生也在为患者罗列出各种医疗方案,但多数医生并不希望由病人参与决策.而这些调查对为什么有时候病人不能充分参与医疗决策并未作出深入探讨,并忽视了对医生就病人参与医疗决策的认知分析.因此,笔者希望通过本次调查,在医生对患者参与医疗决策的态度、医生的态度如何影响病人以及临床医疗决策的构建等方面,做一次试探性、描述性的研究.     

第二讲 如何构建不确定条件下的临床决策

在第一讲我们提到决策有三种类型:一是确定型决策,二是风险型决策,三是不确定型决策。对于确定型和风险型决策,其每种自然状态发生的可能性是确定的或是可以预计的,可以利用文献资料获得的,其结果是确定的或需要承担一定风险的。而临床实践中由于病人个体体质的不同,病情的变化,医生对病情的掌握程度,医学技术的发展等诸多不确定性的因素,往往决策者无法获悉各种可能出现的结果的概率,只能凭主观直觉进行决策,这时就需要采用决策程序来构建不确定条件下的临床决策。在不确定条件下的临床决策最直观,而且最常用的方式就是采用决策树。1决策树…     

医生是否应该让患者参与医疗决策

美国法院要求医生在确定治疗方案时必须得到患者的知情同意。而近来伦理学家提出,尊重患者的自主权不仅要使其知情,还应让病人在医疗决策中发挥作用。然而有调查结果显示,事实上病人在参与医疗决策时起到的作用微乎其微。尽管医生也在为患者罗列出各种医疗方案,但多数医生并不希望由病人参与决策。而这些调查对为什么有时候病人不能充分参与医疗决策并未作出深入探讨,并忽视了对医生就病人参与医疗决策的认知分析。因此,笔者希望通过本次调查,在医生对患者参与医疗决策的态度、医生的态度如何影响病人以及临床医疗决策的构建等方面,做一次试…     

第二讲 如何构建不确定条件下的临床决策

在第一讲我们提到决策有三种类型：一是确定型决策,二是风险型决策,三是不确定型决策。对于确定型和风险型决策,其每种自然状态发生的可能性是确定的或是可以预计的,可以利用文献资料获得的,其结果是确定的或需要承担一定风险的。而临床实践中由于病人个体体质的不同,病情的变化,医生对病情的掌握程度,     

循证医学与临床决策

作为医生每天要面对临床症状体征各异的病人 ,针对其具体情况应用不同诊断方法、提出适合其病情的治疗方案、采取相应的护理措施、对其预后进行分析判断。甚至对所需费用也要作必要考虑。所有上述问题 ,可称之为临床决策。问题的关键是在做出上述决策时 ,其依据是什么 ?医生是惟一拥有决策权的人吗 ?一种正在兴起的医学模式———循证医学对上述问题提出了一种全新的解决模式。循证医学不强调直觉、非系统的临床经验及病理生理学推理作为临床决策的充分依据 ,而更多的强调科学临床研究所取得的证据。循证医学要求医生具备某些新的技能 ,包括…     

急诊室濒死病人临床诊治决策的影响因素

正确、合理的临床决策为病人提供理想的诊疗方案.在急诊室濒死病人的诊治过程中,急诊医生应本着以人为本的原则,根据病情的轻重缓急,抓住重点进行紧急处理.其中,病人疾病的性质与预后、疾病严重程度、医生技术水平、医院护理水平、医院的医疗设备与管理水平、诊治费用、医患关系、家属对待诊治的态度、医德医风、政策法规等对医生的临床诊治决策均有不同程度的影响.     

叙事医学助力医患共同决策

医患共同决策是理想的临床决策模式。它强调医患之间是一种合作伙伴关系,医生与患方之间应彼此交流,相互分享信息,双方同为决策主体,共同选择诊疗方案。但在现实环境下,医患面临诸多的决策困境。叙事医学让医生重视叙事的价值,并要求医生通过关注病人叙事来关注全人、见证病人的痛苦,与病人同在,最终与他们建立归属关系。叙事医学的临床实践有助于化解决策困境,对顺利实现医患共同决策有重要的作用,但需要不断在地化发展。     

恶性肿瘤最佳治疗决策的实证调查与伦理探讨

中国的恶性肿瘤治疗决策中往往会有家属的参与,对家属参与决策的道德辩护常常诉诸于后果论,假设家属的参与有利于实现患者的最佳利益,然而这一假设是否成立?笔者通过对北京市两所三甲医院的11组患者、家属和医生进行访谈,分别了解三方参与决策的方式、程度及考虑因素等。本文在三方观点对比分析基础上,结合最佳利益的伦理概念探讨恶性肿瘤的最佳治疗决策。结论是提高患者的自主性有利于形成最佳治疗方案,并实现其最佳利益,医生和家属应该鼓励患者积极参与决策。     

Construction of the Disciplinary,Academic, and Discourse Systems in the Contemporary Chinese Philosophy of Science and Technology: Retrospect and Prospect

A review of the decades of research shows that Chinese philosophy of science and technology, on the strength of carrying forward traditions and blazing new trails, has made progress in the construction of discipline system and development of institutions, teaching materials and periodicals, with deepening the discussion on discipline orientation. In academic system construction, driven by efforts to update the academic framework and deepen research on the philosophy of nature, philosophy of science, philosophy of technology, science, technology and society, as well as other traditional fields, achievements have been made in ethical reflections on high technology, engineering ethics, big data and artificial intelligence philosophy, responsible innovation and other emerging, frontier and crosscutting fields. In the construction of discourse system, work has been done to make China’s voice heard on the international stage, excavate and elucidate the excellent traditional Chinese culture, and build disciplines with Chinese characteristics. In short, the achievements of the Chinese philosophy of science and technology have not come easily. Though a diverse and dynamic academic pattern has been formed, and wonderful and unique Chinese discourse has been created, we still face some problems. To accelerate the construction of “Three Systems” of the philosophy of science and technology with Chinese characteristics by building on existing achievements, we should carry forward the tradition of dialectics of nature and strengthen the guidance of Marxism, consolidate the foundation of philosophy and support interdisciplinary interaction and cooperation, track the frontiers of science and technology, and pay attention to the social operation of science and technology.     

宫腔镜发展和应用的哲学思考

宫腔镜技术是现代妇科微创技术,宫腔镜技术的产生和发展是技术目的和技术手段矛盾发展的结果,宫腔镜技术的具体应用过程体现了马克思主义哲学原理的作用。以马克思主义哲学为指导,可使我们在对待宫腔镜应用中的具体问题时,高瞻远瞩,安全、有效地对患者实施诊治,同时,提高自己的综合素质。     

微创外科与人文关怀

微创技术是医疗技术发展的重大进步。“人文关怀”的哲学思想始终贯穿微创外科发展之中,人文关怀的哲学基础是以人为本和人本主义思想。“以人为本”体现在外科治疗过程中“以病人为主体”,促进医务人员主观能动性的发挥,有利于“以人为本”的目的实现。     

The relevance of Heidegger’s philosophy of technology for biomedical ethics

Heidegger’s thoughts on modern technology have received much attention in many disciplines and fields, but, with a few exceptions, the influence has been sparse in biomedical ethics. The reason for this might be that Heidegger’s position has been misinterpreted as being generally hostile towards modern science and technology, and the fact that Heidegger himself never subjected medical technologies to scrutiny but was concerned rather with industrial technology and information technology. In this paper, Heidegger’s philosophy of modern technology is introduced and then brought to bear on medical technology. Its main relevance for biomedical ethics is found to be that the field needs to focus upon epistemological and ontological questions in the philosophy of medicine related to the structure and goal of medical practice. Heidegger’s philosophy can help us to see how the scientific attitude in medicine must always be balanced by and integrated into a phenomenological way of understanding the life-world concerns of patients. The difference between the scientific and the phenomenological method in medicine is articulated by Heidegger as two different ways of studying the human body: as biological organism and as lived body. Medicine needs to acknowledge the priority of the lived body in addressing health as a way of being-in-the-world and not as the absence of disease only. A critical development of Heidegger’s position can provide us with a criterion for distinguishing the uses of medical technologies that are compatible with such an endeavor from the technological projects that are not.     

Distributing Responsibility in the Debate on Sustainable Biofuels

In the perception of technology innovation two world views compete for domination: technological and social determinism. Technological determinism holds that societal change is caused by technological developments, social determinism holds the opposite. Although both were quite central to discussion in the philosophy, history and sociology of technology in the 1970s and 1980s, neither is seen as mainstream now. They do still play an important role as background philosophies in societal debates and offer two very different perspectives on where the responsibilities for an ethically sound development of novel technologies lie. In this paper we will elaborate on these to two opposing views on technology development taking the recent debate on the implementation of biofuels as a case example.     

关于药物临床试验伦理问题的思考

医学伦理学是伴随着科学技术的发展而产生的事物,药物临床试验在促进人类健康事业发展的同时,也涉及到与之相驳的伦理学问题,运用哲学的矛盾原理,浅析药物临床试验与医学伦理之间存在的矛盾及矛盾的两面性,以求解决目前药物临床试验中遇到的困难和问题。     

技术哲学的两种经验转向及其问题

当代技术哲学的一个重要发展趋势是在经验转向(empirical turn)和伦理转向(ethical turn)的基础上实现技术哲学的"第三次转向",以便整合前两次转向的优势。(Verbeek,p.51)事实上,经     

The Significance and Research Methods of Enhancing Studies on William James’s Philosophy

William James is one of the first philosophers with significant international influence in the history of American philosophy. James played an extremely important role in the emergence and development of American pragmatism, striving to show cultural self-confidence and pursuing the localization as well as independence of philosophy in the development of America. It is of great importance to further study James’s philosophy in the context of contemporary academics. Academia should value the collection, editing, translation and research of the philosophical classics of James and important literatures, pay attention to the clues of development and academic trends of the important concepts and ideas of James’s pragmatism philosophy, and rethink the status and influence of James’s philosophy in modern Western philosophy, trying to carry out comparative studies between James’s philosophy and traditional Chinese philosophy.     

先天性心脏病新技术——介入导管术

近20年间,伴随着科学技术的发展以及医疗水平的提高,介入导管术治疗先天性心脏病逐渐成为主要选择。该项技术微创、疗效好、安全、并发症少、住院时间短,深受患者青旺火。本文讨论该项技术的主要适应范围以及今后的发展趋势,同时指出医疗技术的创新必须遵守的哲学性原则。     

How Inclusive Is European Philosophy of Science?

The main question of this article is given by its title: how inclusive is European philosophy of science? Phrased in this way, the question presupposes that, as a mature discipline, philosophy of science should provide an inclusive account of its subject area. I first provide an explanation of the notion of an inclusive (in contrast to a restricted) philosophy of science. This notion of an inclusive philosophy of science is specified by discussing three general topics that seem to be missing from, or are quite marginal in, restricted philosophy of science. These topics are the philosophy of historical inquiry, the role of technology in science, and the socio-political and moral dimensions of science. On this basis, I address the question whether European philosophy of science qualifies as more inclusive as compared with Anglo-American philosophy of science.