With Hope and Imagination: Imaginative Moral Decision-Making in Neonatal Intensive Care Units

Although the role of imagination in moral reasoning is often neglected, recent literature, mostly of pragmatist signature, points to imagination as one of its central elements. In this article we develop some of their arguments by looking at the moral role of imagination in practice, in particular the practice of neonatal intensive care. Drawing on empirical research, we analyze a decision-making process in various stages: delivery, staff meeting, and reflection afterwards. We show how imagination aids medical practitioners demarcating moral categories, tuning their actions, and exploring long-range consequences of decisions. We argue that imagination helps to bring about at least four kinds of integration in the moral decision-making process: personal integration by creating a moral self-image in moments of reflection; social integration by aiding the conciliation of the diverging perspectives of the people involved; temporal integration by facilitating the parties to transcend the present moment and connect past, present, and future; and epistemological integration by helping to combine the various forms of knowledge and experience needed to make moral decisions. Furthermore, we argue that the role of imagination in these moral decision-processes is limited in several significant ways. Rather than being a solution itself, it is merely an aid and cannot replace the decision itself. Finally, there are also limits to the practical relevance of this theoretical reflection. In the end, it is up to care professionals as reflective practitioners to re-imagine the practice of intensive care and make the right decisions with hope and imagination.

The use of moral dilemmas for teaching agricultural engineers

Agricultural engineers’ jobs are especially related to sustainability and earth life issues. They usually work with plants or animals, and the aim of their work is often linked to producing food to allow people to improve their quality of life. Taking into account this dual function, the moral requirements of their day-to-day professional practice are arguably greater than those of other professions. Agricultural engineers can develop their ability to live up to this professional responsibility by receiving ethical training during their university studies, not only by taking courses specifically devoted to ethics, but also by having to deal with moral questions that are integrated into their technical courses through a program of Ethics Across the Curriculum (EAC). The authors feel that a suitable pedagogical technique for achieving this goal is the use of moral dilemmas, following Kohlberg’s theory of levels of morality (1981), with the final objective of attaining a post-conventional level. This paper examines the possibilities and limitations of using moral dilemmas as a pedagogical technique for training agricultural engineers. The cases, discussions, and evaluation used in the Agricultural Engineering Department of the Technical University of Valencia (Spain) are also presented. An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.     

略论“延续性医德教育”模式的内涵与构建

目前医德教育在教育时间与教育手段等方面缺乏延续性。通过对医德教育的特点和规律以及传统医德教育存在的弊病、医疗领域不正之风的负面影响等问题的分析,提出应着手构建在校医学生—实习生—在职医务人员"三位一体"的"延续性医德教育"模式,实现"第一课堂与第二课堂"、"系统医德理论与实践"、"被动性与自主性"医德教育三结合。     

Ethical decision-making in research: Identifying all competing interests

Ethical dilemmas are the result of conflicts between potential benefits or harms for two or more competing interests. Therefore, ethical decision-making implies a responsibility to identify those interests, harms, and benefits. For this purpose, researchers have responsibilities to the research, the subjects of research, other researchers, the institution, society, the environment, and self.     

英美医学生伦理困境及教育问题研究简介

英美学者研究认为,医学生在医学院校学习和临床培训期间,由于其身份地位、文化冲突以及医疗管理等方面的原因而经历的种种伦理困境,易于使他们陷入情感和心理的困扰、信仰和行为的冲突、理想和现实的矛盾之中,并最终导致其价值观和伦理原则的损害。他们呼吁教育工作者应当承担起帮助学生应对复杂的矛盾问题以及学习职业伦理困境的处理经验的责任。这些成果对深入研究和积极探索我国医学伦理教育的有效路径具有重要的借鉴意义。     

Moral Management Methodology/Mythology: Erroneous Ethical Equations

Understanding the falsity of certain common beliefs helps students move toward better business ethics and a higher degree of moral management. This article explains one method for teaching moral management, by using ethical equation inequalities, and offers 10 implications and suggestions to managers.     

Match-fixing: Moral challenges for those involved

ABSTRACT

Match-fixing is a major ethical issue in sports. Although research interest in match-fixing has increased in recent years, we remain largely in the dark regarding how both betting- and non-betting-related match-fixing relate to the moral decision-making of those involved. Drawing on Rest’s theory of morality and on the perceptions of a large sample (n = 567) of participants in Flemish sports, this study indicates that most match-fixing incidents are non-betting-related, while moral motivation and associated challenges clearly differ according to the type of match-fixing. Therefore, each type of match-fixing requires different preventive measures.     

虚假医疗信息的道德缺失与伦理重建

伴随着经济和信息技术的发展,医疗信息环境的污染和失衡已严重影响到了医疗卫生事业的健康发展。从虚假医疗信息的表现入手,剖析了虚假医疗信息产生的根源,着重分析了虚假医疗信息的道德缺失,从实际出发提出了具有可操作性的伦理道德重建。     

Moral Perception and the Pursuit of Medical Philosophy

This paper begins by examining the claim that the practice of medicine is essentially a moral endeavor. According to this view, all clinical practice has moral content, and each clinical situation has a moral dimension. I suggest that in order to recognize this moral dimension, clinicians must engage in an interpretive process, and that they must be able to interpret clinical data in ethical terms. However, clinicians often lack the ‘moral perception’ required to appreciate this moral dimension. I will argue that physicians lack moral perception when the clinical data they are given do not offer sufficient opportunity for interpretation. This paper draws on the work of Merleau-Ponty to suggest that this loss of interpretation is, paradoxically, the result of the way that patients experience illness. This thesis may be productive, first, because it suggests opportunities to explore the process of moral perception. This thesis also suggests ways for ethicists and educators to enhance clinicians' perception of the ethical dimensions of clinical practice. Finally, the concept of moral perception, when grounded in the patient's experience of illness, creates a fruitful area of inquiry that warrants inclusion in what may someday be the philosophy of medicine's canon. This revised version was published online in August 2006 with corrections to the Cover Date.     

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.     

伦理生态视阈中的医学伦理精神诠释与建构

基于本体思维的"原子式探讨"不能实现医学伦理精神的现代建构。由本体伦理思维到伦理生态思维的道德哲学范式转换为探讨医学伦理精神提供了新的思维向度和价值资源。伦理生态视阈中的医学伦理精神是一个多维、多层次的张力系统,其建构在于:重建伦理主体的自身精神生态、"医学伦理—卫生经济"政策生态、医学伦理—社会文化生态。     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

医学科研与医学科学的发展——高校附属医院SCI热的利弊分析

针对当前我国各大医院普遍出现的《科学引文索引》(science citation index,SCI)热,对高等医学院校附属医院进行调查研究,从医学科研与医学科学的发展、医院SCI热的利弊,及未来规划三个方面进行详细分析.客观说明对科研工作者的科研成绩进行公正、合理的评价,反对单纯以发表论文数量评价个人学术水平和贡献的做法.只有这样才可以充分调动科研工作者的科学探索兴趣和热情,还科学研究以本来的面目,促进科研管理水平再上新台阶.     

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。     

医学伦理审查如何适应转化医学的要求

随着转化医学的兴起,医学伦理审查面临前所未有的机遇与挑战.如何使医学伦理审查工作更好地适应转化医学发展的需要,提高审查质量,成为亟需解决的问题.在分析当前我国医学伦理审查工作现状和主要问题的基础上,进一步探讨了可行的解决方法,如进一步明确和强化管理部门服务功能、保证伦理委员会成员多样性和重视伦理审查多视角、强化伦理委员会后续跟踪审查、规范伦理审查委员的培训与继续教育等,为我国医学伦理审查工作的规范化发展和医学伦理审查质量的进一步提高提供参考.     

Decision-Making About Reproductive Choices Among Individuals At-Risk for Huntington's Disease

We explored how individuals at-risk for HD who have or have not been tested make reproductive decisions and what factors are involved. We interviewed 21 individuals (8 with and 4 without the mutation, and 9 un-tested) in-depth for 2 hours each. At-risk individuals faced a difficult series of dilemmas of whether to: get pregnant and deliver, have fetal testing, have pre-implantation genetic diagnosis, adopt, or have no children. These individuals weighed competing desires and concerns: their own desires vs. those of spouses vs. broader moral concerns (e.g., to end the disease; and/or follow dictates against abortion) vs. perceptions of the interests of current or future offspring. Quandaries arose of how much and to whom to feel responsible. Some changed their perspectives over time (e.g., first “gambling,” then being more cautious). These data have critical implications for genetic counselors and other health care workers and future research, particularly as more genetic tests become available.     

Negotiating criteria and setting limits: The case of aids

The classification of clinical problems, such as AIDS, requires choices. Choices are made on epistemic (i.e., knowledge-based) and non-epistemic (i.e., action-based) grounds. That is, the ways in which we classify clinical problems, such as AIDS, involve a balancing of different understandings of clinical reality and of clinical values among participants of the clinical community. On this view, the interplay between epistemic and non-epistemic interests occurs within the embrace of particular clinical contexts.The ways in which we classify AIDS is the topic of this paper. We consider the extent to which we construct clinical reality; we examine a suggested classification of AIDS; and we conclude suggesting that the choice regarding how to classify AIDS is the result of negotiation among participants in the clinical community.     

医学伦理决策：原因、立场与方法

医务人员在医疗实践中经常会遇到道德的冲突,就是在道德规范之间、效果之间、规范与效果之间的冲突。解决这一问题的有效方式是进行伦理决策,也就是在一定的价值立场上,通过运用不同的道德判断形式———如直觉、推理、商谈等,来预演各种方案之间的最佳结果并进行选择,为道德行动铺平道路。     

Shaping Medical Students' Attitudes Toward Ethically Important Aspects of Clinical Research: Results of a Randomized,Controlled Educational Intervention

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics.