对植物状态生存的理性思考

分析植物状态生存的判定和分类,从人的本质分析植物状态的生存价值,从生物学、社会学角度分析植物状态生存与死亡的区别与联系,认为植物人仅仅是生物学上的不完全生命状态,在社会学意义上,他是死亡个体。对我国卫生费用的现状进行评估,从医学、社会学和经济学角度对植物状态生存者维持或放弃治疗进行了理性分析。     

对植物状态生存的理性思考

分析植物状态生存的判定和分类,从人的本质分析植物状态的生存价值,从生物学、社会学角度分析植物状态生存与死亡的区别与联系,认为植物人仅仅是生物学上的不完全生命状态,在社会学意义上,他是死亡个体.对我国卫生费用的现状进行评估,从医学、社会学和经济学角度对植物状态生存者维持或放弃治疗进行了理性分析.     

放弃治疗面面观

放弃治疗有广义和狭义两种概念,根据临床实践分为主动放弃和被动放弃、单方放弃和双方放弃、明示放弃和暗示放弃、完全放弃和部分放弃。有许多的放弃治疗从患者本人、亲属、医务人员和医疗付费等方面考虑都有积极的意义。在医学伦理学中放弃治疗一直是一个有争议的问题,其道德意义在于体现了唯物主义观点,对人生命的尊重和社会公益原则。对其立法问题有待解决。     

放弃治疗:ICU决策的经济影响力

对ＩＣＵ放弃治疗的决策,经济因素不应是主要的。人们完全能够在尊重科学和理性、尊重生命末期价值和意义以及追求社会资源公正分配和有效利用基础上对脑死、植物状态或临终病人的放弃治疗达成共识。目前,重要的是需要制定相关政策和法律,保障ＩＣＵ放弃治疗的合理实施。     

脑外伤后植物生存状态病人放弃治疗的伦理学研究

随着医疗水平的提高,重型颅脑外伤病人的病死率有所减少,但同时持续性植物状态（PVS）病人大量地出现。对于这部分患者采取了不同的做法,有的尽量维护其生命的,但大部分患者家属因各种原因选择了放弃治疗。从医学、社会学和经济学角度对植物状态生存者放弃治疗进行了伦理分析,希望放弃治疗能早日规范化,保障医患双方的权益。     

白血病患者放弃治疗的调查与伦理思考

白血病患者放弃治疗在医院时有发生,通过调查白血病患者放弃治疗情况,对其调查结果进行了深入分析,并对白血病患者放弃治疗的含义,判断、标准、伦理原则、医学法规程序进行了深入的思考.     

放弃治疗的伦理关涉

放弃治疗与积极安乐死和消极安乐死不同,它所放弃的是包括针对病因的根治性措施及维持生命的一切支持措施,是病人在特定情形下享有的具有请求性或选择性质的权利.医务人员实施放弃治疗的责任和义务与病人及其家属的意愿、病人的病情等密切相关.一般性的医疗决策授权不应成为放弃治疗代理的理由,放弃治疗及其知情同意权的代理必须基于严格的程序和条件.只有在既符合临床标准又充分尊重病人自主权利的情形下,放弃治疗才能得到伦理辩护.     

晚期乳腺癌局部病灶的外科处理探讨

晚期乳腺癌局部病灶的外科治疗目前仍存在较多争议。本文对近年来晚期乳腺癌外科研究进展、常用的手术技术方法,治疗中应注意的几个问题进行探讨。对于晚期乳腺癌应遵循个体化治疗原则,权衡手术风险与生存获益,而不应该简单笼统选择或放弃局部外科治疗。     

晚期癌症患者生存质量评估体系建立及放弃治疗与安乐死的合法化

癌症的病因涉及一系列不同的基因和引起突变的各种遗传和环境因素.其发病的内在因素是细胞内的病毒感染或由于原癌基因突变产生的活跃癌基因.环境致癌论已普遍被人关注.癌症村是环境因素所致的一种群体疾病现象.晚期癌症患者的生存质量令人堪忧.切合晚期癌症患者生命意义治疗的研究越来越显示出其价值.医生有权对癌症晚期患者进行生存质量评估后做出放弃治疗的医嘱.建立一套完善的生存质量评估体系是临床决策放弃治疗和合法化安乐死的前提.正确而适当的临床放弃治疗和合法化安乐死是人性化选择的需要.     

持续性植物状态病人治疗的伦理学问题

近年来随着医学科学技术的迅猛发展 ,急救系统的完善 ,诊疗技术水平和重症监护技术水平的提高 ,危重病人死亡率明显降低 ,但同时也带来了一个新的医学和社会学问题 ,即大量的持续性植物状态( persistentvegetativestate ,PVS)病人的出现。这些病人虽然有醒觉周期但无认知功能 ,他们的生存给家庭和社会都带来了很大的负担。由于目前人们对这一疾病状态认识的不统一 ,对其治疗方案制定的差异性和对预后判断的不确定性 ,导致了对这种病人的医疗资源分配意见和是否放弃治疗的认识方面都存在很大差异。所以在对这些病人的治疗过程中伦理学的问…     

患者亲属——医疗决策的重要主体

在医患关系中,患者亲属起着重要作用,是医疗行为及后果生理和心理的承担者,患者的疾病本身和康复情况会直接对家庭生活产生影响。患者亲属也是患者医疗费用的主要承担者。由于医疗决策会涉及到患者的家庭利益,患者患病会对其决定能力产生不利的影响,在法律上确立患者亲属在医患关系中的主体地位,甚至在必要时赋予亲属医疗决定权是必要的和现实的。     

诊断脑死亡的伦理思考

随着医学的进步和社会的发展,死亡的定义、诊断标准和医生道德责任有了新的内容,脑死亡就是生命终结已为医学界普遍接受.诊断脑死亡是非常专业的技术性工作,有权进行脑死亡诊断的医疗单位和医生必须达到相应的资质要求.确诊和宣布脑死亡应遵循的伦理准则包含多方面的内容,如家属应有死亡标准选择权、脑死亡的诊断程序、脑死亡诊断结果的宣布和生效等方面的问题.     

试论病人的自主性与医主之间的关系

病人具有自主性,应该受到医生的尊重。由于病人的自主性受到一些条件的限制,因而医主仍具有继续存在的价值。但是,除在一些特定情况下外,病人的自主性应优先于医主,然而医生又不能放弃自己的责任。     

"Am I going crazy, doc?": a self psychology approach to therapeutic assessment

In this case study, we explore the effectiveness of Therapeutic Assessment with a severely disturbed 25-year-old man, referred by his therapist, following Finn's (2007; Finn & Tonsager, 1992, 1997) model. This patient-therapist pair had been working together for approximately 2 months, but the therapy had ceased to progress. The therapist requested a clearer picture of his patient's affective functioning, interpersonal functioning, and self-functioning that might facilitate more effective treatment. Through a collaborative assessment process informed by the principles of Kohutian self psychology, the evaluator and patient slowly formed a working alliance that proved useful for the eventual communication to the patient of his psychologically tenuous reality. This case illustrates the utility of a collaborative, multimethod Therapeutic Assessment with a severely ill patient and the use of Therapeutic Assessment by a less experienced clinician.     

Assessing the Ethics of Medical Research in Emergency Settings: How Do International Regulations Work in Practice?

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. An earlier version of this paper was presented at The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.     

一名宗教信仰者输血引发的思考

输血挽救了无数危重患者的生命,但少数宗教信仰者在自己或其家属急需输血时却拒绝输血治疗,而目前我国的法律法规在这一方面尚无明确规定,在此种情况下是否输血,医师处于两难的选择,也较易引起医患纠纷,为此建议我国卫生及其司法部门尽快制定相关法律法规,使医务工作者,在遇到此类问题时有章可循,有法可依。     

Anticruelty care: commentary

The anticruelty policy is a best-interests test for treatment plans including decisions to forgo life-sustaining therapy for certain incompetent patients. In connection with specific proposed therapy, the policy requires no reference to the patient's unknowable values, subjective experiences, or quality of life. The decision to undertake a treatment plan derives from the caregiver's knowledge of burdens and benefits of that treatment when used in caring for the competent or for those incompetents capable of growth or repair. The caregiver should weigh the potentially cruel effects of treatment against the likelihood of reducing suffering or encumbrance with the treatment. The terms "burden" and "benefit," in fact, are replaced by the terms "cruelty" and "beneficence," as the relevant opposing outcomes that must be weighed. Thus, the anticruelty policy shifts our scrutiny from experiences of the patient that we cannot evaluate to the proposed actions of the competent decision makers and caregivers. Notably, it is a protreatment policy when the goals of medicine are attainable; and it is an anticruelty policy when they are not. The policy does evaluate the world of the patient to the extent that it requires a judgment based upon external appearances about patient pleasure or happiness in living. It presumes to universalize larger societal values about cruelty, beneficence, compassionate concern for the helpless, and certain rights of individuals. And it presumes to universalize on the patient's behalf specific medical values about hopeless injury, timely death, the goals of medicine, and cruelty, which should remain open to societal discussion and revision. The presented definition of hopeless injury does not require brain death, coma, or persistent vegetative state. Specifically, the policy holds that death is timely for a patient with hopeless injury, and that prevention of death for such patients is not a goal of medicine but a cruelty.     

Morality and parenting: An ethical framework for decisions about the treatment of imperiled newborns

This essay is written in the belief that questions relating to the treatment of impaired and imperiled newborns cannot be adequately resolved in the absence of a general moral theory of parent-child relations. The rationale for treatment decisions in these cases should be consistent with principles that ought to govern the normal work of parenting. The first section of this paper briefly examines the social contract theory elaborated by John Rawls in his renowned book A Theory of Justice and extracts from it normative principles that can guide us in our attempt to lay a rational foundation for parenthood. The second section clarifies the implications of a Rawlsian theory for the problem at hand by examining several standards that have been proposed for the treatment of impaired newborns: the strict right-to-life standard, the medical decision standard, and the quality-of-life standard. A Rawlsian standard, by contrast, is autonomy-based. That is, it would have us base our treatment decisions on consideration of the child's capacity for developing critical rationality in making decisions on his or her own. This standard, it is suggested, avoids morally objectionable features of the others.