抗菌药物使用中的伦理辨析

抗菌药物合理使用是人与微生物伦理关系的要求,是社会资源优化使用的重要内容并普惠与民.抗菌药物合理使用恰是良好医患关系注释.医疗政策、医院管理对抗菌药物合理使用影响不可替代,医生应主动介入且有社会广泛参与的伦理讨论对抗菌药物合理使用意义重大.     

合理使用抗茵药物的伦理决策

中国是世界上滥用抗菌药物最为严重的国家之一,抗菌药物滥用会导致耐药菌株形成、不良反应发生、加重社会和患者经济负担三个主要问题。人类合理使用抗菌药物成为当今社会关注的热点问题,从临床角度阐述了合理使用抗茵药物中若干医学伦理问题,医疗政策、医院管理对抗菌药物合理使用影响的不可替代性;合理使用抗菌药物是良好医患关系的注释;合理使用抗菌药物是医患关系伦理要求。抗菌药物合理使用要求医生必须要有相应的伦理决策能力;抗菌药物合理使用要求医生要主动参与社会伦理讨论;抗菌药物合理使用是多方面共同努力的结果。     

临床指征优先谨慎使用抗菌药物

抗菌药物是临床广泛应用的一类药物。根据卫生部全国医院感染监测网监测结果,我国临床抗菌药物使用率较高。抗菌药物压力是细菌产生耐药性最重要的原因。对于临床谨慎使用抗菌药物来说,知晓和掌握使用指征是非常重要的,在任何情况任何时候,指征是优先考虑的。抗茵药物使用指征包括治疗性用药指征和预防性用药指征,尤其是预防用药方面。本文讨论抗菌药物应用指征,包括感染诊断与治疗性用药的关系、手术前预防性使用抗菌药物预防手术部位、内科患者预防性使用抗菌药物指征与药物选择等。     

抗菌药物合理应用的宏观和微观问题

抗菌药物不合理应用现象长期得不到纠正,细菌耐药稳步攀升,正引起医学界、社会和政府的高度关注.本文就宏观上的抗菌药物使用政策与微观上的临床用药两方面存在的问题进行探讨.介绍了国际上关于抗菌药物政策的研究以及抗菌药物合理使用的新观点(尽早开始经验性治疗、"降阶梯"治疗策略、运用抗菌药物PK/PD原理指导临床用药、短程治疗).主张调整宏观抗生素策略,去除该政策单纯、片面限制使用和应用药敏实验结果指导临床用药绝对化的做法,吸纳国际上的新成果,强化监管力度,更多采用教育和技术手段.     

抗菌药物合理应用的宏观和微观问题

抗菌药物不合理应用现象长期得不到纠正,细菌耐药稳步攀升,正引起医学界、社会和政府的高度关注。本文就宏观上的抗菌药物使用政策与微观上的临床用药两方面存在的问题进行探讨。介绍了国际上关于抗菌药物政策的研究以及抗菌药物合理使用的新观点（尽早开始经验性治疗、“降阶梯”治疗策略、运用抗菌药物PK／PD原理指导临床用药、短程治疗）。主张调整宏观抗生素策略,去除该政策单纯、片面限制使用和应用药敏实验结果指导临床用药绝对化的做法。吸纳国际上的新成果,强化监管力度,更多采用教育和技术手段。     

抗菌药物合理使用干预方法研究进展

抗菌药物耐药性是全球性威胁人类健康的重要卫生问题,合理而谨慎地使用抗菌药物是应对耐药性问题的重要策略之一。世界各国尤其是发达国家已在提高医患双方的合理抗菌药物使用行为方面做了很多有益探索,产出了一系列的干预策略和措施,并就这些策略或措施的干预效果进行了评价。本文旨在系统梳理、归类和分析国内外在促进抗菌药物合理使用行为方面所采用的干预策略、方法及其效果,并追踪干预策略和方法的演变历程,展望其未来的发展趋势。     

法医学尸体解剖与伦理学

法医学尸体解剖中遇到许多不可回避的伦理问题,这些问题包括:尸体解剖与社会之间的伦理关系、尸体解剖与尸体之间的伦理关系以及尸体解剖资料使用的伦理问题.研究尸体解剖与社会伦理、尸体与伦理及解剖资料共享与伦理之间的关系,可使我们更好地服务于司法实践.     

法医学尸体解剖与伦理学

法医学尸体解剖中遇到许多不可回避的伦理问题,这些问题包括:尸体解剖与社会之间的伦理关系、尸体解剖与尸体之间的伦理关系以及尸体解剖资料使用的伦理问题。研究尸体解剖与社会伦理、尸体与伦理及解剖资料共享与伦理之间的关系,可使我们更好地服务于司法实践。     

论伦理秩序

实存的伦理关系是客观条件与主观条件的历史性统一,伦理关系本质上是现实合理性秩序中的关系,是有主体精神渗透其中并通过道德、法律、习俗等规则体系维系的关系,它的首要问题是秩序的合理性和正当性。研究伦理秩序应把道德和伦理两个概念加以区分;伦理秩序的顺畅和谐在于道德的有效调节,也在于法律的有效控制。伦理秩序在社会变革中经过必然与自由的辩证运动,使矛盾化解,推动社会和谐发展。和谐社会应当是以公正支撑的合理的伦理秩序的社会。     

产权伦理初论

产权关系是最基本的经济关系 ,产权伦理是经济伦理的核心和基础。作为调节人们之间财产权利关系的一种价值观念和行为准则 ,产权伦理既是一种制度伦理 ,也是一种行为伦理 ;它主要由产权占有伦理、产权使用伦理、产权收益伦理、产权交易伦理构成。产权伦理对社会产权制度的选择和产权运行的绩效 ,以至整个社会经济的发展起着重要的作用     

生育健康的伦理学基础:个人本位还是社会本位

随着“以妇女为中心”生育健康概念的提出,女性的健康与他们在社会中享有权利的关系正引起人们的关注。然而,如何实现女性有生育过程中的主体地位,解决她们所面临的与社会选择的矛盾,在很大程度上取决于特有的社会伦理背景以及所遵循的价值原则。由于中国与西方的社会伦理发展轨迹的差异,构建生育健康的伦理框架和强调女性生育自主权的努力方向也应异于西方。     

面对临床无效治疗:思考与抉择

对于没有临床救治意义的病人 ,要不要继续治疗 ?这既是临床医疗问题 ,又是一个涉及社会、伦理、法规的问题。在社会多元化发展的今天 ,对于临床无效治疗无论放弃与否 ,都应当把维护病人的利益作为医疗活动的出发点。在此基础上 ,知情同意和尊重病人自主权是医务人员必须遵循的基本道德原则 ,同时也应当考虑卫生资源的有效分配和社会公众的健康利益     

围手术期麻醉医师的伦理责任

随着医学模式的转变,麻醉医师应了解本专业特殊的伦理要求。本文通过对围手术期不同时间段的伦理要求进行分析,探讨了麻醉医师应遵守的医学伦理学职责,包括：术前查看病人,以最优化原则制定麻醉方案,坚持知情同意原则,杜绝术中知晓,执行保护性医疗制度,保证病人舒适自然的苏醒以及必要的心理抚慰与指导等。     

Foucault's "fearless speech" and the transformation and mentoring of medical students

In his six 1983 lectures published under the title, Fearless Speech (2001), Michel Foucault developed the theme of free speech and its relation to frankness, truth-telling, criticism, and duty. Derived from the ancient Greek word parrhesia, Foucault's analysis of free speech is relevant to the mentoring of medical students. This is especially true given the educational and social need to transform future physicians into able citizens who practice a fearless freedom of expression on behalf of their patients, the public, the medical profession, and themselves in the public and political arena. In this paper, we argue that Foucault's understanding of free speech, or parrhesia, should be read as an ethical response to the American Medical Association's recent educational effort, Initiative to Transform Medical Education (ITME): Recommendations for change in the system of medical education (2007). In this document, the American Medical Association identifies gaps in medical education, emphasizing the need to enhance health system safety and quality, to improve education in training institutions, and to address the inadequacy of physician preparedness in new content areas. These gaps, and their relationship to the ITME goal of promoting excellence in patient care by implementing reform in the US system of medical education, call for a serious consideration and use of Foucault's parrhesia in the way that medical students are trained and mentored.     

Beyond medical ethics: New directions for philosophy and medicine

A unique relationship exists between physicians and philosophers — one that expands on the constructive potential of the liaison between physicians and, for example, theologians, on the one hand, or, social workers on the other. This liaison should focus in the scientific aspects of medicine, not just the ethical aspects. Philosophers can provide physicians with a perspective on both the philosophy and the history of medicine through the ages — a sense of how medicine has adapted to the social cultural and ethical needs of each period. This perspective, while emphasizing medicine asscience, should not be limited to matters of methodology, or to criteria for distinguishing science from other intellectual pursuits, but should be concerned also with the history, sociology and politics of science. Both physicians and philosophers stand to gain from a strengthening of their active liaison now as never before; but most of all, the public will be the beneficiary.     

Medical ethics in an era of bioethics: Resetting the medical profession’s compass

What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This presentation summarizes the history of medical professionalism and refocuses attention on the interpersonal relationship of doctor and patient. This keynote address was delivered at the Founders of Bioethics International Congress (June, 2010).     

后现代语境下医学语言的伦理解读

医学的现代性遗产和后现代世界的冲突在不断加剧,导致了对医学语言理解的困境和伦理意义的丧失。后现代主义极力寻求人类理解的解释性基础,使后现代医学语言的伦理选择成为可能。在后现代语境下,医学语言的伦理应该是摆脱现代性“文化霸权”的一种诠释学的谈话,是一种境遇伦理。     

Developing an informational tool for ethical engagement in medical tourism

Background

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.

Methods

The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.

Results

The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service.

     

医疗市场化失败后的法律和伦理思考

法律上对于医疗机构的民事主体定位,虽然暂时满足了医疗市场化的需要,但却淡化了医疗机构所应承担的公共伦理职责.私权与公共伦理之间的剧烈冲突,最终使得医疗市场化走向终结.