文化背景与医疗行为:一个少数民族社区中的新型农村合作医疗

现有对民族社区新型农作合作医疗（以下简称新农合）的研究相对较少,同时在研究中忽略了在其独特民族文化背景下对于疾病与医疗的不同认知,这一认知影响了人们的医疗观念和医疗行为,也直接影响了人们对新农合的态度和行为。医学人类学关注文化与疾病、医疗的关系,以云南省福贡县赤恒底傈僳族社区新农合的田野调查为例,应用医学人类学的视角和社区研究方法对其进行研究,以期获得新的认识和理解。     

医学教育环境测量评价的实践与探索

重点讨论了医学教育环境测量和评价在医学教育改革中的地位和作用,在借鉴国外先进经验的基础上,在教育环境评价和教师评价方面提出了重视学生感受,重视教育环境的动态评价,科学公正地评价教师,建立全面系统的分析方法,建立评价的分析反馈机制等看法.     

当前医患纠纷解决模式的法律与道德评价

我国医患纠纷的最终解决是通过传统的民事诉讼途径,然而,这种模式并不符合医疗案件本身的特点。从法律和道德的角度而言,我们必须对医疗诉讼的制度设计重新进行反思,并在此基础上进行变革。     

Action theory as a source for philosophy of medicine

The article tries to demonstrate how the tools and perspectives of action theory may be used in philosophy of medicine and medical ethics. In the first part, some concepts and principles of action theory are reconstructed and used to sketch a view of medicine as a ‘science of actions’. The second part is a contribution to the discussion on medical ethics in the same issue of this journal and consists in a detailed analysis of the main arguments and critical remarks from the point of view of action theory.     

案例教学与医学伦理学教育

案例教学已经成为普遍的方法在我国各医学院校的医学伦理学教学中广泛使用,案例教学作为一种方法,如何客观地看待它,需结合医学伦理学教育的目的和内容。案例教学具有增加互动、加深理解和提高分析能力等优点,但如果驾驭不好,也会暴露一些弱点,而起到反作用。试图还案例教学法于医学伦理学教育的本来位置。     

医疗活动中的利他主义与医务人员的价值取向

医学的目的是增进人的健康,当今医疗技术主义和医疗市场在诱惑医学超越固有疆界。医疗行业必须坚持正确的价值取向,社会公众利益最大化是医疗卫生服务的基本目标。市场经济条件下的医疗卫生服务具有无私利他的道德责任和追求利益的需求,医疗市场中的利他行为包括无私利他与为己利他,为病人最大利益着想是医护专业最根本的道德规范与责任。     

对SARS病人及相关人员实施隔离等强制措施的思考

对SARS病人及相关人员采取隔离等强制措施是有效控制疫情扩展的重要和主要手段,但同时也是剥夺公民人身自由的一种行为。SARS防治的要求与现行法律存在着一定的冲突;紧急特殊情况下的行政应急措施应属必要。对相关法律进行完善,严格依照法定的条件符合法定程序实施强制措施,才能既有利于控制疫情又充分保障被隔离者的合法权益。     

论保密义务与诚信原则

尊重患者隐私,保守执业秘密,是医师的道德义务,也是法律义务,保密义务的理论基础在于诚实信用原则.为此,医疗活动中应引入体现伦理道德要求的诚信理念,从道德和法律两方面规范医师的行为,并且建立以法律规范为主的规制模式.     

举证责任倒置对医疗纠纷诉讼的影响

举证责任倒置是一般举证责任原则的例外,在医疗纠纷诉讼中施行举证责任倒置的法理依据。主要是医患双方的诉讼地位不平等和医患双方的信息不对称,导致患方举证困难,实施新的举证规则后,必将会对医疗纠纷诉讼产生一系列的影响,医方对此要有深刻的认识并积极研究其对策。     

正确认识和对待"举证责任倒置"

“举证责任倒置”作为处理民事诉讼中的例外原则运用于医疗纠纷的处理必将对医患关系的根本好转提供有利的措施保证,如何认识和对待“举主责任倒置”是一个崭新的课题,就此,我们谈点不成熟的看法。     

论故意传播艾滋病行为的法律定性

目前与故意传播艾滋病行为相关的刑事犯罪正在悄然上升,对于故意传播艾滋病行为究竟应以什么罪名定性争议很大.从医学的角度看,传播艾滋病行为的途径不同,故意传播艾滋病行为的法律定性也必然不同.     

临床中实习医生做妇科检查所引发的伦理学问题浅析

实习医生给女性患者做妇科检查是临床教学中的重要内容,也是现代医学生培养中必不可少的一个环节.对医患双方而言,接受实习医生做妇科检查理应无可非议,但最近对实习医生做妇科检查所引发的伦理学问题又起纷争.综合讨论实习医生施行妇科检查的这种医疗行为,并试图提出临床实践中此类现象的合理解决途径.     

近视激光手术治疗几个问题的探讨

近视眼是目前全球发生率最高的屈光不正,我国的近视准分子激光手术水平已与世界先进水平同步,并处于快速、稳健的发展中。依据辩证法正确评价近视激光手术的优缺点,遵循系统论的整体性、最优化、动态化和模型化的基本原则,可以进一步提高激光手术治疗的视觉质量,促进近视激光手术治疗的健康发展。     

Voluntary Control of Behavior and Responsibility

Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs.     

发挥中医药学优势,构建和完善小康社会卫生服务体系

全面分析和阐述了中医药学在我国社区卫生服务体系的理论建设和医疗实践中所具有的作用、意义和优势.提出利用中医药学优势,将促进社区卫生服务,确保小康社会卫生服务体系的完善.     

The uncertainty of certainty in clinical ethics

Physicians accept fallibility in technical matters as a condition of medical practice. When it comes to moral considerations, physicians are often loathe to act without a good deal more certitude and seem less willing to accept error. This article argues that ethics is intrinsic to medical decision making, that error is the inevitable risk of any action and that inaction (clearly action by default) carries even greater risk of error. Whether in the moral or the technical sphere, error must be accepted by physicians as part of the learning process which informs and enriches future decisions. Moral virtue, it is concluded, resides more in the making of a decision and in the agony of making it than it does in the potentially fallible decision itself.     

Prognosis in medicine: An analysis of its meaning and rôles

The medical concept of prognosis is analysed into its basic constituents: patient data, medical intervention, outcome, utilities and probabilities; and sources of utility and probability values are discussed. Prognosis cannot be divorced from contemplated medical action, nor from action to be taken by the patient in response to prognostication. Regrettably, the usual decision-theoretic approach ignores this latter aspect. Elicitation of utilities, decision contemplation and prognostic counselling interweave, diagnostics playing a subsidiary role in decision-oriented clinical practice. At times the doctor has grounds for withholding information. As this is known to the patient, prognostic counselling becomes a conflict-prone and rationality-thwarting activity. The meaning of standard phrases such as “prognosis of a disease”, “the prognosis of this patient”, “the prognosis is unknown”, is examined.     

Who we are: The political origins of the medical humanities

The medical humanities were organized, beginning in the late 1960s, by a small group of people who shared a critique of medical education and a commitment to vigorous action to change it. They proposed to create several demonstration programs in humanities education at American schools. Although the group began with a religious orientation, it soon acquired a broader, more secular mission. As a result of shrewd political organizing, the group attracted members from within medicine, and was awarded a grant to promote the medical humanities. This paper describes these events and sets them in the context of the social and medical history of the 1960s and early 1970s.     

恶性肿瘤动物模型的建立

建立恶性肿瘤动物模型是医学科研工作者重要的研究手段。恶性肿瘤的自发肿瘤模型,诱发肿瘤模型和移植肿瘤模型有着各自的机体与外界施加因素之间对立平衡,对界因素逐渐同体所转化和接纳,最终导致肿瘤形成,同时机体也荷瘤。因此,任何影响动物和施加固的条件均可促进和减弱肿瘤形成的起始,进展,结局。就三种恶性肿瘤动物模型建立过程中启示呈现出来,并对不同模型特点和选择进行评述。     

Reflective thinking and medical students: some thoughtful distillations regarding John Dewey and Hannah Arendt

Reflective thought (critical thinking) is essential to the medical student who hopes to become an effective physician. John Dewey, one of America's foremost educators in the early twentieth century, revolutionized critical thinking and its role in education. In the mid twentieth century Hannah Arendt provided profound insights into the problem of diminishing human agency and political freedom. Taken together, Dewey's insight regarding reflective thought, and Arendt's view of action, speech, and power in the public realm, provide mentors and teachers of medical students guidance in the training of thought and the need for its effective projection at the patient's bedside and in the community.