论医学伦理学的自主性原则

医学伦理学的自主性原则是对个人的自主和自由的尊重,其核心是对人权的尊重,包含有知情同意、保密、隐私等具体规则.自主性原则是根源于西方强调个性自由和选择的自由主义道德传统,我国古代哲人也提出过相近乃至相同的看法.     

论生命伦理学的自主性原则

自主性原则是生命伦理学的首要原则,其本质在于个人自主地选择自己的思想和行为.自主分为思想自主、意愿自主和行动自主.自主性原则的思想前提是道义论与后果论.在生命伦理学中,尊重、知情同意、保密和隐私权是自主性原则的具体表现形式.在医疗实践中,自主权的行使必须与具体的情境相结合,其价值才能充分实现.     

病人自主性与家庭本位主义之间的张力

在中国几千年小农经济和传统文化背景下,个人利益、个人权利一直被置于家庭之下,个人自主性被包含在家庭自主性之内,表现为一种家庭本位主义。源自西方历史、文化的知情同意移植到中国后,受传统文化观念的影响,中国人对知情同意的认知、理解以及实践方式均不同于西方人。这种不同集中表现在人们对家属同意权的认可。以个人本位主义为背景的病人自主性与中国文化中的家庭本位主义之间存在张力。对知情同意在不同文化环境中不同践行方式,应以文化宽容主义的态度对待之。     

履行知情同意原则的指导意见

我们,于2004年7月,参加在大连举行的“医患关系-医疗诉讼-医患维权”学术研讨会上,讨论并修改了《履行知情同意原则的指导意见》。我们认为,这一文件总结了近些年来在医疗实践中履行知情同意原则的经验,体现了以人为本的精神和对病人权利的尊重,它的实施将有助于密切医患关系、增进医患问的信任和理解。因此,我们表示赞成,同意将之作为本院医务人员履行知意同意原则的指导意见,并在实践中不断充实、完善。     

知情同意—《中国医学伦理学辞典》条目选载之二

知情同意原则是临床上处理医患关系的基本伦理准则之一 ,也称为知情承诺原则。这一原则的基本内容是 :临床医师在为病人作出诊断和治疗方案后 ,必须向病人提供包括诊断结论、治疗决策、病情预后以及诊治费用等方面的真实、充分的信息 ,尤其是诊疗方案的性质、作用、依据、损伤、风险以及不可预测的意外等情况 ,使病人或其家属经过深思熟虑自主地作出选择 ,并以相应的方式表达其接受或者拒绝此种诊疗方案的意愿和承诺 ;在得到患方明确承诺后 ,才可最终确定和实施拟定的诊治方案。在知情同意原则中 ,知情原则与同意原则是密切相关、不可割裂的…     

意志自由与生命价值的对峙——精神医学领域知情同意原则泛化的伦理分析

知情同意原则在精神医学领域存在严重的泛化现象.医学技术与疾病治疗之间的不同步性表明,单纯依靠技术理性探寻知情同意原则泛化的根源必将陷入困境,解读该原则本身的伦理涵义为其伦理根源的追溯提供了除反思经验判断与医学技术局限性外的破冰之旅.人类意志自由与生命价值在精神医学领域里的尖锐对峙是这种泛化的伦理根源.     

当代中国心理咨询和治疗师的知情同意与保密状况研究

本研究采用问卷调查法,以自编"心理咨询和治疗伦理问题调查问卷(咨询师版)"对全国范围内1 000名心理咨询和治疗师进行调查,以了解心理咨询和治疗师的知情同意和保密情况.结果发现目前国内的心理咨询和治疗从业者知情同意和保密原则的伦理意识和行为比较欠缺.需要增加专业的训练、进行统一伦理规范.     

当代中国心理咨询和治疗师的知情同意与保密状况研究

本研究采用问卷调查法,以自编“心理咨询和治疗伦理问题调查问卷（咨询师版）”对全国范围内1000名心理咨询和治疗师进行调查,以了解心理咨询和治疗师的知情同意和保密情况。结果发现目前国内的心理咨询和治疗从业者知情同意和保密原则的伦理意识和行为比较欠缺,需要增加专业的训练、进行统一伦理规范。     

论知情同意的家庭主义模式

知情同意是生命伦理学的基本原则.中国语境下,知情同意的临床实践具有区别于西方个体模式的特点,即家庭主义模式.这种模式的产生植根于病人的脆弱性与依赖性、自主的内在联系,并受到儒家文化的深刻影响,其本质是一种家庭自主.在临床实践中,家庭主义模式有利有弊,我们应当发挥其优势,克服其弊端.     

论患者最佳利益原则

尽管何为患者最佳利益尚无法明确进行统一的界定,但是患者最佳利益原则在英国等西方国家已经上升为医事法律的基本原则.患者最佳利益原则由传统的伦理和道德标准上升为法律准则符合社会的发展和患者的利益诉求,亦有利于改善我国当前的医患关系状况,我国将来修订相关医事法律时应将患者最佳利益原则确立为基本法律原则.     

The Professional Autonomy of the Medical Doctor in Italy

This contribution deals with the issue of the professional autonomy ofthe medical doctor. Worldwide, the physician's autonomy is guaranteedand limited, first of all, by Codes of Medical Ethics. InItaly, the latest version of the national Code of MedicalEthics (Code 1998) was published in 1998 by the Federation ofprovincial Medical Associations (FnomCeO). The Code 1998acknowledges the physician's autonomy regarding the scheduling, thechoice and application of diagnostic and therapeutic means, within theprinciples of professional responsibility. This responsibility has tomake reference to the following fundamental ethical principles:(1) the protection of human life; (2) the protection of thephysical and psychological health of the human being; (3) therelief from pain; (4) the respect for the freedom and the dignityof the human person, without discrimination; (5) an up-to-datescientific qualification (Art. 5). The authors underline that autonomyis an anthropological – and consequently ethical –characteristic of the human person. Different positions on autonomy inbioethics (individualistic, evolutionistic, utilitarian andpersonalistic models) are explained. The relation between theprofessional autonomy of the physician and the autonomy of the patientand of colleagues is discussed. In fact, the medical doctor isobliged: (1) to respect the fundamental rights of the person,first of all his/her life; (2) to ensure the continuity of thecare, even if he can only relieve the patient's suffering; (3) tomaintain, except under certain circumstances, professional secrecy andconfidentiality regarding patients and their medical records. Moreover,the physician cannot deny the patient correct and appropriateinformation. He/she should not perform any diagnostic or therapeuticactivity without the informed consent of the patient and the medicaldoctor must give up medical treatment in case of documented refusal ofthe individual. Furthermore, the medical doctor has the right to raiseconscientious objections if he/she is requested to perform medicalactions that are contrary to his/her conscience or medical opinion,unless this attitude would seriously and immediately harm the patient.Regarding the relationships with colleagues, the physician is obliged tosolidarity, mutual respect, and care of sick colleagues. Finally, theauthors discuss the Italian legislation affecting the physician'sprofessional autonomy: (1) the SSN health care Acts; (2) theso-called Charter for Public Health Care Services; (3) the Acts onprivacy; (4) Good Clinical Practice.     

关于医疗同意书的若干法律问题的思考

医疗知情同意书与病人知情权密切相关,还涉及病人的自我决定权和隐私权。对知情同意书的本质及其法律效力,签署主体及告知的标准进行了一些探讨。     

个体危机干预中的伦理学问题

在现代社会中,越来越多的人陷入了不同程度的心理危机中,个体危机干预技术正在得到越来越广泛的应用。个体危机干预是一种短程的心理治疗,在危机干预过程中,对干预对象的隐私权、知情同意权等问题尚未形成相应的伦理规范。为促进危机干预工作的健康发展,对这两个方面的伦理学问题加以讨论,尝试提出一些能够指导个体危机干预工作实践的伦理规范。     

Rethinking Research Ethics

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research.     

Ethics Consultation and Autonomy

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist.     

肤纹学研究的伦理问题

医学伦理学和遗传伦理学的原则同样适合肤纹学的研究.知情同意是肤纹学研究中必须要存在的程序和手续.对于肤纹学研究的检查、分析和保存所涉及的伦理学问题提出了意见.     

美国医疗知情同意案例评介

在美国的医疗活动中,知情同意是规范医患关系的一项伦理道德原则,同时,美国司法活动也在医疗事故背景下适用知情同意说,并形成一些司法适用的医疗知情同意的标准和告知责任的范围,介绍和讨论对涉及到这些问题的三个有影响的判例。     

Genetic Information,Rights, and Autonomy

Rights, autonomy, privacy, and confidentialityare concepts commonly used in discussionsconcerning genetic information. When theseconcepts are thought of as denoting absolutenorms and values which cannot be overriden byother considerations, conflicts among themnaturally occur.In this paper, these and related notions areexamined in terms of the duties and obligationsmedical professionals and their clients canhave regarding genetic knowledge. It issuggested that while the prevailing idea ofautonomy is unhelpful in the analysis of theseduties, and the ensuing rights, an alternativereading of personal self-determination canprovide a firmer basis for ethical guidelinesand policies in this field.