健康与疾病的划界:困境与出路

简单回顾了医学对健康和疾病的认识与划界,重点分析了生物医学模式的划界标准、前提,以及它在医学认识与实践中面临的困境.在此基础上,探讨了19世纪以来医疗界走出困境的主要路径.     

异质性与科学划界─—L.劳丹的划界理论

在一篇题为《划界问题的消亡》的文章中，劳丹说：“习惯上被视为科学活动和科学信念的内容都具有认识异质性（epistemichetero－geneity），这种异质性提醒我们注意，寻求划界标准的认识形式可能是无效的。经过详细分析，看来不存在一个认识常量。…划界问题——被波普尔称为‘认识论中心问题’的那一问题是虚假的，因为它预设了这一常量的存在。”①劳丹是循着以下思路得出上述结论的。首先，他设立了关于科学划界的三个元标准。然后他检查了新老划界主义传统，发现无一划界方案满足元标准。最后他才形成了异质性概念科学观。不难看出，此…     

科学划界:"猴子审判"案例分析

自上个世纪后期以来,20世纪哲学四大主题之一的科学划界研究陷入了进退两难的境地。该文从科学划界的视角出发,分析了科学家和创世论者在“猴子审判”这一著名案件中的辩护与反驳,揭示了特定的社会、文化和政治因素对科学划界标准的影响,并且指出在现实社会中研究有关的科学争论,从研究科学精英的科学观转向研究社会公众的科学观,可能是有助于摆脱这一困境的努力方向。     

科学的划界与医学：—一论在医学中坚持科学精神

这里所论的科学划界标准是就自然科学而言的，区分科学与非科学最重要的标准是它的可检验性和可重复性。科学的这个划界标准今天并未过时，医学和一般自然科学相比有其特点，但其为实验科学的医学也应坚持这个标准。     

科学划界与中医

科学划界就是在科学与非科学之间作出区分,依据科学划界的逻辑主义的绝对标准、历史主义的相对标准以及重建划界的多元标准,中医不晃科学,但中医也不是伪科学,而是一门实用的技艺,因此中医科学化、现代化及中西医结合的提法有待于进一步商榷。我们反对把中医伪科学化,中医的出路只有一条,那就是融入现代医学的发展之中,为医学的发展而奉出自己的经验和思路。     

当代医学现象与本质的分离

人是什么?人性是什么?身心生命的价值意义何在?医学目的何在?医学人文深层困境何在?从哲学视角剖析,人的多维结构与复杂性,指出现实困境的深层根源,提出走出困境的对策,特别对人性需要滋养、医学人文文化土壤建设的改善对策予以阐述.     

重访、拼图与激生——“做中国哲学”的“手筋”

<正>自其作为一个学术领域诞生开始，中国哲学就一直在划界:哲学在中国，抑或中国的哲学?“照着讲”的译介工作与历史叙述，抑或“接着讲”的思想探索与理论建构?划界的尝试凸显了中国哲学的三重理论困境:其一，哲学反思被预设了的“普遍性”与中国的哲学的“中国性”之间的张力;其二，在中国传统的思想世界与精神生活中抽绎出哲学性并加以申发的哲学史，与面向当下的、基于中国经验的哲学探索之间的牵扯;其三，西方哲学的汉语化与中国思想的哲学化之间的双重他者性。     

当下高等医学人文教育的困境与出路

医学人文教育是医学教育不可或缺的重要组成部分,医学科学精神与医学人文精神的融合是医学学科发展的目标和方向.当下医学人文教育的困境在于:医学人文教育与政治教育混谈,人文教育目标不明;医学人文教学与社会现实脱节,人文教学效果不佳.破解医学人文教育的困境,必须从顶层设计,跳出医学人文教育看教育,实施医学人文教育发展战略,实现医学教育的全面、协调、可持续发展.     

现代医学技术与人文离散的困境及对策探析

医学的技术性和人文性从来就是医学内在的不可分割的两重属性,自医学走向了以还原和分科的方法研究医学的技术路径后,医务人员便以寻求技术手段解决人类疾病,现代医学发展中人文困境愈加凸显。通过从医学理念碎片化、医学技术异化、医患关系物质化探讨引发现代医学技术与人文分离的困境,剖析由医学技术主体化的演进、资本全面渗入医学、技术与资本结合和医生角色的多元化是现代医学技术与人文分离的原因,提出通过立足整体医学观、转变技术至上思想观念、医学技术融入人文精神、提高医疗服务质量回归医学技术与人文的统一。     

医学理性:技术、资本与人文的张力平衡

随着现代新技术发展和医学资本的介入,现代医学的规模在不断壮大。但同时引发的负面效应也很严重。在技术、资本与人文的交割之中,医学正经受前所未有的抉择。医学的人文性与医学的科学性正逐渐丧失了平衡,技术主体与医学目的的错位,医学资本与资本道德的分离,而医学中的集体无意识状态则更令人担忧。因此,摆脱医学困境迫切需要保持医学理性,妥善协调技术、资本与人文的张力关系,坚持技术的人文性方向,促进资本的公益性发展,以人为本构建医学的理性精神。     

Beyond the Biomedical Paradigm: Generating a Spiritual Vision of Ageing

SUMMARY

The time has come to enlarge our understanding of what an ageing older person truly is. What is called for is an approach to ageing and its multiple processes that moves beyond an empirical research model, which is limited to a positivistic focus on the bio-medical and social conditions of ageing. The spiritual dimension of the individual as well as the physical and social need to be acknowledged and valued in any definition of human existence. A segmental approach to the ageing process can only result on a reductionistic, one-dimensional caricature of the older person. There is an imperative need for the inclusion of the spiritual dimension in the study of ageing and its meaning. By issuing a call for a new wholistic paradigm that moves beyond the bio-medical model, and understanding the personhood is affirmed which includes a person's capacity to find meaning in life, indeed, even in ageing, suffering and dying.     

重建现代医学模式中的传染病防治策略

以当下SARS流行为例,考察了传染病概念的演变以及在现代社会中突发性传染病流行事件的多维影响,指出将传染病防治归结为生物医学模式,把慢性病防治隶属于生物心理社会医学模式是片面的,提出现代社会的传染病防治策略也必须建构在生物心理社会医学模式的基础之上。     

THE ORIGINS AND ISSUES OF SCEPTICISM, EAST AND WEST

The scepticism of the academicians: the illusions of perception, the frailty of induction, the indecency of deduction, the conundrums of negation, is not the concern of this paper. It is thinkers for whom the human situation is a predicament demanding some kind of resolution who interest me. These are thinkers who see knowledge, philosophy if you will, within the horizon of predicament and resolution, who see knowledge exhausting itself well before any resolution of the human predicament is reached, who hold that knowing is not the model by which to understand how humans relate to the way things really are.     

病人、医生与知情同意

医务人员应当视病人为治疗疾病过程中的参与者.知情同意的目的是,使病人充分理解他的困境后做出理性的决定.医生与病人分享信息、分担责任与做出决定,以保持良好的医患关系.     

存在与解释：刍议心理咨询境域的诗性智慧

诗性智慧是生活境域中非主体化、非对象化的此在智慧,解释学是迄今诗性智慧在哲学中的最好阐发,它消解了思与诗之间长期紧张的二元对立,为至今仍困扰于科学主义与人本主义范式分裂的心理咨询提供了可资超越的借鉴。理解在时间的境域中氤氲着诗性智慧的光焰生生不息。     

当前实施麻醉过程中遇到的困惑及解决办法

当前麻醉应用过程中存在困惑,表现为：麻醉知情告知与患者接受存在矛盾;麻醉应用费用支出与患者经济节约构成冲突;麻醉风险意外出现与患者期待绝对安全冲突;麻醉要求与外科医生要求冲突。当前麻醉应用困惑的解决在于将告知沟通贯穿治疗全程,体现人文关怀;提高麻醉质量,提高麻醉安全系数;加强麻醉医生与外科医生沟通配合,共同提高手术效果...     

A Combined- Constructionist Therapeutic Approach To Couples Experiencing Erectile Dysfunction: Part I

Marked changes have occurred in the conceptualization and treatment of Erectile Dysfunction (ED) in the past two decades. Emphasis has shifted to the role of biomedical and organic factors using medical and surgical interventions in the etiology of sexual dysfunction, deemphasizing the quality of the overall couple relationship. However, by using only a medical approach, the couple is left with balancing the positive and negative facets of a considerably different relationship with sex now in their lives and their relationship. This paper is Part I of a two part article on erectile dysfunction. Part I presents information on the bio-medical factors that may be related to ED and the medical model treatment approaches. Part II presents information on the psychological and systemic issues that may be related to erectile dysfunction, encouraging the use of a combined-constructionist framework.     

How Should We Foster the Professional Integrity of Engineers in Japan? A Pride-Based Approach

I discuss the predicament that engineering-ethics education in Japan now faces and propose a solution to this. The predicament is professional motivation, i.e., the problem of how to motivate engineering students to maintain their professional integrity. The special professional responsibilities of engineers are often explained either as an implicit social contract between the profession and society (the "social-contract" view), or as requirements for membership in the profession (the "membership-requirement" view). However, there are empirical data that suggest that such views will not do in Japan, and this is the predicament that confronts us. In this country, the profession of engineering did not exist 10 years ago and is still quite underdeveloped. Engineers in this country do not have privileges, high income, or high social status. Under such conditions, neither the social-contract view nor the membership-requirement view is convincing. As an alternative approach that might work in Japan, I propose a pride-based view. The notion of pride has been analyzed in the virtue-ethics literature, but the full potential of this notion has not been explored. Unlike other kinds of pride, professional pride can directly benefit the general public by motivating engineers to do excellent work even without social rewards, since being proud of themselves is already a reward. My proposal is to foster a particular kind of professional pride associated with the importance of professional services in society, as the motivational basis for professional integrity. There is evidence to suggest that this model works.     

A Combined-Constructionist Therapeutic Approach to Couples Experiencing Erectile Dysfunction: Part II

This paper is Part II of an exploration of the treatment and conceptualization of Erectile Dysfunction (ED). In the past two decades, there has been a shift in the treatment of Erectile Dysfunction to more medically based approaches. Part I of the paper presented the role of biomedical and organic factors involved in ED. However, although important for the couple therapist to understand, by focusing only on the bio-medical aspects of ED, the couple may face new issues in their considerably different relationship with sex now a part of their lives. The current paper, while respectful of the medical model approach, emphasizes the overall quality of the couple relationship, presenting information on the psychological and systemic therapies and issues that may be related to Erectile Dysfunction, encouraging a combined-constructionist approach.     

Maintaining lies: The multiple-audience problem

In an examination of lying in social context, undergraduates were videotaped while describing teachers. Each student described a teacher truthfully to one peer, described the teacher deceptively to a second peer, and was then required to describe the teacher to both peers as the latter sat side-by-side. Three experiments examined the psychology of this multiple-audience predicament. Results of an initial experiment show that students who are in the predicament appear deceptive. They appear deceptive whether they are lying or telling the truth. A second experiment replicates this finding, and suggests that the students’ apparent deceptiveness is conveyed more strongly by audible than visible cues. In the interpersonal predicament created by multiple audiences, students offer equivocal, disfluent remarks, as a third experiment shows. Discussion centers on the challenge of maintaining lies in the context of multiple relationships.