“医学伦理学再启程”亟待破解的医学伦理课题

面临新境遇的医学伦理学,亟待破解的医学伦理课题有：医疗资本和医疗利益集团追求利润最大化的行为对公立医疗机构公益性造成持续性损害;医学高新技术僭越伦理底线,无限制地对身体进行技术干预;医学技术权力与医学高新技术、医疗资本结盟形成挑战医学伦理的异化力量;确立利益伦理是医学伦理学研究的重要内容;确认患者利益置于首位是现代医学伦理学的首要原则;促进美德伦理与规范伦理结合,推进制度伦理建设与机构伦理建设是医学伦理学落地生根的关键环节。

     

Students' Ethical Awareness and Conceptions of Research Ethics

The study focused on university students' understanding and conceptions of ethical issues in research. Domain-specific and domain-transcending measures were developed to gauge the students' awareness of ethical issues. Responses were obtained from 269 undergraduate and graduate students at a U.S. regional university. Participant withdrawal, the debriefing of research participants, the dissemination of findings, and giving credit to co-contributors were the most challenging ethical issues for the students. Ethical awareness was predicted by professional and organizational socialization, and perspective taking. Contextualization greatly improved the students' ability to recognize ethical issues. Simulations and role-taking are suggested as the means with which to teach students about the ethical issues perceived as challenging.     

Four Roles of Ethical Theory in Clinical Ethics Consultation

When clinical ethics committee members discuss a complex ethical dilemma, what use do they have for normative ethical theories? Members without training in ethical theory may still contribute to a pointed and nuanced analysis. Nonetheless, the knowledge and use of ethical theories can play four important roles: aiding in the initial awareness and identification of the moral challenges, assisting in the analysis and argumentation, contributing to a sound process and dialogue, and inspiring an attitude of reflexivity. These four roles of ethical theory in clinical ethics consultation are described and their significance highlighted, while an example case is used as an illustration throughout.     

Theistic Ethics and the Euthyphro Dilemma

It is widely believed that the Divine Command Theory is untenable due to the Euthyphro Dilemma. This article first examines the Platonic dialogue of that name, and shows that Socrates's reasoning is faulty. Second, the dilemma in the form in which many contemporary philosophers accept it is examined in detail, and this reasoning is also shown to be deficient. This is not to say, however, that the Divine Command Theory is true—merely that one popular argument for rejecting it is unsound. Finally some brief thoughts are presented concerning where the real problems lie for the theory.     

Where it Hurts: Indian Material for an Ethics of Organ Transplantation

This article focuses on ethical issues surrounding the selling and buying of human organs. The author argues that most people who sell their organs (mainly kidneys) in India do so in order to pay already existing debts. The transaction is only temporarily an exchange of “life for life,” and most “donors” are back in debt soon after the operation. The author discusses the flexible ethics that reduce reality to dyadic transactions and the purgatorial ethics that collapse real and imaginary exploitation in the service of complex interests. He also offers a sophisticated discussion of the ethics of publicity and public ethics. He emphasizes the lack of factual information, intentional manipulation of information, and the dissemination of kidney panics and kidney scandals, especially by the new developing bioauthorities and bioethical brokers.     

On Using Ethical Theories to Teach Engineering Ethics

Many engineering ethics classes and textbooks introduce theories such as utilitarianism and Kantianism (and most others draw from these theories without mentioning them explicitly). Yet using ethical theories to teach engineering ethics is not devoid of difficulty. First, their status is unclear (should one pick a single theory or use them all? does it make a difference?) Also, textbooks generally assume or fallaciously ‘prove’ that egoism (or even simply accounting for one’s interests) is wrong. Further, the drawbacks of ethical theories are underestimated and the theories are also otherwise misrepresented to make them more suitable for engineering ethics as the authors construe it, viz. the ‘moral reasoning’ process. Stating in what various theories disagree would allow the students to frame the problem more productively in terms of motive–consequence or society–individual dichotomies rather than in terms of Kant–utilitarian.     

The Ethics of Opinion in Academe: Questions for an Ethical and Administrative Dilemma

If we accept that all plagiarism is wrong, the issue is black and white. But are there more challenging questions that color the issue with shades of gray that may influence or help clarify the ethical underpinnings of the act? Does intent matter? Does the venue matter? Does the form of writing matter? What about a professor when working as a private citizen, rather than in his/her academic role? Might plagiarism be mitigated when there is no associated financial gain? Is a writer’s history that exhibits impeccable ethical integrity relevant? Should these factors, and/or other factors, even be considered in a university’s administrative response — or non-response? What might employing an ethical approach contribute to wrestling with the dilemma? The authors explore critical issues that might face a senior academic administrator when confronting the need to respond on behalf of a university to a charge of plagiarism leveled by an influential newspaper against a university professor for a social responsibility-focused opinion-editorial published in this newspaper.     

医学伦理学不可忽视的课题:利益伦理

当今是一个以利益为轴心的时代。利益伦理学是医学伦理学不可忽视的课题。将病人利益置于首位应当是现代医学伦理学的首要原则。欲望是无穷的,利益是有限的。任何利益都有自己的边界和限度。我们必须设置利益的道德界限,以回答当前医学伦理学面临的种种现实课题。     

医学伦理学不可忽视的课题：利益伦理

当今是一个以利益为轴心的时代。利益伦理学是医学伦理学不可忽视的课题。将病人利益置于首位应当是现代医学伦理学的首要原则。欲望是无穷的,利益是有限的。任何利益都有自己的边界和限度。我们必须设置利益的道德界限,以回答当前医学伦理学面临的种种现实课题。     

英美医学生伦理困境及教育问题研究简介

英美学者研究认为,医学生在医学院校学习和临床培训期间,由于其身份地位、文化冲突以及医疗管理等方面的原因而经历的种种伦理困境,易于使他们陷入情感和心理的困扰、信仰和行为的冲突、理想和现实的矛盾之中,并最终导致其价值观和伦理原则的损害。他们呼吁教育工作者应当承担起帮助学生应对复杂的矛盾问题以及学习职业伦理困境的处理经验的责任。这些成果对深入研究和积极探索我国医学伦理教育的有效路径具有重要的借鉴意义。     

The Latent Structure of Substance Use Among American Indian Adolescents: An Example Using Categorical Variables

Researchers frequently have only categorical data to analyze and cannot, for theoretical or methodological reasons, assume that the observed variables are discrete representations of an underlying continuous variable. We present latent class analysis as an alternative method of measuring latent variables in these circumstances. Latent class analysis does not require the assumptions of factor analyses about the nature of manifest and latent variables, but does allow the use of more precise model selection than techniques such as cluster analysis. We modeled the lifetime substance use of American Indian youth. The latent class model of American Indian teenagers' substance use had four classes: Abstaining, Predominantly Alcohol, Predominantly Alcohol and Marijuana, and Plural Substance. We then demonstrated the usefulness of this latent variable by using it to differentiate levels of several variables in a manner consistent with Social Cognitive Theory.     

Christian Ethics,Religious Ethics,and Secular Ethics: A Contemporary Reappraisal

In this essay, I argue that Christian ethicists should not think of themselves as religious ethicists. I defend this claim by arguing that the concept of religious ethics, as it has come to be understood as a discipline that is distinct from secular ethics, is incoherent. In part one, I describe the fraught attempts by theologians in the 20th century to identify the distinctiveness of Christian ethics. In part two, I argue that certain accounts of natural law unwittingly reinforce a problematic conception of secular ethics. Part three examines some trends in religious studies and comparative religious ethics to highlight problematic conceptions of religion. Drawing together these strands of inquiry, I contend that that the secular-religious dichotomy in contemporary ethics should be rejected, but by the same token, I suggest that comparative ethics remains a worthwhile enterprise.     

Ethical Academic Judgments and Behaviors: Applying a Multidimensional Ethics Scale to Measure the Ethical Academic Behavior of Graduate Students

Using Reidenbach and Robin's Multidimensional Ethics Scale, this study investigated the relationships between background variables and students' ethical evaluations, judgments, and behavioral intentions using 3 scenarios involving dilemmas related to academic dishonesty. The sample included 436 master's students and 142 doctoral students. The study found that the participants used a combination of ethical philosophies to make ethical decisions. The respondents judged improper citations more harshly than acts of inappropriate authorship or the falsification of data. The doctoral students generally considered behaviors related to plagiarism and falsification to be more unethical than the master's students did, though no gender differences were found.     

伦理即服务之可能性——以护理机器人的伦理设计为例

基于“平台即服务”框架的“伦理即服务”(ethics as a service, EaaS)概念旨在解决抽象道德准则与人工智能实践间的转化鸿沟。当前护理机器人的伦理设计存在伦理服务者定位模糊、伦理设计简单化、伦理设计智能化误区与伦理场景单一化困境等不足。将EaaS框架运用到当前护理机器人的伦理设计活动中,有助于构建多方协调的伦理服务体系,实现多抽象层次的伦理设计审查,构建模块化的伦理情境,开展自发性的伦理定制服务。服务化和过程化的EaaS伦理设计,有助于实现伦理原则与具体应用之间的协调与统一,但也会对服务过程中的责任划分与隐私保提出更高要求。

     

责任伦理视角下临床决策支持系统的伦理责任考量

从责任伦理的视角,提出临床决策支持系统（clinical decision support system,CDSS）在确保准确性、尊重自主性、保护隐私安全等责任中存在的合作意识缺失、职业责任薄弱、社会责任缺位等伦理责任问题,针对上述问题,通过以人为本、共存共生的责任伦理原则指出CDSS各方承担责任的主要路径,包括增强合作意识提高CDSS准确性、明确医生与开发者职业责任确保CDSS应用的自主性、加强企业社会责任保障隐私保护等,期望为责任相关者更好地承担伦理责任提供思路,为CDSS未来发展提供新的视角。

     

Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records

Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool (ECQAT). ECQAT enables raters to assess the quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation (ethics question, consultation-specific information, ethical analysis, and conclusions and/or recommendations), established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT, the resulting product, and recommended future testing and potential uses for the tool.     

Feminist Ethics and Religious Ethics

This focus issue is a conversation at and about the interface of feminist ethics and religious ethics, in order to show what these multifaceted fields of intellectual endeavor and practical import have to say to each other, to teach and to learn. The seven essays approach that dialogue from a variety of angles and traditions, reflecting the fecundity of both fields and the wide‐ranging concerns of colleagues in religious ethics who share commitments and methods with feminist ethics.     

《全球旅游伦理规范》的脆弱基础和错误主张

《全球旅游伦理规范》是世界旅游组织为促进负责任的和可持续的旅游发展,给21世纪的旅游者和旅游利益相关者制定的一个参考框架,但近年来的实践证明,《规范》没有得到应有的支持和响应,其中有多方面的原因。就《规范》本身而言,存在着两大问题:其一,旅游权利论不能为《规范》提供坚实的伦理基础;其二,支持市场经济的错误主张阻碍《规范》的执行。     

A Preface to Ethics:

This essay outlines a new preface for ethics demanded by the massive developments of the global age. It does so in and through the comparative use of “myths” to explicate the lived structure of experience. The essay begins by isolating main features of global dynamics, including proximity, the compression of the world and the expansion of consciousness, and also global, cultural reflexivity. In the second step of the “preface,” it is argued that globality itself is a moral space in which peoples must orient their lives. It is a moral space defined by the massive extension of human power in the modern world. In light of the challenge that global dynamics and the extension of human power now pose, the essay then isolates, methodologically, options for developing a global ethics, and advocates a distinctly hermeneutical approach. This approach is practiced in the last section of the “preface” by engaging ethically the biblical “myth” of creation and its reinterpretation in an epitome of Jesus's Torah teaching. The intention is to show how current religious thought can speak to massive challenges in a distinctive way. It is, again, to offer a preface to ethics.