葡萄入药史考述——以中医药典籍为中心

葡萄是通过丝绸之路传入中原的物质文明,葡萄一入中原,即被广泛使用,可食用、可酿酒、可入药。中文文献记载的葡萄入药最早见于《神农本草经》,此后历代医家不断积累和完善葡萄入药经验,葡萄果、葡萄根、葡萄籽、葡萄叶等均可入药。学界研究葡萄的成果丰富,但研究葡萄入药的成果却甚少。通过详细梳理中医药典籍中的葡萄相关文献,探讨葡萄在中医药典籍中的演变历程,总结历代医家使用葡萄的经验和规律,在此基础上研究葡萄在中医药发展史上的意义和药用价值,并为现代医药学家使用和发掘葡萄丰富的药用价值提供借鉴。

     

医疗机器人的伦理风险与治理探析——基于“医−患−机”分析框架

基于“医−患−机”分析框架,医疗机器人的不断发展面临主体资质复杂、责任认定困难等责任伦理风险,医患关系重构、医患信任危机等医患伦理风险,数据质量与数据隐私等数据伦理风险,算法安全与算法偏见等算法伦理风险以及医疗资源分配正义风险。医疗机器人的伦理治理要以医学伦理和机器人伦理准则为依据,建立多元伦理治理体制,推动学术共同体的构建,探索自愿型、调节型与管制型等伦理治理工具的组合运用,加快医疗机器人伦理治理的法治化发展。

     

基于叙事医学的人文医学实践教学体系建构——以《温暖的医学》课程为例

叙事医学强调叙事能力的养成从而为医学人文的落地和人文医学的实践提供路径。《温暖的医学》基于叙事医学理论,设计了覆盖“生•老•病•死”全生命周期的两层进阶式实践教学体系,将叙事医学能力培养和临床实践有机结合,在实际医疗场景中锻炼医学生运用叙事医学理念和工具,围绕“生物−心理−社会”三个层面开展观察和反思,并做出回应和行动。实践教学提升了医学生对医学本质的理解,促进了医疗关系中主体间性的建立及全人医学诊疗思维的形成。该课程的设计和建构在医学人文课程教学的系统化、规范化、标准化方面也开展了有益的探索。

     

预防还是增强？——人类增强与预防医学之辨析

基因编辑婴儿事件暗示了预防医学和人类增强之间存在某些联系。预防医学以相对明确的潜在疾病为对象,通过增强人体抵抗疾病的能力从而减少或避免由疾病产生的既得利益损失。人类增强以人类的某种特性为对象,通过增强这些特性或保持这些特性的最佳状态,从而获得额外收益或避免既得利益的损失。在“对象−方法−目的”模型下,预防医学和人类增强表现得极为相似,并且在诉求、技术、概念和形而上学方面的相互交错也进一步模糊了两者之间的界线。然而,人类增强完全市场化分配制度及其对公平的固有破坏性是它与预防医学之间的一个根本区别。

     

医患关系中个人自主的局限与突围——关怀伦理对医疗决策的启示

知情同意和医疗家长主义的改良方式都将自主性理解为一种个人自主,通过对知情同意和改良后的医疗家长主义中个人自主因素的批判性反思,可以发现它们在个人自主的影响下仍然难以解决医疗程序的形式化、医患关系的沉默问题。借助关怀伦理的视角和对关怀关系的分析,表明自主性可以在人与人之间的关怀和支持中实现,并鼓励医生、患者家属对医疗决策的积极参与,促进医患关系的良好发展。因此,关怀伦理对关系的强调将有助于打破个人自主的局限性,并为医疗决策方式带来一种关系转向,也为其提供了一个新的理论基础。

     

麻醉科医患沟通现状及认知分析一一我国45家医院联合调查报告——

2017年8月1日~9月30日,在全国45家医院进行了电子问卷调查,旨在从医方角度调研麻醉科医患关系的现状。结果显示在导致医患沟通不畅的原因中除客观因素(病情复杂及疗效不确定)之外,麻醉科医务人员对患者防备心理过重位列首位(37.8%),其次为沟通时间不够(33.4%)、沟通意识缺乏(29.2%)以及沟通能力不足(28.3%),由此可见如今麻醉科医患沟通问题比较突出。建议麻醉科医生通过转变医疗观念,强化沟通意识;掌握语言工具,提高沟通技能;积极向患者科普麻醉学科的进展和局限等综合措施,逐渐改善麻醉科医患沟通现状。

     

社区护理病房中长期慢性病患者的照料服务机制——基于质性研究的方法

现有社区护理病房照料服务存在不能充分满足患者的深层需求、生活质量不佳的问题。访谈材料显示出由于照料者缺乏对“善终”概念的认知,患者、家属以及医护人员的三方关系中,患者处于权力的弱势地位,主体之间在讨论死亡相关问题上存在严重的脱节。患者的意愿从表达、传递、实施等环节中都存在阻碍,患者“善终”的需求无法实现。“以患者为中心”的照料理念应在现有照料服务中加以推广,通过提升社区照料质量来满足医学关系、家庭关系和患者自身利益的既定政策目标。

     

医患关系何解？——医者患病经历文献述评

综述医者患病经历相关文献发现,医、患分野和矛盾植根于医学和医学模式本身,是在现代医学发展过程中被建构出来的,解决医患关系问题应着眼于审视和改变医学文化和医学模式内部造成医患矛盾、分歧的根本原因,创造机会打破严格的医、患角色区隔,实现病人得治、医者得安、医患共同。在医者患病经历文献中,能追溯医患同源的起点,能洞悉医患分化和冲突所在,也能看到形成医患共同体的可能性,为实现和谐医患关系指明方向。

     

机构伦理视域下安徽省某三级医院不良事件管理策略研究

医疗质量安全一直是国内外共同关注的话题,其中不良事件的管理是医院质量安全的核心议程,而现有的归因和治理模式对不良事件的分析不充分,是对不良事件的“误诊”。通过收集汇总医院不良事件电子上报系统中2 588例事件,从事件发生类型、严重程度、发生人员和变动情况进行系统分析,基于机构伦理逻辑分析医疗机构伦理准则、伦理氛围、伦理激励,尝试从系统层面构建机构伦理视域下不良事件管理策略模型,为医疗质量改进和安全管理提供参考。

     

National Human Research Ethics: A Preliminary Comparative Case Study of Germany,Great Britain,Romania, and Sweden

Although international research is increasing in volume and importance, there remains a dearth of knowledge on similarities and differences in “national human research ethics” (NHREs), that is, national ethical guidelines (NEGs), Institutional Review Boards (IRBs), and research stakeholder’ ethical attitudes and behaviors (EABs). We begin to address this situation by reporting upon our experiences in conducting a multinational study into the mental health of children who had a parent/carer in prison. The study was conducted in 4 countries: Germany, Great Britain, Romania, and Sweden. Data on NHREs were gathered via a questionnaire survey, two ethics-related seminars, and ongoing contact between members of the research consortium. There was correspondence but even more so divergence between countries in the availability of NEGs and IRBs and in researcher’ EABs. Differences in NHREs have implications particularly in terms of harmonization but also for ethical philosophy and practice and for research integrity.     

某三甲医院五年科研项目伦理审查情况分析

通过对国内某三甲医院五年科研伦理审查情况进行分析,探讨科研项目伦理审查工作的重点、难点及对策。汇总2013年~2017年经医学伦理委员会会议审查的科研项目,分析研究者的学历、职称、学科与通过率关系。近5年医学伦理委员会共审查科研项目285项,通过238项,未通过47项,其中内科通过率高于外科(P<0.05),副高以上职称通过率高于中级(P<0.05),研究生以上学历通过率高于本科及以下学历(P<0.05)。只有强化伦理意识,规范审查形式,健全监管机制,才能保证科研伦理工作健康规范发展。     

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。

     

Professional Boundary Ethics Attitudes and Awareness Among Nurses and Physicians in a University Hospital in the Kingdom of Saudi Arabia

This study sought to gauge ethical attitudes about professional boundary issues of physicians and nurses in the Kingdom of Saudi Arabia. Respondents scored 10 relevant boundary vignettes as to their ethical acceptability. The group as a whole proved “aware/ ethically conservative,” but with the physicians' score falling on the “less ethically conservative” part of the spectrum compared to nurses. The degree of ethicality was more related to profession than to gender, with nurses being more “ethical” than physicians.     

案例研究与决疑法：当代医学伦理学的经验主义方法论反思

当代医学伦理学至今没有形成较为成熟稳定的研究方法,方法论的“革命”往往意味着科学的革命、学科范式的转型和知识谱系的变革。案例研究与决疑法是医学伦理学常见的两种经验主义方法。这两种方法的广泛运用,是当代医学伦理学对于规范伦理学中“原则主义”的一种实践“反叛”与深度批评。对这两种方法的基本逻辑、实践特征、优点和弊端进行详细分析,深入探讨医学伦理学的学科方法论,通过对方法学的反思,表明当代医学伦理学的方法论在原则与例外、普遍与特殊之间“徘徊”不定,进一步推进对医学伦理学学科建设的理解与反思。

     

Validity and Reliability of a Turkish Version of the Modified Moral Sensitivity Questionnaire for Student Nurses

This study examined the validity and reliability of a Turkish version of the Modified Moral Sensitivity Questionnaire for Student Nurses (MMSQSN). After obtaining permission to adapt the MMSQSN into Turkish, the translation/back-translation method was used with expert opinions to determine content validity. Factor analysis was conducted to examine the construct validity and test–retest was performed on the questionnaire to determine reliability. Cronbach’s alpha coefficients were calculated to assess for internal consistency. Participants included 272 baccalaureate degree student nurses who took ethics lessons prior to their clinical internship. The factor analysis revealed that even though the factor structure in the original scale was the same, relevant items were categorized with similar components, and factor loads were sufficient. The correlation coefficient in the analyses of test–retest scores was .66 for the total scale (p < .05) and the Cronbach’s alpha was .73 for the total scale. The translated MMSQSN is a valid and reliable measure of ethical sensitivity in student nurses in Turkey.     

Nursing Practices in Catholic Healthcare: A Case Study of Nurses in a Catholic Private Hospital

We aimed to investigate Catholic Identity and Mission communication specifically how nurses were expressing the Catholic healthcare values in practice. A mixed-methods, case study design was used and included non-participant observation, a mid-level manager focus group (n = 7) and online surveys (n = 144). Document and observational data analysis revealed the organisation’s commitment to visible indication of Catholic values adherence. Focus group analysis revealed two themes, ‘Catholic values in action’ and ‘taking the extra step’. The impact of Catholic Identity and Mission on nurses and nursing care recipients remains elusive and warrants further understanding.     

The Ethics of Enhanced Interrogations and Torture: A Reappraisal of the Argument

This article critically reviews what is known about the ethical status of psychologists’ putative involvement with enhanced interrogations and torture (EITs). We examine three major normative ethical accounts (utilitarian, deontic, and virtue ethics) of EITs and conclude, contra the American Psychological Association, that reasonable arguments can be made that in certain cases the use of EITs is ethical and even, in certain circumstances, morally obligatory. We suggest that this moral question is complex as it has competing moral values involved, that is, the humane treatment of detainee competes with the ethical value/duty/virtue of protecting innocent third parties. We also suggest that there is an ethical duty to minimize harm by making only judicious and morally responsible allegations against the psychologists alleged to be involved in EITs. Finally, we make recommendations regarding completing the historical record, improvements in the professional ethics code, and the moral treatment of individuals accused in this controversy.