公共卫生监测中的伦理原则及标准

从理论上概述了各时期监测定义的演变以及相关伦理辩论,列举了公共卫生监测所引发的普遍的伦理问题及适用的主要伦理原则,揭示了临床医学和公共卫生中伦理问题的不同。人权是个人利益和集体利益的共同基础,因此,也可能是临床伦理和公共卫生伦理的共同基础。最后,依据《世界卫生组织关于公共卫生监测中伦理问题的指南》及其他文献列出多种公共卫生伦理标准,试图在实际工作中帮助评估公共卫生监测方案在伦理上的可接受性。     

农民需要更多的伦理关怀--农村医疗保障体系构建的伦理思考

我国农村医疗保障的困境有深刻的伦理原因,忽视农村医疗保障的伦理特质,公共医疗资源投入的不公平,农村医疗卫生主体职业伦理的缺失,以及农民互助意识的不足,是造成目前农民求医看病难,农村医疗保障体系构建举步维艰的伦理根源。要从根本上走出农村医疗保障的困境,解决农民求医看病的难题,需要确立农村医疗保障体系的公共产品性质和医疗资源分配的公平原则,倡导整个社会给予农民更多的伦理关怀,弘扬医者救死扶伤的伦理精神,提升农民的公共意识和伦理素质。     

我国公共卫生中的伦理学问题

在公共卫生研究中重点探讨了伦理审查、研究对象选择、知情同意、保护研究对象隐私、对研究对象的适当补偿等方面的伦理学问题;在公共卫生实践中重点探讨了传染病防治、疾病监测、计划免疫、疾病筛查及卫生资源配置领域中的伦理学问题。重视这些问题并参照一定的伦理学原则将有助于解决问题,更好地促进公共卫生事业的发展,促进人群健康。     

我国公共卫生中的伦理学问题

在公共卫生研究中重点探讨了伦理审查、研究对象选择、知情同意、保护研究对象隐私、对研究对象的适当补偿等方面的伦理学问题;在公共卫生实践中重点探讨了传染病防治、疾病监测、计划免疫、疾病筛查及卫生资源配置领域中的伦理学问题.重视这些问题并参照一定的伦理学原则将有助于解决问题,更好地促进公共卫生事业的发展,促进人群健康.     

论公共卫生决策的伦理模式

公共卫生决策的伦理问题是公共卫生伦理研究的一个核心问题。近年来我国公共卫生领域出现了大量严重的伦理问题,其主要根源在于公共卫生决策的伦理缺失。强调指出公共卫生伦理决策应当树立科学健康观,并以此为基础,从转变政府职能、强化公共卫生信息系统和加大政府投入等方面详细论述了公共卫生伦理决策的一种新模式。     

论公共卫生决策的伦理模式

公共卫生决策的伦理问题是公共卫生伦理研究的一个核心问题.近年来我国公共卫生领域出现了大量严重的伦理问题,其主要根源在于公共卫生决策的伦理缺失.强调指出公共卫生伦理决策应当树立科学健康观,并以此为基础,从转变政府职能、强化公共卫生信息系统和加大政府投入等方面详细论述了公共卫生伦理决策的一种新模式.     

公共卫生监测中的伦理问题及其借鉴意义

公共卫生监测作为公共卫生实践的重要组成部分,在具体实施过程中存在着一系列伦理问题,通过介绍有关监测的各类伦理问题,包括个人利益(和权利)与集体利益之间可能的冲突,知情同意的问题,网络数据的收集和保存中的伦理问题,死者数据利用问题等,揭示了公共卫生监测伦理学与临床伦理学的差异,以帮助评估公共卫生监测的伦理可接受性。随着监测项目日益增多且伦理要求越来越高,世界卫生组织公布了《世界卫生组织公共卫生监测的伦理指南》,希望通过总结和梳理这些问题为相关的伦理培训提供信息,为伦理委员会提供参考,并提高从业人员的认识。     

伦理治理:医疗卫生机构的角色和责任

在推进"健康中国"战略的大环境下,医疗卫生机构承担着服务全民健康的重大职责。然而,当前医疗卫生实践面临着诸多伦理问题,其中一个关键原因在于医疗卫生机构尚缺乏相应的伦理规约。从"机构伦理"的视角出发,探讨医疗卫生机构的伦理治理。在从理论角度梳理医疗卫生机构面临的伦理问题和挑战的基础上,探讨医疗卫生机构同时作为"治理主体"和"治理对象"应当承担的道德责任,以期为探讨医疗卫生机构伦理提供一个可能的视角。     

加拿大安大略公共卫生伦理框架及相关启示

2012年,加拿大安大略公共卫生机构发表《公共卫生项目伦理实施框架》工作报告,尝试建构一个综合性的公共卫生项目伦理监管框架。报告主张在公共卫生领域打破"研究"与"实践"的传统二分,这一理念的提出,一方面是想满足公共卫生领域不断发展的伦理监管需求;同时,也是对传统的研究伦理监管模式的改进。在介绍安大略公共卫生伦理框架的基础上进行反思,分析打破研究与实践二分的重要性,强调关注公共卫生项目在数据收集、保存、使用等方面所涉及的伦理问题的共性特征,拓展既有受试者保护概念,实现公共卫生项目全过程的人的保护的理念转变。     

人群流行病学研究的伦理审查

以人群流行病研究为代表的公共卫生研究,因其与生物医学研究在研究目的、可能的收益和风险、实施的方式和力度等方面的不同,要求对此类研究的伦理审查也需要随之调整。从知情同意、风险获益评估、隐私和保密、弱势群体/族群保护和公平选择受试者等方面的伦理考虑入手,结合北京大学生物医学伦理委员会的工作经验及思考,尝试提出人群流行病学研究伦理审查的要点。最后结合北京大学生物医学伦理委员会审查的案例,提出对新型研究的伦理考量和思考,并提出伦理委员会和研究者之间的良好沟通是非常必要的。     

Health care, equality, and inequality: Christian perspectives and moral disagreements.

Equality is a concept that is often used in health care discussions about the allocation of resources and the design of health care systems. In secular discussions and debates the concept of equality is highly controverted and can take on many different specifications. One might think that Christians hold a common understanding of equality. A more careful study, though, makes it clear that equality is just as controversial among different Christian communities as it is in the secular world.     

Fair equality of opportunity and decent minimums: a reply to Buchanan

Responding to criticism by Allen Buchanan in a Winter 1984 Philosophy and Public Affairs article on "The right to a decent minimum of health care," Daniels defends his thesis that if justice requires protecting equality of opportunity, then health care institutions should be governed by the principle of fair equality of opportunity because impairments of normal functioning, seen as impediments to opportunity, are obviated by good health care. He defines his concept of normal opportunity range, which is relative to certain social considerations, and shows that health care services affect the distribution of opportunity, but not the normal opportunity range, among individuals. He agrees with the criticism that his argument does not guarantee minimum health care or solve problems of resource allocation.     

卫生服务公平性:理念、制度和实践——读《关于深化医药卫生体制改革的意见(征求意见稿)》有感

长期以来,我国的卫生服务一直存在着不公平的状况,看病难、看病贵等问题在农村表现十分突出,一直是社会关注的焦点。对卫生服务不公平问题的讨论也已经持续很久,正因为如此,人们对新一轮的卫生体制改革寄予厚望。人们深知,实现卫生服务公平性需要从理念转变到人、财、物的支持,从构建相应的制度、机制、法规到付诸实践等多方面着手,只有这样才能实现人人享有卫生保健的目标。     

The right to a decent minimum of health care

Buchanan examines, and finds inadequate, several philosophical approaches to justifying and specifying the content of a universal right to a decent minimum of health care: utilitarian arguments, Rawlsian ideal contract arguments, and Norman Daniels' equality of opportunity argument. Also rejecting the libertarian hypothesis that there is no right to a decent minimum of care, he contends that the claim that society should guarantee certain health care services can be supported by a pluralistic approach encompassing special right-claims, harm prevention, prudential arguments emphasizing public health benefits, and beneficence.     

The National Commission on AIDS

A decade after the first cases were recognized in the United States, AIDS continues to vex policymakers and fascinate the public. It has been said that AIDS acts as a prism, refracting a spectrum of controversial topics. For bioethicists, these topics include: equity in the allocation of resources for treatment and research; forgoing life-sustaining care and proxy decision making; informed consent in the context of HIV testing and screening; the ethical duties of health care workers to provide care for persons with HIV disease; and competing obligations of health care professionals to patients and to third parties who may be put at risk.     

The Legal and Ethical Fiction of “Pure” Confidentiality

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem of weight. The genetic difference principle is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies–that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice.     

The genetic difference principle

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem of weight. The genetic difference principle is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies--that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice.     

COVID in NYC: What We Could Do Better

Abstract

New York City hospitals expanded resources to an unprecedented extent in response to the COVID pandemic. Thousands of beds, ICU beds, staff members, and ventilators were rapidly incorporated into hospital systems. Nonetheless, this historic public health disaster still created scarcities and the need for formal crisis standards of care. These were not available to NY clinicians because of the state’s failure to implement, with or without revision, long-standing guidance documents intended for just such a pandemic. The authors argue that public health plans for disasters should be well-funded and based on available research and expertise. Communities should insist that political representatives demonstrate responsible leadership by implementing and updating as needed, crisis standards of care. Finally, surge requirements should address the needs of both those expected to survive and those who will not, by expanding palliative care and other resources for the dying.     

Professional Autonomy in the Health Care System

Professional autonomy interferes at a structural level with the variousaspects of the health care system. The health care systems that can bedistinguished all feature a specific design of professional autonomy,but experience their own governance problems. Empirical health caresystems in the West are a nationally coloured blend of ideal type healthcare systems. From a normative perspective, the optimal health caresystem should consist of elements of all the ideal types. A workableoptimum taking national values into account could be attained bygovernance structures that also introduce elements from other ideal typesystems. Thus a normative approach to medical practice guaranteeing anessential degree of professional autonomy for a relationship of trustbetween the patient and the physician, could be combined with anefficient and equitable allocation of health care resources.     

论我国艾滋病防治工作中的政府职能

艾滋病是世界性的重大公共卫生问题和社会问题。近年来,我国艾滋病的流行呈现快速上升趋势,流行范围广,局部地区疫情相当严重,疫情正在从高危人群向一般人群传播。政府的组织领导是做好我国艾滋病防治工作的根本保证,各级政府要强化政府的公共卫生职责,发挥政府的主导作用,动员足够的防治资源和力量,引导社会各方面力量的广泛参与,打一场防治艾滋病的“人民战争”,我们一定能够控制艾滋病的流行。