生命伦理之争的文化视角——以安乐死和人工流产为例

从文化的角度看,生命伦理之争是文化之争。也就是说,生命伦理之争的背后是不同文化传统之间、同一文化内部不同派别之间、对同一经典的不同诠释之间的争论。然而,东西方文化之间,以及同一文化内部各派别之间也并非完全不可通约,未来生命伦理学的发展必须保持其普世性和多元性之间的张力。     

Medical ethics in Norway: Modern medicine — Traditional morality

In Norway, by tradition a Lutheran country, the puritan ethics of a “moral minority” has a strong influence on the development and manifestations of medical ethics. Those who exert this influence are found primarily among politicians, the clergy, and, last but certainly not least, among nurses and doctors. The focus of interest is not so much on problems of bioethical moral theory or the teaching of bioethics to students, but very much on attitudes and policies with regard to substantive issues traditionally regarded in Norway as burning bioethical issues, such as: medical research ethics, abortion, prenatal diagnosis, euthanasia, definitions of death, and reproductive technologies.     

Maqasid al-Shariah as a Complementary Framework to Conventional Bioethics

With the rapid advancements made in biotechnology, bioethical discourse has become increasingly important. Bioethics is a multidisciplinary and interdisciplinary field that goes beyond the realm of natural sciences, and has involved fields in the domain of the social sciences. One of the important areas in bioethical discourse is religion. In a country like Malaysia, where Muslims make up the majority of the population, Islam plays a crucial role in providing the essential guidelines on the permissibility and acceptability of biotechnological applications in various fields such as medicine, agriculture, and food processing. This article looks at the framework of a complementary model of bioethics derived from the perspective of Islam. The framework is based on ‘maqasid al-shariah’ (purposes or objectives of Islamic law) which aims to protect and preserve mankind’s faith, life, intellect, progeny, and property. It is proposed that ‘maqasid al-shariah’ be used as a pragmatic checklist that can be utilized in tackling bioethical issues and dilemmas.     

What Really Happened: A Tribute to John C. Fletcher

John C. Fletcher, a pioneer in the field of bioethics and friend and mentor to many generations of bioethicists, died tragically on May 27th at the age of 72. The son of an Episcopal priest from Bryan, TX, Fletcher graduated in 1953 with a degree in English Literature from the University of the South in Sewanee, TN. After completing a Masters in Divinity degree from the Virginia Theological Seminary and a stint as a Fulbright scholar at the University of Heidelberg in 1956, he was ordained in the Episcopal Church and received a doctorate in Christian ethics from the Union Theological Seminary in New York. After ordination, Fletcher worked in various Episcopal churches and founded the Interfaith Metropolitan Theological Seminary in Washington, D.C. However, despite his religious faith, he was also a skeptic, and renounced his ordination in the mid-1990s due to his need for ‘intellectual honesty.’

Fletcher began his bioethics contributions in the early 1970's, when he became a founding Fellow of the Hastings Center and eventually the first Chief of the Bioethics Program at the Clinical Center of the National Institutes of Health. At the University of Virginia in Charlottesville, he was the Founding Director of the Center for Bioethics and a professor of biomedical ethics at the medical school, and became the Kornfeld Professor of Biomedical Ethics until his retirement in 1999. Fletcher was a prominent authority and voice in the national and international bioethical dialogue through his talks, his testimonies before scientific and congressional panels, his many articles, and his bioethical and religiously-orientated books, including: An Introduction to Clinical Ethics (1997), Coping with Genetic Disorders: a Guide for Clergy and Parents (1982), Ethics and Human Genetics: A Cross-Cultural Perspective (1989), which he wrote with sociologist Dorothy C. Wertz. Dr. Fletcher received the Lifetime Achievement Award from the American Society of Bioethics and Humanities in 2000. With the passing of Dr. John C. Fletcher, bioethics has lost one of its great voices, a dedicated teacher and mentor, and a friend and colleague to scholars in bioethics and a host of other fields. Below is a touching tribute from one of his former students.     

Confidentiality: a survey in a research hospital

Despite the many justifications for protecting patient confidentiality, we recognize that confidentiality cannot be absolute. Our world of automated information and easy access and storage poses many threats to confidentiality. This paper has described a survey conducted at the NIH Clinical Center to assess the knowledge, attitudes, and behaviors of clinical physicians and nurses about confidentiality of patient information. The survey findings demonstrate the need for reminders and increased awareness about confidentiality in our setting. Most of the survey respondents had a good knowledge of what was expected of them, and they believed that confidentiality was important and maintaining it was their responsibility. Of interest was that in several simulated clinical situations, there was a discrepancy between what respondents indicated they should do and what they thought they would do. The biggest discrepancies appeared in situations that involved overhearing a patient conversation on the elevator, approaching an unfamiliar person who is reading a medical record in the nurses' station, and answering a patient's inquiry about the status of another patient. The findings support the speculation that this difference may be attributed to discomfort or decreased awareness, and not necessarily to lack of knowledge. Results indicate that policies and administrative expectations should be frequently communicated and enforced, and that educational programs that address issues of confidentiality should be provided. The results of this survey have been influential in guiding educational strategies and administrative activities at the clinical center. The clinical center initiated a confidentiality awareness campaign, displaying a new poster every three months in strategic locations and distributing other tangible reminders (such as pens, magnets, and buttons) containing the same confidentiality message.(ABSTRACT TRUNCATED AT 250 WORDS)     

Shiite Perspective on the Moral Status of the Early Human Embryo: A Critical Review

According to Shiite perspective, the relative inviolability of the human embryo starts at the time of implantation and attains complete ethical status at ensoulment. Different paradigms of embryology have been influential on the understanding of Shiite jurists of the relevant Qur’anic verses. This paper provides a critical review of the process of issuing religious decrees on issues related to the early human life and concludes that Shiite jurisprudence needs to obtain consistency in its adopted account of embryology and adopt a proactive approach toward the bioethical new-emerging issues.     

Bioethical decisions: The political context and challenges

Rapid advances in biomedicine, accompanied by changing social values, are thrusting bioethical decision making into the political spectrum. This article examines the forces which are politicizing bioethical decisions and demonstrates the challenges they raise. It also presents an overview of the current political context and concludes that American political institutions and processes are not well-suited for dealing with these intense, sensitive bioethical issues. Although the article reflects skepticism concerning the ability of the political system to fulfill the expansive demands confronting it, it ends by suggesting several potential adaptations which should make the process more responsive and the institution's actions more effectual.     

Marking the anniversary: adolescents and the September 11 healing process

Clinical data are presented from a day spent at a New Jersey high school severely impacted by the World Trade Center disaster. Dissociation, a sense of numbness, anger, and guilt about feelings induced by the tragedy are all common dynamics in adolescents responding to trauma. The developmental issues that adolescents are confronting are described and discussed in terms of the challenges they present to the healing process. An argument is made that using groups to aid in the long recovery process with our young people should be a top public health priority.     

“Editing” Genes: A Case Study About How Language Matters in Bioethics

Metaphors used to describe new technologies mediate public understanding of the innovations. Analyzing the linguistic, rhetorical, and affective aspects of these metaphors opens the range of issues available for bioethical scrutiny and increases public accountability. This article shows how such a multidisciplinary approach can be useful by looking at a set of texts about one issue, the use of a newly developed technique for genetic modification, CRISPRcas9.     

Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts

It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is “accountability for reasonableness.” We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients’ rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks. The opinions expressed are the authors’ own. They do not reflect any position or policy of the National Institutes of Health, US Public Health Service, or Department of Health and Human Services. This research was supported by the Intramural Research Program of the NIH Clinical Center.     

Feminism, law, and bioethics

Feminist legal theory provides a healthy skepticism toward legal doctrine and insists that we reexamine even formally gender-neutral rules to uncover problematic assumptions behind them. The article first outlines feminist legal theory from the perspectives of liberal, cultural, and radical feminism. Examples of how each theory influences legal practice, case law, and legislation are highlighted. Each perspective is then applied to a contemporary bioethical issue, egg donation. Following a brief discussion of the common themes shared by feminist jurisprudence, the article incorporates a narrative reflecting on the integration of the common feminist themes in the context of the passage of the Maryland Health Care Decisions Act. The article concludes that gender does matter and that an understanding of feminist legal theory and practice will enrich the analysis of contemporary bioethical issues.     

Bioethics and the challenges of a society in transition: the birth and development of bioethics in post-totalitarian Slovakia

This paper provides an analysis of the first decade of bioethics development in Slovakia (1990-1999), together with an overview of the most important bioethical issues entering the scene of public debate and scholarly ethical analysis.     

Maqasid al-Shariah as a Complementary Framework for Conventional Bioethics: Application in Malaysian Assisted Reproductive Technology (ART) Fatwa

Rapid development in the area of assisted reproductive technology (ART), has benefited mankind by addressing reproductive problems. However, the emergence of new technologies and techniques raises various issues and discussions among physicians and the masses, especially on issues related to bioethics. Apart from solutions provided using conventional bioethics framework, solutions can also be derived via a complementary framework of bioethics based on the Higher Objectives of the Divine Law (Maqasid al-Shariah) in tackling these problems. This approach in the Islamic World has been applied and localised in the Malaysian context. Thus, this paper highlights a conceptual theoretical framework for solving current bioethical issues, with a special focus on ART in the Malaysian context, and compares this theory with conventional theories of bioethics.     

Empirical investigation of the ethical reasoning of physicians and molecular biologists – the importance of the four principles of biomedical ethics

Background  

This study presents an empirical investigation of the ethical reasoning and ethical issues at stake in the daily work of physicians and molecular biologists in Denmark. The aim of this study was to test empirically whether there is a difference in ethical considerations and principles between Danish physicians and Danish molecular biologists, and whether the bioethical principles of the American bioethicists Tom L. Beauchamp and James F. Childress are applicable to these groups.     

A Decade of Genetic Counseling in Frontotemporal Dementia Affected Families: Few Counseling Requests and much Familial Opposition to Testing

A decade of genetic counseling of frontotemporal dementia (FTD) affected families has generated two important observations. First, the uptake rate for presymptomatic testing for FTD is low in our department of Clinical Genetics at the Erasmus Medical Center in the Netherlands. Second, FTD at-risk counselees reported substantial familial opposition to genetic testing, which is distinct from the attitude in Huntington Disease affected families. We hypothesize that the low acceptance for FTD genetic counseling is consequential to the familial opposition and explain this within the theoretical framework of separation-individuation. Furthermore, we hypothesize that separation-individuation problems do not similarly influence the acceptance of HD genetic counseling, due to the educative role of the well-organised patient organization for HD in the Netherlands. We offer counseling recommendations that serve to facilitate the individuation of the counselee with respect to the FTD genetic test.     

AIDS Group Psychotherapy

Abstract

Clinical data are presented from a day spent at a New Jersey high school severely impacted by the World Trade Center disaster. Dissociation, a sense of numbness, anger, and guilt about feelings induced by the tragedy are all common dynamics in adolescents responding to trauma. The developmental issues that adolescents are confronting are described and discussed in terms of the challenges they present to the healing process. An argument is made that using groups to aid in the long recovery process with our young people should be a top public health priority.     

Reflections on public bioethics: a view from the trenches

For many reasons, and more than its predecessors, the President's Council on Bioethics has been the subject of much public attention and heated controversy. But little of that attention and controversy has been informed by knowledge of the Council's mission, its ways of working, and, most importantly, its actual work. This essay describes the Council's mission, discusses its public ways of working, and reviews the five major works produced during the Council's first term. In all its activities, the Council has sought to develop a richer bioethics, one that recognizes and tries to do justice to the deep issues of our humanity raised by the age of biotechnology. Believing that these issues are properly matters to be discussed and governed by the polity as a whole, the Council also has sought to contribute to a genuinely public or political bioethics, beyond the rule of "experts," scientific and bioethical.     

Cross‐Species Chimeras: Exploring a Possible Christian Perspective

Various entities that combine material from humans and other animals at either the cellular or subcellular level have attracted growing public interest. I explore the controversy by considering both the scientific rationale behind creating various entities that have prompted the greatest public concern and possible ethical implications. I note a number of potentially relevant biblical passages and reflect on the imago Dei and considerations of telos in order to prompt wider discussion regarding how Christians might respond to such emerging bioethical issues.     

Mediation in Health Care Settings: Some Theoretical and Practical Concepts

Selected topics are discussed that may be relevant to psychologists in medical mediation and bioethical consultations, such as family conflict and DNR (do not resuscitate) orders. The premise is that psychologists will be more involved in these disputes than ever before. This article includes some relevant theoretical issues and practical procedures for conducting mediation disputes in health care settings.     

Bioethical issues in biostatistical consulting: development of a survey

To develop a survey, the Bioethical Issues in Biostatistical Consulting Questionnaire, for investigating bioethical issues in analysis, a comprehensive literature review was conducted to specify areas of bioethics. Through a focus group study and the evaluation by 10 biostatisticians, the questionnaire was constructed. Validation must involve a panel of experts. Now, test-retest reliability and factor analysis should be conducted on a group of eligible subjects.