适宜技术选择中的利益冲突及其化解途径

适宜技术的选择要考虑简、便、廉、验,要从大多数患者的需求出发,要始终定位在医患等利益关系的结合点上,它是一种动态发展的技术或技术体系.然而,正是基于各种利益的结合点,在实际选择适宜技术中常常因为利益冲突的多主体性而变得复杂多样,并衍生出各种各样的利益冲突.分析利益冲突的产生根源对于寻求利益冲突的化解途径具有重要意义,同时也为各种途径提供了理论支持.     

工程中的利益冲突与道德选择

本文从工程活动复杂的利益关系出发 ,提出对工程活动进行道德审视的五个基本因素 ,希望工程技术人员和管理决策人员在各种利益冲突中作出正确的选择。     

利益与利益冲突

利益是以特别强烈和持久地满足一定需要为目的的;需要总要表现为主体对某种目标的渴求。人类最基础的需要无疑是生活资料的需要,但也不能由此忽视人的其他方面的需要,正是那些各种不同的持久的和不易满足的需要形成不同的利益。需要的多样性决定了利益的多样性。利益体系中各种利益主体相互交错、相互作用,构成各种利益矛盾和冲突。利益冲突可能是由于根本利益不一致、不相容造成的;也可能是根本利益是一致,但由于实现条件的制约,两种利益不能同时实现或不能充分实现造成的。一般地说,前者是对抗的,后者是非对抗的。利益冲突可分为利益主体的内部冲突和利益主体之间的冲突。利益冲突有两种表现:即敌对情绪和行为。利益主体所赖以存在的环境结构状况,     

临床研究者对临床研究利益冲突认知的探讨

通过对广州数家高校附属医院的临床研究者进行问卷调查,分析临床研究者对临床研究中利益冲突的认知情况。利益冲突的主要环节表现在不良事件的处置、研究对象隐私保护、研究对象的选择和分组等。原因主要有研究者的工作压力大、研究方案的不足、研究者注重自身工作便利、伦理审查不够严格等。并提出了重点防范有直接诊疗关系的研究者与研究对象的利益冲突;提高临床研究者对研究对象利益保护的意识;建立临床研究管理体系,对临床研究进行全面的审查、监督、管理;减轻研究者的研究压力,为研究者创造适宜的研究环境的针对性对策。     

商业银行信贷风险管理中的内部利益冲突与伦理治理

商业银行信贷风险管理中最大的难题是内部利益冲突导致的风险管理失灵甚至无效。信贷从业人员个人权力与组织利益的冲突、眼前利益与长远利益的冲突、等等银行内部利益的冲突时刻都在冲击着风险管理的闸门。这些利益冲突因为风险本身的特征而具有隐蔽性。要真正落实风险管理,就必须运用伦理治理手段平衡有关利益。     

生态环境危机中的利益问题思考

当前的生态环境危机 ,主要是由于人与人之间的利益冲突造成的。利益冲突是当代生态环境危机的实质 ,是人们的经济利益冲突在自然领域的反映。它表现了人们在生态环境方面的目前利益与长远利益、民族和国家利益与全人类利益、局部利益与整体利益、个人利益与社会利益的冲突。但是无论哪种利益 ,在这个问题上进行善恶评价的标准只有一个 ,这就是社会整体利益和全人类的共同利益     

泌尿外科微创技术与临床决策

微创技术在泌尿外科中的应用越来越广泛,对临床决策也产生了深远的影响。临床决策应以最佳证据作指导,充分评价不同方案的风险和利益,选择出最优方案应用于临床实践。微创技术的应用要以人为本,要贯穿诊断和治疗的全过程,要因地制宜,充分考虑应用的物质条件和基础。微创技术的应用也必须考虑经济因素,应选择适宜技术进行适度治疗。     

泌尿外科微创技术与临床决策

微创技术在泌尿外科中的应用越来越广泛,对临床决策也产生了深远的影响.临床决策应以最佳证据作指导,充分评价不同方案的风险和利益,选择出最优方案应用于临床实践.微创技术的应用要以人为本,要贯穿诊断和治疗的全过程,要因地制宜,充分考虑应用的物质条件和基础.微创技术的应用也必须考虑经济因素,应选择适宜技术进行适度治疗.     

医患利益冲突及其平衡

在现代语境下,利益冲突是对医患主体身份的认可与利益多元的表达,而成为考察医患关系的重要向度。制度性的经济利益冲突、个体性的合法权益冲突以及潜在性的价值冲突成为医患利益冲突的主要表现形式。医疗职业化催生了医务人员职业角色与私人角色的分化,价值判断的多元化成为利益冲突发生的道德根源,而医疗市场化改革成为利益冲突的制度性原因。重新审视医患关系本质成为利益平衡的关键,利益平衡强调医患双方利益的合理性,是对双方利益的公平表达,从而有利于医患利益冲突的解决。为此,医改设计中需要平衡医患双方的合法权利,平衡双方的经济利益表达,并注意保护医务人员的合法利益。     

浅析基因治疗临床试验中的"利益冲突"

基因治疗临床试验中的"利益冲突"问题多聚焦在如何规范利益冲突的不良后果上,却忽视了一些更基本的问题,如临床试验中的不同"利益",利益冲突的表现及防范等.以基因治疗为例,归纳了临床试验中的不同利益和利益冲突形式,并指出"公开经济利益安排"是解决冲突的基本对策.     

The troublesome semantics of conflict of interest

The sensible response to conflicts of interest is impaired by misconceptions and sloppy usage of terminology. Apparent and potential are widely misused modifiers for conflicts. Excessive legislative focus on financial interests limits understanding of the scope and significance of researchers' conflicts of interest. There is no moral or ethical failing in having a conflict of interest; the problem occurs when conflicts are not disclosed appropriately and when conflicts are allowed to bias research, teaching, or practice. Avoidance and prevention should be applied to bias, not conflicts.     

Intrinsic conflicts of interest in clinical research: a need for disclosure

Protection of human subjects from investigators' conflicts of interest is critical to the integrity of clinical investigation. Personal financial conflicts of interest are addressed by university policies, professional society guidelines, public standards, and government regulation, but "intrinsic conflict of interest"--conflicts of interest inherent in all clinical research--have received relatively less attention. Such conflicts arise in all clinical research endeavors as a result of the tension among professionals' responsibilities to their research and to their patients and both academic and financial incentives. These conflicts should be disclosed to research subjects and managed as assiduously as are financial conflicts of interest.     

The Troublesome Semantics of Conflict of Interest

The sensible response to conflicts of interest is impaired by misconceptions and sloppy usage of terminology. Apparent and potential are widely misused modifiers for conflicts. Excessive legislative focus on financial interests limits understanding of the scope and significance of researchers' conflicts of interest. There is no moral or ethical failing in having a conflict of interest; the problem occurs when conflicts are not disclosed appropriately and when conflicts are allowed to bias research, teaching, or practice. Avoidance and prevention should be applied to bias, not conflicts.     

The impact of conflict of interest on trust in science

Conflicts of interest have an erosive effect on trust in science, damaging first the attitude of the public toward scientists and their research, but also weakening the trusting interdependence of scientists. Disclosure is recognized as the key tool for management of conflicts, but rules with sanctions must be improved, new techniques for avoidance of financial conflicts by alternative funding of evaluative research must be sought, and there must be new thinking about institutional conflicts of interest. Our profession is education, and both the public and research professionals of all ages would benefit from greater understanding of how science should and does work. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

人际冲突中失望的个人效应及冲突类型的调节作用

通过两个计算机情景模拟实验, 分别采用“保证游戏”与“最后通牒博弈”范式, 考察了人际冲突中失望的个体对于威胁评价与冲突行为的影响。在此基础上进一步探讨了冲突类型对人际冲突中失望个人效应的调节作用。结果发现：(1)失望个体相比无情绪个体的威胁评价更高, 冲突行为更多。(2)冲突类型影响处于失望状态的个体的威胁评价, 即价值观冲突中失望个体的威胁评价要高于利益冲突中失望个体的威胁评价; 但是冲突类型并不影响失望个体的冲突行为。     

Authors and publication practices

Although authors are usually considered to be the main perpetrators of research and publication misconduct, any person involved in the process has the potential to offend. Editors may breach ethical standards particularly with respect to conflicts of interest. In the same way that authors are now required to declare competing interests, notably commercial affiliations, financial interests and personal connections, so must editors. Editors can influence the chances of acceptance or rejection of a paper by reviewer selection. Reviewers should also be ready to disclose conflicts of interest. They must ensure that their reviews are evidence based and free from destructive criticism driven by self interest. It seems likely that ultimately we will progressively move towards 'open' peer review in which both the authors and the reviewers are known to each other. There is an urgent need for increased transparency of the relationship between editors and owners. The events of the last few years indicate that unless this interface is fully understood by all parties, conflicts may arise. There is also a need for a radical overhaul in the relationship between journals, journal editors and the biomedical industry. It is now increasingly accepted that all clinical trials should be registered in a centrally held database and that protocols should include the primary and secondary outcome measures and the intended approach to data analysis thereby avoiding opportunistic post hoc analyses. However, the even more radical proposal that journals should cease to publish clinical trials sponsored by industry deserves wider debate.     

Conflict of interest from a Romanian geneticist’s perspective

This paper examines Romanian bioethics regulations for biomedical sciences, looking in particular at the genetics area as a source for conflict of interest. The analysis is focused on the organizational level, national regulations, the sources for generating conflicts of interest, and management of conflicts. Modern biotechnology and gene technology are among the key technologies of the twenty-first century. The application of gene technology for medical and pharmaceutical purposes is widely accepted by society, but the same cannot be said of the development and application of gene technology in agriculture and food processing. Because the use of a technology in the production and processing of food is regarded more sceptically than in the production of biomedical products, there can be areas of conflict in many cases when communication is undertaken about gene technology in the agro-food sector. Ethical concerns play an important factor in this, but a society’s attitude to a developing technology is an amalgam of many effects which are beyond ethics as such. This paper contains a study carried out by the author for the Romanian Association for Consumer Protection about the attitudes of consumers towards genetically modified (GM) foods. This study revealed that in Romania more than 98% of consumers did not know anything about GM foods and frequently were confused about the definitions of these terms. In conclusion, it is necessary to say that there is a low level of knowledge regarding biotechnology in Romania and this is an important reason why there is neither public acceptance of gene technology products nor is there a rejection. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. Ioana Ispas, MD in Molecular Biology, is a scientific researcher and Member of the Romanian Association for Consumer Protection, NCP for FP5-Quality of life and management of living resources.     

Psychopharmacology and the Power of Narrative

This report offers recommendations to physicians who provide information or services through online sites. The recommendations maintain that physicians responsible for health-related information should ensure that it is accurate, timely, reliable, and scientifically sound. Also, advice to online users with whom physicians do not have preexisting relationships or the use of decision-support programs that generate personalized information directly transmitted to users should be consistent with general and specialty-specific standards. In particular, these standards should address truthfulness, protection of privacy, informed consent, and disclosures including limitations inherent in the technology. Finally, physicians who establish or are involved in health-related online sites must minimize conflicts of interest and commercial biases and, if patient specific information is transmitted, they must provide high-level security protections, as well as privacy and confidentiality safeguards.     

Use of health-related online sites

This report offers recommendations to physicians who provide information or services through online sites. The recommendations maintain that physicians responsible for health-related information should ensure that it is accurate, timely, reliable, and scientifically sound. Also, advice to the online users with whom physicians do not have pre-existing relationships or the use of decision-support programs that generate personalized information directly transmitted to users should be consistent with general and specialty-specific standards. In particular, these standards address truthfulness, protection of privacy, informed consent, and disclosures including limitations inherent in the technology. Finally, physicians who establish or are involved in health-related online sites must minimize conflicts of interest and commercial biases and, if patient specific information is transmitted, they must provide high-level security protections, as well as privacy and confidentiality safeguards.