ICU治疗实践的伦理问题辨析

从重症加强护理病房(intensive care unit, ICU)医生角度出发,通过工作中所接触的典型案例,提出患者入住ICU三个不同时间所产生的伦理问题,包括：患者入住ICU前,不同患者实际情况与ICU收治标准不符,作为ICU医生应在尊重患者自主意愿前提下,最大限度地完成治疗;患者于ICU治疗期间,ICU综合征及ICU后综合征产生原因及解决方案,家属代表患者做医疗决定时面临的两难抉择,ICU医生应该做好医患沟通工作,从多角度实施人文关怀;ICU治疗终末期患者生命尊严和短暂生存之间的选择,ICU医生应建议家属接受缓和医疗并介绍器官捐献参与过程中伦理原则。

     

Long-Term successful Marriages in Israel

Long-Term Marriages (LTM) in Israel is part of a larger on-going international research. Our study focuses on two related questions: Are all long term marriages successful and satisfying? Similar studies have been undertaken in the United States, Sweden, Germany, and Chile. This paper focuses on the Israeli results with a few cross-cultural comparisons. Israel adds several unique features to the research: the people to whom LTM applies have emigrated to Israel from 112 different countries, with different cultures and nationalities; how Holocaust survivors are distributed in comparison to the rest of the population; Israel has the lowest divorce rate in the west; family life being a highly valued norm among Jewish people, it will be interesting to determine what keeps couples together and whether the motives and ingredients for satisfying marriages are similar or different from other countries.     

持续性植物状态病人治疗的伦理学问题

近年来随着医学科学技术的迅猛发展 ,急救系统的完善 ,诊疗技术水平和重症监护技术水平的提高 ,危重病人死亡率明显降低 ,但同时也带来了一个新的医学和社会学问题 ,即大量的持续性植物状态( persistentvegetativestate ,PVS)病人的出现。这些病人虽然有醒觉周期但无认知功能 ,他们的生存给家庭和社会都带来了很大的负担。由于目前人们对这一疾病状态认识的不统一 ,对其治疗方案制定的差异性和对预后判断的不确定性 ,导致了对这种病人的医疗资源分配意见和是否放弃治疗的认识方面都存在很大差异。所以在对这些病人的治疗过程中伦理学的问…     

Ethical Issues and At-Risk Behaviors in Marriage and Family Therapy: A Qualitative Study of Awareness

This exploratory study investigated perceptions of and relationship with professional ethics of therapists-in-training. A focus group of marriage and family therapy doctoral students explored self-awareness and at-risk behaviors regarding ethical competence and compliance. A grounded theory analysis of data is presented as a conditional matrix, which offers a theory of development between therapists and their perception of ethics. The Practitioner-Relationship Ethics Model represents findings of interaction between confidence in ethical principles, field experience, use of justification, and at-risk behaviors. Implications and limitations of these findings are presented, as are suggestions for research.     

供精助孕技术的社会伦理问题

供精助孕技术作为人类辅助生殖技术之一,是实现不育症家庭生育后代的重要手段。通过对人类精子库的发展历程和相关政策的介绍,探讨全球不同社会环境下供精助孕技术所面临的对个人、家庭、社会等方面的伦理问题。讨论供精过程对捐精者的心理社会影响、供精助孕技术后代的知情权及其与供精者的关系界定、供精助孕后代近亲婚配及社会地位和心理状况、实施供精助孕技术对社会学父亲心理社会的影响等问题。如何充分发挥供精助孕技术在辅助生育上的优势并协调社会家庭结构将是未来辅助生殖技术政策调整的方向。

     

Ethical Issues in Gerocounseling

Recently, there has been a tremendous increase in the attention paid to counseling older adults and the importance of maintaining sound ethical practices in professional counseling. Unfortunately, to date there has been little movement to combine the two areas and examine the unique ethical issues faced in gerocounseling practice. To address this void, the authors enumerate some ethical dilemmas they have encountered in gerocounseling, examine the American Association for Counseling and Development (formerly American Personnel and Guidance Association) Ethical Standards (1981) that are pertinent, and suggest options for handling the conflicts raised.     

Legal and Ethical Issues in the Court-Mandated Treatment of Batterers

Summary

In the following article, we will explore the nature of the therapeutic relationship as it relates to batterers' treatment programs. We will consider the impact of obligations created by forces outside the relationship, such as those imposed by legal proceedings. We will discuss the concepts of confidentiality, privilege, and agency and their impact on the therapeutic relationship and the extent to which the therapists' understanding of the role these concepts play may be altered by court orders that impose treatment on a client/patient. Finally, we examine the issues and choices a therapist must make when engaging in court-ordered treatment of batterers, and the implications of those choices for both therapist and client; we will also suggest guidelines to help therapists sort through the often conflicting goals of therapy and the legal process.     

重离子放射治疗技术实践场域中的伦理问题及治理

重离子放射治疗技术既有因技术突破带来的无限发展的前景,也有因技术不确定性带来的风险和挑战。以重离子放射治疗技术为研究对象,从实践伦理的角度出发,分析重离子放射治疗技术在研发、投产、临床应用三个实践场域中的伦理问题,发现其在研发领域存在技术不确定性、投产领域存在社会价值和科学有效性争议、临床使用场域存在技术价值冲突等问题。在深入分析三个场域存在的风险和伦理问题的基础之上,提出了加强风险评估和伦理约束、增强公众对重离子放射治疗技术的认知和参与度、加强重离子放射治疗技术的全球治理的相关建议。

     

高新生命技术的伦理问题

高技术的推广应用引起人们对人体客体化的忧虑,以及对维护人的价值和尊严的关注。高新生命技术的伦理问题的特点是它对社会或人类的影响深远,以及在利用高新技术干预人体过程中涉及未知的、不确定的因素太多。因此必须开发新的战略调控这些高新技术的发展和应用。本文集中讨论异种移植和基因治疗中的伦理问题,认为对这些高新生命技术应该采取“有罪推定”的政策,在提供证据证明它不会给人类带来严重危害前,应该暂停在人体上试验     

Ethical Issues in Gestational Surrogacy

The introduction of contraceptive technologies hasresulted in the separation of sex and procreation. Theintroduction of new reproductive technologies (mainlyIVF and embryo transfer) has led not only to theseparation of procreation and sex, but also to there-definition of the terms mother and family.For the purpose of this essay, I will distinguishbetween:1. the genetic mother – the donor of the egg;2. the gestational mother – she who bears and gives birth to the baby;3. the social mother – the woman who raises the child.This essay will deal only with the form of gestationalsurrogacy in which the genetic parents intend to bethe social parents, and the surrogate mother has nogenetic relationship to the child she bears anddelivers. I will raise questions regarding medicalethical aspects of surrogacy and the obligation(s) ofthe physician(s) to the parties involved. I will arguethat the gestational surrogate is “a womb to rent,”that there is great similarity between gestationalcommercial surrogacy and organ transplant marketing.Furthermore, despite claims to freedom of choice andfree marketing, I will claim that gestationalsurrogacy is a form of prostitution and slavery,exploitation of the poor and needy by those who arebetter off. The right to be a parent, although notconstitutional, is intuitive and deeply rooted.However, the issue remains whether this rightoverrules all other rights, and at what price to theparties involved. I will finally raise the followingprovocative question to society: In the interim periodbetween today's limited technology and tomorrow'sextra-corporeal gestation technology (ectogenesis),should utilizing females in PVS (persistent vehetativestate) for gestational surrogacy be sociallyacceptable/permissible – provided they have leftpermission in writing?     

Ethical Issues in Intergenerational Equity

ABSTRACT

Family systems theory illumines the way in which family interactions influence the spirituality of each member of an aging family. Five spiritual tasks of the aging family are: facing mortality, defining the shape and limits of love and fidelity, struggling with the meaning of evil and suffering, seeking forgiveness and reconciliation, and giving and receiving a spiritual legacy. Professionals who work with families are encouraged to help families explore their spiritual concerns, work toward small and immediate changes with families as they address spiritual issues, listen for and affirm the family's spiritual resources, and support the enactment of family rituals and ceremonies.     

Ethical Issues in Counselling in Education

It is suggested that there are two quite distinct Systems of ethics and practice in use by counsellors in education: the integrated model, which emphasises viewing the counsellor-institution relationship as theprimary ethical perspective; and the differentiated model, which emphasises the counsellor-client relationship as the starting point for an ethical understanding of the counsellor's role. The implications of these two perspectives for ethical issues relating to sources of referrai, issues of confidentiality, accountability for resources, the implications of role diffusion, and the outcomes of counselling, are examined. The ethical consequences of viewing the two Systems as reconcilable or incompatible are explored.     

管理科学研究与实践中的问题

科技对社会的影响日益加强的同时,人们也逐渐意识到科学的发展不能脱离人们对价值和伦理的判断。本质上,管理科学或运筹学仍然是一种人文科学。事实上,许多管理科学家都提倡伦理主义,主张把社会的和伦理的关注纳入传统的“理性”技术和管理决策。通过联合两者进行分析,可以拉近管理科学或运筹学和商业伦理的关系。     

The Use of Communication Technology in Private Practice: Ethical Implications and Boundary Dilemmas in Therapy

This study investigates the use of communication technology (CT) by therapists in private practice. CT has exploded in the last decade and therapists have begun to implement this technology in their work. It is important to understand better the types of technology therapists are using and how they decide which devices are most useful for clinical practice. Additionally, the availability of the therapist has long been debated and CT provides media to make therapists readily available. Results show that therapists have boundary concerns and ethical dilemmas regarding CT and often feel unprepared to handle inappropriate out-of-session contacts when they occur.     

Ethical Issues in Observational Family Research

Ethical issues raised by the increasing reliance on observational technology in family research are discussed. The tensions between scientific advancement and participant welfare are highlighted by delineating the process of observational research and the nature of the relationship between family scientists and the families they study. Guidelines are proposed for ethical decision making regarding potential child abuse, suicidality, informed consent, confidentiality, and debriefing.