对药品临床试验的伦理性与科学性的思考

药物临床试验首先要符合伦理学原则,同时又必须具备科学性.伦理学原则要求受试者最大程度受益和尽可能避免伤害.随机、双盲对照的方法在保障科学性的同时,对伦理学提出了挑战.     

药物临床试验中科学原则、法规原则与伦理原则的权重与取舍

药物临床试验既要符合伦理学原则、法规原则,又要具备科学原则.伦理学原则要求受试者最大程度受益和尽可能避免伤害.在法规原则上也首先强调的是受试者的权益,然而试验设计的科学性原则有很多时候却对伦理学提出了挑战.当药物临床试验的科学性、法规性与伦理性发生矛盾时,我们应把伦理问题摆在首位.     

将病人利益置于首位的原则不能变——医学伦理学30年的回顾与思考之一

将病人利益置于首位的原则,是整个医学伦理学的根基.在当今更需要强调这个根基.要澄清将病人利益置于首位的各种误解,同时认清四原则之不足;只有将病人利益置于首位的原则与四原则结合起来,方能形成医学伦理学较为完整的观点.     

虚构的幸福与善好的功能 ——拉康对边沁功用主义伦理学的另类解读

从其精神分析伦理学的立场出发,拉康对边沁功用主义伦理学进行了一种全新的解读,拉康认为在伦理学的现代转向中,边沁具有里程碑意义的贡献并非"最大多数人的最大幸福原则",而是这一原则的语言学基础:"虚构理论"。按此理论的理解,幸福与善好是人类基于语言所进行的一种必要的虚构,它已完全丧失其在传统伦理学中的实在论基础。由此,边沁的功用主义既实现了同传统伦理学的形上学基础的决裂,同时又开创了从语言学维度对伦理学进行反思和建构的方向。     

对外科急腹症诊疗中伦理学矛盾的探讨

由于外科急腹症的特殊性,产生了与其他科室不同的伦理学矛盾。本文探讨了急腹症诊疗中存在的伦理学矛盾和相应对策。在急腹症诊疗过程中,要重视伦理学矛盾产生的原因,完善急腹症诊疗中存在的流程问题,自觉实践医学伦理学的知情同意原则,有助于化解医患矛盾,减少医疗纠纷;同时也要减轻医生工作压力,加强团队合作精神。     

论伦理学的性质——兼论理论伦理学与应用伦理学的关系

本文针对现行伦理学把伦理学理解为关于道德的学问的片面性和忽视应用伦理学研究的缺陷 ,正面阐述作者对伦理学的性质以及理论伦理学与应用伦理学的关系的看法。作者认为作为哲学分支之一的伦理学既是人生哲学 ,也是价值哲学 ,又是幸福哲学。伦理学的意义在于 ,它能促进个人反思和规划人生并为之指示路向和提供原则 ,从理论上为社会确立终极价值目标和构建价值体系 ,为各门自然科学、社会科学、人文科学提供理论观念、一般原则和活动规范。伦理学的研究方法是反思、批判、构建有机统一的思辨方法。作者主张把运用理论伦理学的观念和原则解决当代人类生活和实践中出现的实际问题的应用伦理学研究划分为领域伦理学研究、职业伦理学研究、人群伦理学研究 ,认为它们构成应用伦理学研究的三个基本领域。     

彼彻姆和查瑞斯的生命伦理原则主义进路评析

彼彻姆和查瑞斯的原则主义是现代生命伦理学领域最具影响力的伦理分析进路,它在得到广泛支持和认可的同时也遭到越来越多的批评.有关彼彻姆和查瑞斯原则主义的争论凸显出道德境遇在生命伦理分析中的重要性,同时也暴露出彼彻姆和查瑞斯原则主义认识论和方法论上的一些弱点.尽管如此,彼彻姆和查瑞斯原则主义基于自身的一些合理性与必要性仍有可能在未来的生命伦理学领域以不断改进了的形式发挥重要作用.     

精神科医师医疗干涉权的伦理限度

精神科医师特殊干涉权,因精神科领域医疗活动的行为、对象及医师权利具有特殊性,同时符合伦理学的不伤害原则和公正原则,这也是医师自主权的合理运用,因此具有合理性.但是在社会实践中,干涉权由于经常被扩张化而侵犯了患者的利益.由此提出干涉权必须坚持人道主义精神的、坚持医学伦理学的基本原则以及技术规范.     

伦理学在法医学实践中的举隅

本文在于探讨临床法医学、尸体检验以及法医科研中的道德问题,并试图寻求解决问题的途径;通过学习伦理学基本原则、实证分析等方法说明伦理学原则在法医学实践中的具体应用。结果发现尊重原则、知情同意原则以及隐私权、遗体权保护等问题在法医学实践中较为常见,将伦理学原则应用到法医学实践中可以减少群众投诉、信访、预防群体性事件、提高群众满意度等;最后提出转变工作思维方式及科技创新是解决法医学中伦理学问题的主要方法,法医需将以法律为准绳兼顾伦理学原则的思维方式作为工作指导。     

德性伦理学的特征与维度

在中西伦理思想史上,主导性的规范伦理学都是德性伦理学,即"人是什么"或人"应当成为什么"的问题处于规范伦理学的中心地位.同时,"是什么"包括了"做什么"的问题.对于行为,义务论强调了道德原则的重要性,功利论强调了后果的重要性,德性论则强调对人的判断的重要性.同时,德性伦理学的重点在于对德性的研究,德性指的是人的内在品性的规定性.     

Basing Science Ethics on Respect for Human Dignity

A “no ethics” principle has long been prevalent in science and has demotivated deliberation on scientific ethics. This paper argues the following: (1) An understanding of a scientific “ethos” based on actual “value preferences” and “value repugnances” prevalent in the scientific community permits and demands critical accounts of the “no ethics” principle in science. (2) The roots of this principle may be traced to a repugnance of human dignity, which was instilled at a historical breaking point in the interrelation between science and ethics. This breaking point involved granting science the exclusive mandate to pass judgment on the life worth living. (3) By contrast, respect for human dignity, in its Kantian definition as “the absolute inner worth of being human,” should be adopted as the basis to ground science ethics. (4) The pathway from this foundation to the articulation of an ethical duty specific to scientific practice, i.e., respect for objective truth, is charted by Karl Popper’s discussion of the ethical principles that form the basis of science. This also permits an integrated account of the “external” and “internal” ethical problems in science. (5) Principles of the respect for human dignity and the respect for objective truth are also safeguards of epistemic integrity. Plain defiance of human dignity by genetic determinism has compromised integrity of claims to knowledge in behavioral genetics and other behavioral sciences. Disregard of the ethical principles that form the basis of science threatens epistemic integrity.     

Ambiguity, trust, and the responsible conduct of research

Ambiguity associated with everyday practice of science has made it difficult to reach a consensus on how to define misconduct in science. This essay outlines some of the important ambiguities of practice such as distinguishing data from noise, deciding whether results falsify a hypothesis, and converting research into research publications. The problem of ambiguity is further compounded by the prior intellectual commitments inherent in choosing problems and in dealing with the skepticism of one's colleagues. In preparing a draft code of ethics for the American Society of Biochemistry and Molecular Biology (ASBMB), an attempt was made to take into account the ambiguities of practice. Also, the draft code adopted trust as its leading principle, specifically the importance of trust as a condition necessary for there to be science. During revision of the code, the focus on trust was changed. The new orientation was on trust as a consequence of carrying out science responsibly. By addressing the obligations necessary to engender trust, the ASBMB ethics code not only sets professional standards, but also makes a clear statement of public accountability.     

Contextualizing clinical research: the epistemological role of clinical equipoise

Since its introduction in 1987, Benjamin Freedman’s principle of clinical equipoise has enjoyed widespread uptake in bioethics discourse. Recent years, however, have witnessed a growing consensus that the principle is fundamentally flawed. One of the most vocal critics has undoubtedly been Franklin Miller. In a 2008 paper, Steven Joffe and Miller build on this critical work, offering a new conception of clinical research ethics based on science, taking what they call a “scientific orientation” toward the ethics of clinical research. Though there is much to recommend Joffe and Miller’s scientifically oriented conception of clinical research ethics, I believe that both the critical and constructive projects suffer from the same basic mistake: inattention to context. The internal norms of science cannot be fully specified, let alone satisfied, independently of contextual (external) factors that only come into view when we are attentive to the particular context of that form of inquiry.     

论现代医学视野中的伦理与现代伦理视野中的医学

医学与伦理的关系从古代、近代到现代,经过了一个浑然一体、相互分离和重新融合的否定之否定过程。通过对这一过程的简要考察和分析,着重阐述了现代医学视野中的伦理与现代伦理视野中的医学应当所具有的本质形相。在现代医学视野中,现代医学伦理是来自人类伦理遗产和对现实生命道德问题的伦理认识结果两方面的理论交汇。现代伦理应当是多层次的理论与实践系统,其中包括道德哲学层次的思考;生命伦理中的道德原则和规范的构建;关于生命道德规范长入现代医学的机制问题的思考;现代医学伦理的发展与相关学科的相互借鉴的研究。在现代伦理的视野中,现代医学的本质在于,现代“大医学”的概念已经取代了对医学的传统认识;医学作为现代社会文化构成部分的特质逐渐地被揭示出来;现代医学已经成为特定社会职业群体以科学技术为主体的重要社会活动。站在现代医学和现代伦理各自的立场认识和了解对方,对全面把握二者之间的关系和推进二者之间的有机结合具有重要意义。     

Evolutionary Ethics: Its Origin and Contemporary Face

The development of modern evolutionary ethics began shortly after the publication of Charles Darwin's On the Origin of Species by Natural Selection . Early discussions were plagued by several problems. First, evolutionary ethical explanations were dependent on group-selection accounts of social behavior (especially the explanation of altruism). Second, they seem to violate the philosophical principle that "ought" statements cannot be derived from "is" statements alone (values cannot be derivedfrom facts alone). Third, evolutionary ethics appeared to be biologically deterministic, deemed incompatible with the free will required for ethics to be possible. Fourth, social policies based on evolutionary theory (for example, eugenics in the early part of this century) seemed patently unethical. Sociobiology (which coalesced as a field of study with Edward O. Wilson's Sociobiology: The New Synthesis , 1975) addressed several of these problems and provided a rich framework and a new impetus for evolutionary ethics. The lingering problems were the philosophical is-ought barrier and biological determinism. After tracing the early and more recent development of evolutionary ethics, I argue that the remaining problems can be surmounted and an incipient evolutionary ethics can be defended. Thoroughgoing evolutionaryethics must await theoretical developments in neurobiology and cognitive science.     

Oral History and Ethical Practice: Towards Effective Policies and Procedures

This article examines how Canadian ethics policies affects historians who use oral history, and focuses on privacy and confidentiality, free and informed consent, and research involving Aboriginal peoples. The article concludes with recommendations for developing ethics policies that accord with historical methodology.     

“How dare you sport thus with life?”: Frankensteinian fictions as case studies in scientific ethics

Fictional scenarios involving "hard" science offer what are in effect case studies of scientific ethics. From his analysis of Shelley's novel, biologist Leonard Isaacs constructed a model of a "Frankenstein scenario," applicable to the dilemmas posed by the advancement of science in our time, as well as to fiction about science by such contemporary writers as Robin Cook and Michael Crichton. The special contribution of fiction to the study of ethics is that it both reflects and evaluates reality's infinite permutations. In reflecting and judging, the fictional scenarios engage our moral imagination and compel us to confront our personal ethos in relation to the evolving ethos of science.