论患者就医的责任伦理

仅强调医务人员的职业操守而忽视患者的责任伦理,难以构建和谐的医患关系。患者责任伦理是患者在就医及相关活动中要遵循的为自己行为后果承担责任的伦理规范,包括以敬为先的人际责任伦理,即尊重和信任医务人员,客观公正地对待疾病治疗效果;遵纪守法的秩序责任伦理,即遵守法律和管理制度,正确对待争议和分歧;我命在我的自为责任伦理,即珍爱生命,在疾病治疗和养生保健中发挥主观能动性。吸收传统文化中的思想精华,加强患者责任伦理教育,有利于促进医患关系和谐。     

法制环境下的现代医学--一个必须面对的新问题

法制社会强调医疗行为的合法性.强调现代医学的法制环境主要目的是规范医疗行为,合法行医,和谐医患关系和防止医学科学技术的异化造成伦理和社会危机.法制医学对医务人员的责任要求包括:强制责任(救治责任)、民事责任、刑事责任、诉讼的举证责任和医疗免责条件.     

诺丁斯关怀伦理对我国医患关系构建的启示

诺丁斯关怀伦理是论述人与人之间的责任、情感、关系以及相互关怀的伦理理论。通过论述诺丁斯关怀伦理基本特点与医患关系的关系,说明诺丁斯关怀伦理在医患关系中有较强的适用性。为缓解我国医患关系日益紧张的形势,医患之间需要更多彼此间的关怀。从关怀视角提出了促进医患关系和谐发展的途径,即培养道德情感,构建有利于医患关系发展的关怀环境;突出人本性,强化以患者为中心的服务理念;强调关怀的关系性,重视医患之间的尊重、信任与理解。     

医务人员在医疗活动中的利益边界与道德责任分析

当今是一个以利益为轴心的时代,利益伦理是医学伦理学不可忽视的课题。欲望是无穷的,利益是有限的,任何利益都有其边界和限度,我们必须设置利益的道德界限。医患双方未能遵守利益限度和利益边界原则,使矛盾转化为冲突。利益冲突不仅影响医生的专业判断,而且影响了其医疗决定。医生既是医疗职业者,也是社会的一员,社会公众利益最大化是医疗服务的基本目标,为病人最大利益着想是医护专业最根本的道德规范与责任。     

不对称伦理：境遇危机下医患诚信的一种解读

医患诚信是一种不对称伦理形态,主体责任和缺失补偿不对等构成其伦理特质,崇敬生命承载其价值本质,原则倒置表征其正义诉求.我国医患诚信深陷境遇危机,人们对医患诚信的读误致使医患冲突进一步加剧.从伦理视域直面医患矛盾,重新解读深陷境遇危机的医患诚信,对于重建医患诚信具有重要的理论和现实意义.     

中国当前的医疗危机与医护人员的专业责任和使命

分析了导致当前国内医患关系恶化的种种宏观与微观的因素,认为其中最重要的原因是医患关系中出现不应存在的利益冲突,最终导致医患关系出现一种诚信危机.以此为讨论起点,分析了西方国家的信托模式的七种特征,论证医患关系的本质为何是一种信托关系,并指出忠诚与守信是信托关系和医疗专业精神的核心价值.在结论中特别指出,这种认知明确了医疗专业在当前的医患危机中应该扮演的角色和担当的责任.     

社会转型期医患关系的异化及其重构

因诸多原因相互作用,致使今天的医患关系出现不和谐状态,其中医患关系本质由伦理关系异化为经济关系和抽象的法律关系.重建医患关系除了发展医学科学、提高医疗水平外,还要强化政府职责,完善医惠关系的制度设计;加强医院管理,健全医患关系的规章制度;加强医师的主体自觉,明确医患关系的伦理诉求.     

不同类型医患关系下的风险损失责任承担探讨

介绍了伦理-行为规范在协调信息不对称及不确定损失结果事务中的一般原理,阐述了风险损失与医患关系的伦理-行为规范及其相应的三种类型的医患关系,从医患交往双方风险损失责任承担的视角,探讨了传统熟人社会中的"民间自愿"规范、全社会科层体系化的单位归属等级规范以及匿名交易市场条件下的"知情同意"规范。基于中国传统文化和转型经济现状,分析了当下多元伦理-行为规范下,医患矛盾的根源——医患之间相互交往中各自所持的伦理-行为规范的不一致。     

医患双方对医患关系认知情况的调查分析

为了解医患双方对医患关系的认知情况,对江西吉安市五家医院的医生和住院患者采取整群随机抽样法进行随机问卷调查.发现医患双方对医患关系性质、发展趋势及医患冲突的主要诱因、责任主体、主要解决途径的认识状况均存在显著性差异.这种差异直接影响医患关系发展.如何解决医患双方认知的差异是重构和谐医患关系的根本措施.     

论医患之间建立诚信关系的社会意义

医患诚信是病人权利让渡契约的伦理基础;是社会伦理公平正义的基本表现;是医患经济利益调整的必然要求,也是医学人文精神回归的体现;医患诚信是医学职业道德的重要使命.在医患之间建立诚信关系具有十分重大的社会意义.     

医疗活动中的利他主义与医务人员的价值取向

医学的目的是增进人的健康,当今医疗技术主义和医疗市场在诱惑医学超越固有疆界。医疗行业必须坚持正确的价值取向,社会公众利益最大化是医疗卫生服务的基本目标。市场经济条件下的医疗卫生服务具有无私利他的道德责任和追求利益的需求,医疗市场中的利他行为包括无私利他与为己利他,为病人最大利益着想是医护专业最根本的道德规范与责任。     

医学生对医师责任和伦理修养若干问题的认知

为了探索以患者为中心的医学生医师职业精神教育,本研究调查了四川大学医学生对医师职业精神中的“伦理修养”（“保密与尊重”和“知情同意”）和“医师责任”两方面的认知,并将其与患者认知进行比较。笔者分析了医学生和患者认知差异,并对医学生医师职业精神的影响因素进行探讨。结果显示,医学生对医师职业精神的认识停留在比较肤浅的层面,未能发自内心地把患者的利益放在首位,最重视的仍然是临床技能的提高。研究提示医学生医师职业精神教育需要增强感染力和实践性。     

When pestilence prevails...physician responsibilities in epidemics

The threat of bioterrorism, the emergence of the SARS epidemic, and a recent focus on professionalism among physicians, present a timely opportunity for a review of, and renewed commitment to, physician obligations to care for patients during epidemics. The professional obligation to care for contagious patients is part of a larger "duty to treat," which historically became accepted when 1) a risk of nosocomial infection was perceived, 2) an organized professional body existed to promote the duty, and 3) the public came to rely on the duty. Physicians' responses to epidemics from the Hippocratic era to the present suggests an evolving acceptance of the professional duty to treat contagious patients, reaching a long-held peak between 1847 and the 1950's. There has been some professional retrenchment against this duty to treat in the last 40 years but, we argue, conditions favoring acceptance of the duty are met today. A renewed embrace of physicians' duty to treat patients during epidemics, despite conditions of personal risk, might strengthen medicine's relationship with society, improve society's capacity to prepare for threats such as bioterrorism and new epidemics, and contribute to the development of a more robust and meaningful medical professionalism.     

医学职业精神视域下的医学生诚信教育研究

开展医学生诚信教育,是培养高素质的医学人才的关键环节,是构建和谐医患关系的基础。从医学职业精神的专业视角分析了诚信的科学内涵及作用,并提出了加强医学生诚信教育,培养医学职业精神的对策建议。     

医学专业精神的初步研究

由于历史和社会文化的差异,中西方对医学专业精神有着不同的理解。在中西不同语境下,分析了“Profession”和“Professionalism”这两个核心概念的涵义,并从中西对比的视角,对中西方医学专业精神所面临的几个共同问题进行了初步研究,包括医学专业核心道德价值观念、利益冲突、行业自治等。在此基础之上,还对我国医学专业精神的发展提出建议。     

Regulatory models for human embryo cloning: the free market, professional guidelines, and government restrictions.

Both experimental and therapeutic uses of the new reproductive technologies have been governed not by the medical ideology of the best interests of patients and their children, but by the market ideology of profit maximization under the guise of "reproductive liberty." Government in our constitutional, democratic society has the authority and obligation to make and enforce reasonable regulations to manage the new reproductive market in order to protect the interests of the public, prospective parents, and their future children. The "cloning" debate provides a useful opportunity to compare and contrast the competing regulatory models of the free market, professional guidelines, and government restrictions.     

Cost containment as professional challenge

Cost containment by means of prospective payment and other mechanisms is widely seen as a challenge to modern medicine; but the challenge is seldom articulated clearly in terms of core professional values and the moral content of a claim to professionalism. Medical ethics, as it has evolved as a field of study in the past twenty years, has contributed little to the concept of professionalism in medicine. For an investigation of professionalism in the face of cost containment to evolve fruitfully, several things must occur. The true nature of today's challenge to medicine must be appreciated. The balance between tradition and response to social change in defining a professional value system must be appreciated. Physician income must be explicitly addressed as a moral issue. And practical strategies for investigating and affirming core professional values must be developed for health delivery systems and medical education settings.     

Conscientious objection and emergency contraception

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested.     

医药回扣是最大的医患利益冲突

分析医患利益冲突如何影响医生的临床决策,并在此基础上探讨如何处理医患利益冲突。医患利益冲突影响医生临床决策有两个环节,其一是影响其专业判断,其二是影响其医疗决定。医药回扣具备商业贿赂的典型特征。医药回扣是最大的医患利益冲突。     

Medical ethics in an era of bioethics: Resetting the medical profession’s compass

What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This presentation summarizes the history of medical professionalism and refocuses attention on the interpersonal relationship of doctor and patient. This keynote address was delivered at the Founders of Bioethics International Congress (June, 2010).