L’affaire Lambert

In the case Lambert, the Council of State (high court of the Public law) finished a long trial. The question concerned the power of medical decision: family? doctor? judge? The European Court of Human Rights disputes its solution.     

Improved classification of mammograms following idealized training

People often make decisions by stochastically retrieving a small set of relevant memories. This limited retrieval implies that human performance can be improved by training on idealized category distributions (Giguère & Love, 2013). Here, we evaluate whether the benefits of idealized training extend to categorization of real-world stimuli, namely classifying mammograms as normal or tumorous. Participants in the idealized condition were trained exclusively on items that, according to a norming study, were relatively unambiguous. Participants in the actual condition were trained on a representative range of items. Despite being exclusively trained on easy items, idealized-condition participants were more accurate than those in the actual condition when tested on a range of item types. However, idealized participants experienced difficulties when test items were very dissimilar from training cases. The benefits of idealization, attributable to reducing noise arising from cognitive limitations in memory retrieval, suggest ways to improve real-world decision making.     

世界医学会《国际医学伦理准则》的诞生与发展：一项历史的回顾

《国际医学伦理准则》是世界医学会代表性伦理规范之一。世界医学会成立于第二次世界大战结束之际,是国际重要的医学专业组织,致力于制定体系化的伦理规范对个体医生提供道德指导,也对世界各国医学会、政府和国际组织提供帮助。《国际医学伦理准则》于1949年诞生,70余年来历经4次修订不断完善,2022年最新修订版做出了重要调整,中国参与了最近一次修订工作。历史性地分析《国际医学伦理准则》,有助于进一步理解当代医学职业精神的特征,深入认识世界医学会的伦理治理体系,也对推进中国医学伦理学规范建设有借鉴性意义。

     

金代医家张子和医学地位变迁与攻邪论学术史研究

金代医家张子和,精通汗、吐、下三法,开创攻邪派。在中国医学史上,张子和与刘完素、李东垣、朱丹溪并称为中医“金元四大家”。实际上,在历代有关中医“四大家”的历史书写演变历程中,张子和的医家地位并非一成不变,而是经历医学地位变迁的三个不同阶段。其医家地位变化脉络可概括为：医名盛于金元,淡于明清,名归于近代。在中医学术发展史上,自明代以及降,攻邪论逐渐淡出中医主流学术范畴,其学术传承脉络出现明显的断层现象。到了近现代,尽管张子和的医家地位重新回归中医“金元四大家”之列,但是攻邪论实际影响力仍旧式微。

     

洛克菲勒大学的开拓者:西蒙·弗莱克斯纳

西蒙·弗莱克斯纳 (1863年~1946年) , 病理学家, 1903年~1935年担任洛克菲勒医学研究所首任所长, 他认为研究所应为优秀科学家联盟, 他消除种族、文化、性别和学术背景差异广招人才, 重视物理学、化学及生物学对医学科学的影响, 主张打破学科界限跨学科交流与合作。在弗莱克斯纳领导下, 到20世纪30年代, 洛克菲勒医学研究所在病毒学、细菌学、病理学和酶学等领域达到世界领先水平, 开辟了洛克菲勒研究所发展历史上的第一个黄金时代, 西蒙·弗莱克斯纳可谓洛克菲勒大学的开拓者和领路人。     

试论《医林改错》中的实物观

清代医家王清任的《医林改错》自1830年刊行之时起即引起广泛关注, 究其原因不仅在于该书改正古人所记脏腑之错误, 关键在于其看待人体的视角及实践方法与传统中医不同——采用了实物观看待人体, 并且实施解剖观察实践, 这种革新举动挑战了传统中医的方法论。与西方近代科学相比较, 发现《医林改错》的思想萌芽和实践方法与之有相似处。结合医学史研习该著作, 看到中医学的方法论与历史环境不可分离, 随时代有所改变。《医林改错》的独特思维能够启发人们对中医方法论的认知。     

Les autorisations d’équipements lourds d’imagerie médicale : un désordre organisé

Medical imaging is essential for all medical specialties and it is natural that the government wants to create a real healthcare provision policy in this area. Medical imaging and particularly the “heavy” equipment are subject to a regulatory and legal framework. This framework results in respect of administrative authorization mechanism. These authorizations are a major tool for development of medical imaging on French territory. This mechanism is an important instrument of economic regulation in controlling health costs. However, the access to this kind of equipment raises various issues in governance and administration but also in matter of economic regulation, distribution of healthcare supply in medical imaging in health territories and respect of public health issues. The authorization mechanism raises questionings, not only at national and regional level in terms of unequal access, but also at European and international level. Indeed, France is among the last countries in the ranking of CT (computed tomography) and MRI (magnetic resonance imaging) equipment rates in comparison with many OECD (Organization for Economic Cooperation and Development) countries. Now, these authorizations will integrate much more the concepts of accessibility and quality of patient care. The legal and regulatory framework of these authorizations will have to evolve and to adapt to new technologies and practices, which today should be a source of significant cost savings.     

Déontologie et santé publique en droit constitutionnel

Ethics, even if there is a renewed interest today, has long been important in the public health domain, keeping constitutional law at a distance for the benefit of a relative autonomy of the medical field. However, the indifference between sanitary ethics and constitutional law tends to become less marked because of the appearance of a double opposite movement, consisting on the one hand of a public “déontologisation” of health law, including constitutional law and, on the other hand, in a constitutionalisation of ethics regarding public health. This evolution sets up as an arbitrator of State interventionism a Constitutional Council originally reluctant to check the intervention of public authorities in the field of health.     

Du secret médical aux dossiers de santé électroniques. Réflexions juridiques sur la protection des données de santé

Health data give rise to a plurality of qualifications. The exercise players are forced this not unusual for the legal system. In the case of health data, especially when these data are processed through folders to which several categories of actors need access, it may still be problematic. Electronic medical records, in which the authorities have in recent years invested a lot of hope and money, fail to cross the course of a generalization though it was presented as being beneficial for our public health system and financing of health spending. Without exaggerating the extent of social problems related to the interpretation and application of standards, it is reasonable to think that they are partly responsible for this fact. After presenting the two great bodies of norms which where initially protecting personal health data, this paper develops the analysis of their confrontation before highlighting the status of one of the most complex issues in this field, that is the people's consent to the various treatments that their data may be subject of.