论患者的不真正义务

患者的不真正义务是法律没有规定且医患双方亦没有约定患者必须履行的,医方通常不得请求履行,而其违反也不发生损害赔偿责任,仅使患者遭受权利减损或者丧失之不利益的义务.主要包括患者的披露的义务、遵照医嘱的义务与签字的义务.患者的不真正义务是不同于患者给付义务和附随义务的一种独立义务.患者的不真正义务不应保护医方使其免于承担治疗失当的责任.     

医学专业面临的危机：利益冲突——再论医学专业精神

医患间未能遵守利益限度和利益边界原则,使矛盾转化为冲突。当前我国面临的医患冲突与一些国家相比是全面而深刻的。体制与非体制原因相互交错,直接冲突与间接冲突相互影响,理性冲突向非理性冲突转化,群体性与个体性的不同表现,即发生与后发性的不同特点,是我国医患冲突演化的规律与特征。要正确对待第三方的介入。端正专业思想是理顺医患关系的治本之道。     

医学伦理学不可忽视的课题：利益伦理

当今是一个以利益为轴心的时代。利益伦理学是医学伦理学不可忽视的课题。将病人利益置于首位应当是现代医学伦理学的首要原则。欲望是无穷的,利益是有限的。任何利益都有自己的边界和限度。我们必须设置利益的道德界限,以回答当前医学伦理学面临的种种现实课题。     

The fit of Holland’s RIASEC model to US occupations

Holland’s [Holland, J. L. (1959). A theory of occupational choice. Journal of Counseling Psychology, 6, 35-45; Holland, J. L. (1997). Making vocational choices: A theory of vocational personalities and work environments (3rd ed.). Odessa, FL: Psychological Assessment Resources, Inc.] RIASEC types were initially developed using a restricted range of occupational titles. Holland’s type classification system has been extended to encompass the full range of occupations in the US, using both statistical and expert rating methods. However, the extent that Holland’s classification model is sufficient to represent the full range of occupational interests has not been examined. Multidimensional scaling (MDS) was used to analyze college students’ (266 men, 572 women) interests in occupations representing approximately 85% of the US labor market. A two-dimensional MDS solution of the full set of occupations did not fit Holland’s model, but limiting the analysis to occupations used in Holland-based measures produced the expected RIASEC structure. In comparison, a three-dimensional solution included Prediger’s [Prediger, D. J. (1982). Dimensions underlying Holland’s hexagon: Missing link between interests and occupations? Journal of Vocational Behavior, 21, 259-287] dimensions (Things/People and Data/Ideas) consistent with Holland’s model, but also included prestige and sex-type dimensions that were not orthogonal to Prediger’s dimensions. These results demonstrate that the RIASEC types are not sufficient to represent the full range of occupational interests and are confounded with prestige and sex-type.     

Nanotoxicology and Ethical Conditions for Informed Consent

While their strength, electrical, optical, or magnetic properties are expected to contribute a trillion dollars in global commerce before 2015, nanomaterials also appear to pose threats to human health and safety. Nanotoxicology is the study of these threats. Do nanomaterial benefits exceed their risks? Should all nanomaterials be regulated? Currently nanotoxicologists cannot help answer these questions because too little is known about nanomaterials, because their properties differ from those of bulk materials having the same chemical composition, and because they differ so widely in their applications. Instead, this paper answers a preliminary ethical question: What nanotech policies are likely to contribute to society’s ability to give or withhold free informed consent to the potential risks associated with production and use of nanomaterials? This paper argues that at least four current policies appear to jeopardize the risk-disclosure condition that is required for informed consent. These are the funding problem, the conflict-of-interest problem, the labeling problem, and the extrapolation problem. Apart from future decisions on how to ethically make, use, and regulate nanomaterials, this paper argues that, at a minimum, these four policies must be modified. Government must spend greater monies on nanotoxicology; ensure independent nanotoxicology research; label consumer products containing nanomaterials; and avoid assuming that nanotoxicological properties are based merely on mass and chemical composition. Otherwise free informed consent to these new technologies and materials may be jeopardized.     

职业评定量表(VIESA)的信度和效度研究

根据D.E.Super的职业发展理论,职业选择的成熟与发展一般分为五个阶段,中学生正处在从探索到成熟的重要转变期。本研究以美国大学测验中心的职业分类系统为基础,以职业评定量表VIESA为工具和对象,对北京市第六十五中学的179名高中三年级学生和北京师范大学心理学系的55名二年级学生进行了施测,检验了量表的信度和效度。量表的信度指标基本在.70以上,构想效度良好,以专业满意感为效标的效标效度达到显著水平。     

临床试验中的利益冲突：伦理和政策问题

人们对于研究人员、赞助商和研究机构三者之间的经济利益关系给予越来越多的关注,人体试验研究中的经济利益与其他利益有所不同,这种经济利益会导致偏见或诱导不正当的行为,尤其是当有从研究中获益的机会存在时,将会影响到研究人员关于应该选择哪个受试者,应该提供给受试者什么样的医疗服务,甚至应该如何正确使用受试者保密的健康信息方面的判断,由经济利益引起的明显的风险同样也会威胁公众的学术机构研究使命的支持,从处理临床试验中利益冲突的准则,什么样的经济利益是研究中的重大经济利益。准则的实施等方面进行了详尽的叙述,最后指出没有潜在受试者和公众的信任,我们就不能有效地开展研究。     

Harmony and Justice

The reason why justice and harmony are the most-prized values and the highest aims of human beings is that these qualities are the foundation which makes possible the realization of all other positive goals. Interpersonal conflicts and conflicts between individuals and the society lead to social, cultural, and moral crises. Confucian culture argues that moral reason is only possessed by human beings, and that this is what can make human existence harmonious and rational. Harmony creates power, and power can defeat impediments. As a result, physical qualities are humanized, and moral qualities increase. Goodness promotes the establishment of mutually beneficial systems and procedural justice in a society. Therefore, Chinese traditional culture provides a method for resolving contemporary social conflicts and crises, including accumulating goodness to increase virtue, constructing social integrity and harmonious righteousness, and the building up of a just society.     

The <Emphasis Type="Italic">Not Unreasonable</Emphasis> Standard for Assessment of Surrogates and Surrogate Decisions

Standard views on surrogate decision making present alternative ideal models of what ideal surrogates should consider in rendering a decision. They do not, however, explain the physician's responsibility to a patient who lacks decisional capacity or how a physician should regard surrogates and surrogate decisions. The authors argue that it is critical to recognize the moral difference between a patient's decisions and a surrogate's and the professional responsibilities implied by that distinction. In every case involving a patient who lacks decisional capacity, physicians and the treatment team have to make judgments about the appropriateness of both the surrogate and the surrogate's decision. They have to assess the surrogate's decisional capacity and attitude toward the patient as well as the reasons that support the surrogate's decision. This paper provides a model for acceptable surrogate decisions and a standard for blocking inappropriate surrogates. Only decisions based on widely shared reasons are allowable for surrogate refusal of highly beneficial treatment.