医学教育改革与医学生整体素质培养的再思考

新时期对医学生的素质有新的要求,医学教育改革面临新的挑战.医学问题最终是关于"人"的问题,能培养出素质高、能力强、全面发展、自我发展、持续发展的医学人才,是改革的关键.     

Educational Background,Modes of Discourse and Argumentation: Comparing Women and Men

This paper analyses the way in which discourse and argumentation may vary depending on participants educational level and gender. Men and women from three different educational levels (literacy, advanced level and university students) participated in discussion groups that debated about women and work, the sharing of housework and the way in which girls and boys are educated. The results showed important differences depending on participants educational level and gender. In general, the main differences were related to educational level, while gender tended to interact with educational level, as a moderating factor.     

The interpretation of classically quantified sentences: a set-theoretic approach

We present a set-theoretic model of the mental representation of classically quantified sentences (All P are Q, Some P are Q, Some P are not Q, and No P are Q). We take inclusion, exclusion, and their negations to be primitive concepts. We show that although these sentences are known to have a diagrammatic expression (in the form of the Gergonne circles) that constitutes a semantic representation, these concepts can also be expressed syntactically in the form of algebraic formulas. We hypothesized that the quantified sentences have an abstract underlying representation common to the formulas and their associated sets of diagrams (models). We derived 9 predictions (3 semantic, 2 pragmatic, and 4 mixed) regarding people's assessment of how well each of the 5 diagrams expresses the meaning of each of the quantified sentences. We report the results from 3 experiments using Gergonne's (1817) circles or an adaptation of Leibniz (1903/1988) lines as external representations and show them to support the predictions.     

Animal experimentation

Millions of animals are used every year in oftentimes extremely painful and distressing scientific procedures. Legislation of animal experimentation in modern societies is based on the supposition that this is ethically acceptable when certain more or less defined formal (e.g. logistical, technical) demands and ethical principles are met. The main parameters in this context correspond to the “3Rs” concept as defined by Russel and Burch in 1959, i.e. that all efforts to replace, reduce and refine experiments must be undertaken. The licensing of animal experiments normally requires an ethical evaluation process, oftentimes undertaken by ethics committees. The serious problems in putting this idea into practice include inter alia unclear conditions and standards for ethical decisions, insufficient management of experiments undertaken for specific (e.g. regulatory) purposes, and conflicts of interest of ethics committees’ members. There is an ongoing societal debate about ethical issues of animal use in science. Existing EU legislation on animal experimentation for cosmetics testing is an example of both the public will for setting clear limits to animal experiments and the need to further critically examine other fields and aspects of animal experimentation. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005. The paper has been expanded from an article to be published in the forthcoming Council of Europe publication entitled “Animal Protection and Welfare”.     

The Regulation of Animal Research and the Emergence of Animal Ethics: A Conceptual History

The history of the regulation of animal research is essentially the history of the emergence of meaningful social ethics for animals in society. Initially, animal ethics concerned itself solely with cruelty, but this was seen as inadequate to late 20^th-century concerns about animal use. The new social ethic for animals was quite different, and its conceptual bases are explored in this paper. The Animal Welfare Act of 1966 represented a very minimal and in many ways incoherent attempt to regulate animal research, and is far from morally adequate. The 1985 amendments did much to render coherent the ethic for laboratory animals, but these standards were still inadequate in many ways, as enumerated here. The philosophy underlying these laws is explained, their main provisions are explored, and future directions that could move the ethic forward and further rationalize the laws are sketched.     

A Compassionate Autonomy Alternative to Speciesism

Many people in the animal welfare communityhave argued that the use of nonhuman animals inmedical research is necessarily based onspeciesism, an unjustified prejudice based onspecies membership. As such it is morally akinto racism and sexism. This is misguided. Thecombined capacities for autonomy and sentiencewith the obligations derived from relationssupport a morally justifiable rationale forusing some nonhuman animals in order to limitthe risk of harm to humans. There may be a fewcases where it is morally better to use a neversentient human than a sentient animal, butthese cases are few and would not fulfill thecurrent need for research subjects. The use ofnonautonomous animals instead of humans inrisky research can be based on solid moralground. It is not necessarily speciesism.     

Should we presume moral turpitude in our children? – Small children and consent to medical research

When children are too young to make their ownautonomous decisions, decisions have to be madefor them. In certain contexts we allow parentsand others to make these decisions, and do notinterfere unless the decision clearly violatesthe best interest of the child. In othercontexts we put a priori limits on whatkind of decisions parents can make, and/or whatkinds of considerations they have to take intoaccount. Consent to medical research currentlyfalls into the second group mentioned here. Wewant to consider and ultimately reject one ofthe arguments put forward for putting medicalresearch into the second category. We willargue that some objections to children'sparticipation in research are either based onan implausibly restrictive conception of whatis in fact in the child's best interests orthat there is an implicit and false premisehidden in this argument; i.e., the premise thatour children have so deeply fallen into moralturpitude that we must assume that they wouldnot want to fulfill their moral obligations,or, that they will grow up to be morallydeficient and will then wish not to have actedwell while a child.     

Child Assent and Parental Permission in Pediatric Research

Since children are considered incapable ofgiving informed consent to participate inresearch, regulations require that bothparental permission and the assent of thepotential child subject be obtained. Assent andpermission are uniquely bound together, eachserving a different purpose. Parentalpermission protects the child from assumingunreasonable risks. Assent demonstrates respectfor the child and his developing autonomy. Inorder to give meaningful assent, the child mustunderstand that procedures will be performed,voluntarily choose to undergo the procedures,and communicate this choice. Understanding theelements of informed consent has been theparadigm for assessing capacity to give assent.This method leaves the youngest, leastcognitively mature children vulnerable towaiver of assent and forced researchparticipation. Voluntariness can also becompromised by the influence of authorityfigures who can exert undue influence andcoerce children to participate in research. This paper discusses factors that may influencethe decision to give assent/permission,potential parent-child conflict in theassent/permission process and how it isresolved, and potential parental undueinfluence on research participation. Theseissues are illustrated with quotations drawnfrom a larger qualitative study of parentalpermission and child assent (data notpresented). We suggest a developmentalapproach, viewing assent as a continuum rangingfrom mere affirmation in the youngest childrento the equivalent of the informed consentprocess in the mature adolescent.     

To identify and limit the risks of neglect in orphaned students: Can France manage it?

Orphans' needs are barely identified, barely acknowledged, and barely treated notably in France. Yet, parental loss might generate specific needs associated with cognitive, relational/behavioral, and emotional difficulties. In turn, such difficulties are likely to give rise to lower academic achievement. In this theoretical paper, we argue that, due to the detrimental impact of parental loss on academic achievement, orphaned students should be considered as students with special educational needs. This is important to provide appropriate educational responses consistent with inclusive education. The present paper aims to identify different specific needs of orphaned children, as a way to limit neglect of orphans. We discuss various ways to reduce the risks of neglecting orphans in French schools by using Bronfenbrenner's ecological development model and propose avenues for relevant pedagogical responses.