临床代理决策中的利益冲突及其消解

对于限制/无行为能力患者的医疗决策采取代理决策模式,该模式奠基于社会习俗与习惯法。通常情况下,亲属能够更加准确地评判患者的个人价值取向和医疗决定偏好。但是,基于利益判断的主观性,代理决策中的道德冲突难以避免,其合理性辩护基于代理身份的合法性、“善意”与“患者利益”的标签、制度缺失,对于其批评在于代理者德性基础上的一致性不足。按照解决问题的逻辑进程,规避代理决策中利益冲突的方式有寻求共识的可能、临床伦理咨询与司法介入,其中伦理咨询与司法介入需要依托国家制度设计。     

支持死后医疗数据捐赠：呼吁对个人健康数据的伦理利用

死后医疗数据捐赠对于科学研究的意义重大。但目前不存在有针对性的准则用于指导捐赠过程。如果死后医疗数据的使用缺乏监管可能会引发多种风险,一是给他人利益造成损害;二是造成数据的不规范使用。因此,应当类比现有捐献制度,允许并鼓励捐献死后医疗数据用于科学研究,并起草专门的捐赠准则。该准则的制定应当建立在遵循五大基本原则的前提下,主张以自愿参与的方式使用个人医疗数据,反对未经书面同意将数据用于以病例档案为基础的医学研究。

     

精神疾病诊断:科学的判断?伦理的判断?

自精神病学纳入医学的范畴之后,精神疾病的诊断因为其所声称的科学手段而被认为是科学的判断。20世纪中叶开始的反精神病学运动全面否定其科学性,认为精神疾病的诊断是单纯的伦理价值判断。两种观点都显得过于极端。精神疾病的特殊性决定了精神疾病的诊断是科学判断基础上的伦理判断。其中科学的判断不是决定性的,而是基础性的。决定性的是伦理的判断,只是这种伦理判断必须建立在科学判断的基础之上而已。     

Impact of Ethical Information Resources on Independently Licensed Counselors

A random sample of 430 independently licensed counselors evaluated 4 ethical information interventions in the context of 16 boundary‐crossing scenarios. Results indicated that counselors have serious reservations about any form of boundary crossing. They reported mostly reviewing various codes of ethics, reviewing state laws and rules, consulting with others, working from gut instincts, and reflecting on personal experience when confronted with boundary‐crossing issues. Participants clearly preferred streamlined ethical information interventions.     

Responsible engineering: Gilbane Gold revisited

This paper addresses several concerns in teaching engineering ethics. First, there is the problem of finding space within already crowded engineering curricula for meaningful discussions of ethical dimensions in engineering. Some engineering programs may offer entire courses on engineering ethics; however, most do not at present and may not in the foreseeable future. A promising possibility is to weave ethics into already existing courses using case studies, but most current case studies are not well integrated with engineering technical analysis. There is a danger that case studies will be viewed by both instructors and students as departures from “business as usual”—interesting perhaps, but not essentially connected with “real” engineering. We offer a case study, inspired by the National Society of Professional Engineer’s popular video Gilbane Gold, that can be used to make the connection. It requires students to engage in technical analysis, but in a context that makes apparent the ethical responsibility of engineers. Further, the case we present marks a significant departure from more typical cases that primarily focus on wrongdoing and its prevention. We concentrate more positively on what responsible engineering requires. There is a need for more such cases, regardless of whether they are to be used in standard engineering courses or in separate courses in engineering ethics. This article is the product of the NSF/Bovay Endowment “Workshop to Develop Numerical Problems Associated With Ethics Cases for use in Required Undergraduate Engineering Courses” (NSF Grant DUE-9455141) held at Texas A&M University in August 1995. For further information about this project, contact Michael J. Rabins, Director of the Ethics and Professionalism Program in the Look College of Engineering at Texas A&M University. Additional case studies from this workshop are available on the Internet site http://ethics.tamu.edu. The writing of this article was supported in part by “Engineering Ethics: Good Works” (NSF/EVS Grant SBR-930257). Michael Pritchard teaches ethics and is co-author of Engineering Ethics: Concepts and Cases (1995) with C.E. Harris and Michael Rabins (Wadsworth, Belmont CA). Mark Holtzapple teaches chemical engineering and is author of Foundations of Engineering (McGraw-Hill) which includes an ethics chapter suitable for freshman engineering students.     

医院引进股份制机制改革的伦理思考

在卫生改革中医院可不可以进行股份制的试点是一个极富挑战性的问题,我国医院公有制已经实行了数十年,在保障国民健康上作出巨大贡献,但随着改革的进程,医院的发展遇到现有体制、机制方面的许多难题。浙江、上海等地已经实行医院股份制改革试点的经验证明,股份制不等于私有制;在国力不可能更多增加卫生投入的情况下,医院股份制改革促进了医院的管理、社会效益和经济效益,可能是发挥社会力量办好医院、解决我国卫生改革深层次矛盾的途径之一。     

Critiques of Casuistry and Why They Are Mistaken

Casuistic methods of reasoning in medical ethics have been criticized by a number of authors. At least five main objections to casuistry have been put forward: (1) it requires a uniformity of views that is not present in contemporary pluralistic society; (2) it cannot achieve consensus on controversial issues; (3) it is unable to examine critically intuitions about cases; (4) it yields different conclusions about cases when alternative paradigms are chosen; and (5) it cannot articulate the grounds of its conclusions. Two main versions of casuistry have been put forward, and the responses to these objections depend in part on which version one is defending. Jonsen has advocated a version modeled on the approach to casuistry used by moral theologians in the 15th and 16th century, involving comparison of the case at hand with a single paradigm and a lineup of cases. The present author has advocated another version, drawn from experience with cases in clinical ethics, which involves comparing the case at hand with two or more paradigms. Four of the five objections are unsuccessful when directed against Jonsen'sapproach, and all of them are unsuccessful when directed against the approach involving comparison with two or more paradigms.     

Protection of animal research subjects

The use of experimental animals, mostly rodents, in biomedical research and especially in oncology and immunology should be acknowledged with respect, recognizing the contribution of animal experimentation in the fascinating scientific progress in these disciplines of research. It is an obligation of the investigator to justify the scientific and ethical aspects of each study requiring the use of animals. The international guiding principles for using animals in biomedical research are well defined and have been distributed worldwide by the International Council for Laboratory Animal Science (ICLAS) since 1956, when this Organization was founded. In Poland the ICLAS philosophy and principles are highly respected and were implemented firstly by the members of the Commission on Biology of Experimental Animals appointed in 1962 by the Department of Medical Science of the Polish Academy of Science in Warsaw. Animal Protection Acts, first proclaimed in 1928 were gradually modified and improved. Actual legislation (enacted in 1997, 2003 and 2005) is consistent with EU Directives (86/609/EEC) and follows the internationally recommended principles that include ICLAS guidelines concerning animal welfare and care condition in biomedical research. The problem of “alternative methods” is briefly discussed. Dr. Donald Boisvert, CCAC — Canadian Council on Animal Care A lecture on the subject of this paper was presented at the 6th International Bioethics Conference entitled ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005. The author is the National Representative of Polish Academy of Science to the International Council for Laboratory Animal Science (ICLAS) and a Member of the ICLAS Governing Board.     

The small helm project: An academic activity addressing international corruption for undergraduate civil engineering and construction management students

This paper presents an academic project that addresses the issue of international corruption in the engineering and construction industry, in a manner that effectively incorporates several learning experiences. The major objectives of the project are to provide the students a learning activity that will 1) make a meaningful contribution within the disciplines being studied; 2) teach by experience a significant principle that can be valuable in numerous situations during an individual’s career, and 3) engage the minds, experiences, and enthusiasm of the participants in a real ethical challenge that is prevalent in all of their chosen professional fields. The paper describes the full details of the project, the actual implementation of it during Winter Semester 2005, the experiences gained during the initial trial, and the modifications and improvements incorporated for future implementation. An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.