世界医学会《国际医学伦理准则》2022年版修订述评

2022年10月,世界医学会第73届全体大会审议通过了2022年修订版本《国际医学伦理准则》。此次修订历时4年,修订过程的参与度和透明度均有重大突破。新版准则充实了医生对患者的义务,补充扩展了对其他医生、医务人员、学生和其他人员的义务,对社会的义务以及作为医学专业成员的义务。通过对尊重患者的尊严和自主性、知情同意的新要求、良心反对、利益冲突等修订重点和亮点的介绍与评论,对国际医学共同体关注的现代医学伦理问题进行初步探讨,以期加强我国医学伦理理论和制度规范的进一步研究和交流。

     

麻醉科医患沟通现状及认知分析一一我国45家医院联合调查报告——

2017年8月1日~9月30日,在全国45家医院进行了电子问卷调查,旨在从医方角度调研麻醉科医患关系的现状。结果显示在导致医患沟通不畅的原因中除客观因素(病情复杂及疗效不确定)之外,麻醉科医务人员对患者防备心理过重位列首位(37.8%),其次为沟通时间不够(33.4%)、沟通意识缺乏(29.2%)以及沟通能力不足(28.3%),由此可见如今麻醉科医患沟通问题比较突出。建议麻醉科医生通过转变医疗观念,强化沟通意识;掌握语言工具,提高沟通技能;积极向患者科普麻醉学科的进展和局限等综合措施,逐渐改善麻醉科医患沟通现状。

     

人工体内授精中亲子关系的认定

随着人工体内授精的技术发展与社会思维方式的变化,不仅颠覆了传统亲子关系的认定规则,同时也挑战了以亲子关系为基石的家庭法制。基于人工体内授精技术可能造成血统事实与法律事实的割裂矛盾,应当坚持保密认定、知情同意、风险自负、子女利益最大化等重要原则。同时,以类型化分析为基础,具体化阐释同质人工授精与异质人工授精在适用规则与利益衡量中的不同之处,以最大程度调适人工体内授精中所涉利害关系人的价值冲突。

     

医学伦理学发展新阶段的历史使命

每个时代都有每个时代伦理学的主轴。当今医学伦理学面临崭新的境遇,资本、技术、权力和全民健康等问题,已经构成医学伦理学应对和挑战的主要课题。新形势向医学伦理学提出了种种新任务,探索完成这些新任务的政策建议和伦理举措;适应新形势医学伦理学如何加强自身理念的充实、创新和提高;在新情境下如何促进医学伦理学在医学领域内的全面覆盖,让医学伦理学在医学中深深扎根,促进医学技术更好地服务于人民大众的健康,都是开启医学伦理学新征程面临的担当。

     

从伦理辩护到国家权力、个人权利界限的划定——公共卫生领域特殊伦理冲突的和解之道

在流行病防控等公共卫生工作中,为了维护公共健康不得不侵犯传染病患者的个人权利,这是公共卫生领域不同于临床医学的特殊伦理冲突。虽然有学者分别依据“效果论”、“差异原则”和“公共善优先”为公共健康的优先性进行了辩护,但都不能与医学伦理学的个体论视角相融洽。实际上,固守单一的理论视角是伦理冲突和解的最大障碍,只有改变单一视角,才能开启理论的兼容性。伦理辩护必须转化为实践智慧,即必须在公共卫生实践中实现国家权力与个人权利的有序协调,使国家权力和个人权利坚守各自的界限。     

初中生对父母冲突的知觉结构分析

以我国初中生为研究对象,以Grych等人的父母冲突子女知觉量表为工具,对量表是否适用于中国的初中生进行了验证研究,以此探明了初中生对父母冲突知觉的结构,初中生对父母冲突知觉问卷具有良好的信度和效度。     

Money versus pain: experimental study of a conflict in humans.

Ten healthy human males volunteered to be subjects in an experiment in which they were to be paid to endure a painful sensation. This sensation was produced by isometric muscular contraction in the thighs. For each of six sessions the subjects received either a payment that was changed for each session (0.2, 0.5, 1.25, 3.125, 7.8125 French francs per 20 s) or a lump sum. At the beginning of a session, the subjects assumed a seated position against a wall, but without a seat, and the duration for which they could hold this position was the chief variable measured. Heart rate, blood pressure, and magnitude estimation of pain were also recorded periodically throughout each session. Pain was reported after a mean delay of 15 +/- 7 s (SE), and the magnitude estimates then increased linearly with time. The duration of maintaining the painful position increased linearly in relation to the logarithm of the increase in the amount of payment. Thus, utility of money decreased when pitted against pain.     

从知觉负载理论来理解选择性注意

知觉负载理论被认为解决了选择性注意研究的早选择和晚选择观点之争。当前任务对注意资源的耗用程度决定了与任务无关的干扰刺激得到多少加工,从而导致在低知觉负载下,注意资源自动溢出去加工干扰刺激（晚选择）,而在高知觉负载下,注意资源被当前任务耗尽而无法加工干扰刺激（早选择）。知觉负载理论提出后,研究者进行了一系列研究。一部分工作专注于知觉负载对选择性注意的调节作用;另外一些工作则关注其他认知过程如何影响注意资源的分配,其中知觉负载与工作记忆负载的关系是当前关注重点。     

Conflict Buffers and Marital Satisfaction: On the Effects of Different Forms of Social Support

This paper deals with the deterioration in the subjective quality of life of women as a result of marital conflict. Whereas primary and secondary prevention are generally targeted at maintaining or increasing the current level of marital happiness this paper focuses on the possibilities for buffering the negative impact of conflict on women’s quality of life. In particular, this paper is interested in the conflict buffering effects of various forms of social support such as home visiting by professional social workers or informal contacts with peers. In order to assess and compare the effectiveness of these forms of tertiary prevention, data from interviews with young mothers in the city of Zurich (Switzerland) will be reanalyzed. The data confirm the phenomenon of stress buffering from social support and reveal variation with regard to the effectiveness of different stress buffers. Female peer support e.g. seems to be at least as successful as home visiting by professional nurses and social workers.