医疗机器人的伦理风险与治理探析——基于“医−患−机”分析框架

基于“医−患−机”分析框架,医疗机器人的不断发展面临主体资质复杂、责任认定困难等责任伦理风险,医患关系重构、医患信任危机等医患伦理风险,数据质量与数据隐私等数据伦理风险,算法安全与算法偏见等算法伦理风险以及医疗资源分配正义风险。医疗机器人的伦理治理要以医学伦理和机器人伦理准则为依据,建立多元伦理治理体制,推动学术共同体的构建,探索自愿型、调节型与管制型等伦理治理工具的组合运用,加快医疗机器人伦理治理的法治化发展。

     

患者就医伦理责任认知问卷的编制与信效度检验分析

采用文献分析法,结合专家咨询,对患者就医伦理责任进行概念与范畴界定,拟定问卷条目。采用随机抽样调查法对南通市某三级甲等医院的患者进行问卷调查。问卷可划分为责任范畴认知、责任态度信念两个维度,共计18道条目,累计方差贡献率为82.434%。项目分析中各分析项均呈现出显著性差异（P＜0.05）。问卷总体的Cronbach's α系数为0.979,内容效度为0.910,在结构效度分析中,问卷因子分析KMO值为0.971,聚敛效度和区分效度皆达到标准。本问卷具有良好的信效度,可为日后进一步的研究分析提供科学可靠的依据。

     

从平等与责任谈医患共同体何以可能

研究对“医患共同体”这一颇具可能性的命题进行分析,指出其成立的基础之一是对医患双方“分裂”处境的认知与承认,通过以对医患平等的探讨为起点,提出应将医、患双方知识/权力上的优劣转化为差异的能动性,在促进共同责任的基础上,建立在理论及实践的医患共同体。目前可能的临床实践包括鼓励医护讲述成为患者的真实体验,鼓励包括叙事医学在内的促进平等共情的实践以及赋能患者、使其具备更强能力参与医疗共同决策的实践等。

     

突发公共卫生事件中舆论性信息弱势群体的伦理问题

突发公共卫生事件发生后,为了避免疾病扩散,通过流行病学调查得到的患者信息需进行公布,其中与私行私德有关之处在公众围观中可能被放大评判,话语权不足的患者成为舆论中信息弱势群体。这一状况会导致公私边界不明晰,患者私行入公域;道德评价成为情绪宣泄,负面后果无人负责;以道德为名造成撕裂,消解舆论的监督作用等负面后果。要解决这些伦理问题,需要把握适宜的伦理距离,树立距离伦理意识;依照分布式道德行为措施追责,发挥网络平台道德促进者作用;同时增强公共卫生沟通机制中的伦理因素,推进规范化管理。

     

罕见病患者权利保障的伦理责任

罕见病患者的道德、法律、经济与文化权利都无法得到应有保障。这与传统道德以亲疏远近来决定责任的承担顺序有关。在这种道德模式下,各个责任主体对罕见病患者的有效支持不足。罗伯特·E·古丁的弱势原理提供了一个全新审视伦理责任的维度,指出责任源于弱势,责任效力与责任对象依赖责任主体的程度密切相关。从不同维度看,罕见病患者都属于弱势群体,因而可运用此原理,将其权利保障的责任分配于不同责任主体,并以责任效力的高低顺序,重构以政府、医护方、企业、社会组织、媒体与大众、家庭对罕见病患者的伦理责任体系。

     

“本己”抑或“他性”？——海德格尔与列维纳斯死亡观比较分析

海德格尔与列维纳斯都“直面”死亡问题,并对死亡的本性、自我与死亡的关系以及他人之死与自我的关系等问题做出充分回应。海德格尔认为死亡是始终“悬临”于此在生存之中的向终结存在的方式,死亡构成了此在最为本己的整体能在,并展现为主体“我-能”的意向性结构。列维纳斯却要打破生存论上的死亡“悬临”,消解主体的“我-能”,并将“向来属我”的死亡孤独转换为伦理学上“异质属他”的死亡责任,由此,死亡不再是此在为自身存在负责的方式而是为“他者”担负责任的伦理要求。

     

突发事件中民众责任归因的心理需求与应对

突发事件发生后,通过责任归因对事件原因和责任归属进行推断是民众心理活动的重要特征之一。从民众心理需要来看,突发事件带来的不确定感驱使个体寻找事件的解释来实现认知闭合,控制感的不足则会让个体更加强调外部世界的秩序性,这两种需要也是事件中阴谋论传播和替罪羊效应的心理基础。相应地,在事件中负有责任的组织主体,也应当基于民众的心理需要采取适当的应对策略,来重塑组织形象和民众的信任,避免责任规避带来的负面效应。未来研究可以进一步从心理学视角补充整合性的实证证据,对突发事件的不同类型进行区分,关注责任归因与其他社会心理学变量之间的联系,以及探索适合中国社会的有效应对措施。     

What is the Accordion Effect?

In "Action and Responsibility,' Joel Feinberg pointed to an important idea to which he gave the label "the accordion effect.' Feinberg's discussion of this idea is of interest on its own, but it is also of interest because of its interaction with his critique, in his "Causing Voluntary Actions,' of a much discussed view of H. L. A. Hart and A. M. Honoré that Feinberg labels the "voluntary intervention principle.' In this essay I reflect on what the accordion effect is supposed by Feinberg to be, on differences between Feinberg's understanding of this idea and that of Donald Davidson, and on the interaction between Feinberg's discussion of the accordion effect and his critique of the voluntary intervention principle.     

Rearing practices and impulsivity/hyperactivity symptoms in relation to inflated responsibility and obsessive‐compulsive symptoms

Smári, J., Rúrik Martinsson, D., & Einarsson, H. (2010). Rearing practices and impulsivity/hyperactivity symptoms in relation to inflated responsibility and obsessive‐compulsive symptoms. Scandinavian Journal of Psychology, 51, 392–397. The aim of the study was to investigate potential precursors of inflated responsibility (responsibility attitudes) and obsessive‐compulsive (OCD) symptoms. It was argued that both parental overprotection and impulsivity, separately and in interaction with each other, contribute to inflated responsibility and OCD symptoms. In a large sample of young adults (N = 570), self‐report measures of OCD symptoms (OCI‐R), responsibility attitudes (RAS), anxiety/depression (HADS), rearing practices (EMBU), present and past impulsivity/hyperactivity symptoms (IMP/HY) were administered. Overprotection as well as IMP/HY were found to predict OCD symptoms as well as inflated responsibility. Finally, a significant interaction was found between IMP/HY and overprotection with regard to both OCD symptoms and inflated responsibility. This effect reflected that IMP/HY was more strongly related to OCD symptoms and responsibility in people who had not been overprotected than in people who had been. Conversely overprotection was related to OCD symptoms and responsibility in people low but not in people high in IMP/HY. The results seem to indicate that the inadequacy between offer and need for parental control may play a role in the development of OCD symptoms.     

Autonomy,Reciprocity, and Responsibility: Darwall and Levinas on the Second Person

Abstract

Stephen Darwall’s The Second‐Person Standpoint converges with Emmanuel Levinas’s concern about the role of the second‐person relationship in ethics. This paper contrasts their methodologies (regressive analysis of presuppositions versus phenomenology) to explain Darwall’s narrower view of ethical experience in terms of expressed reactive attitudes. It delineates Darwall’s overall justificatory strategy and the centrality of autonomy and reciprocity within it, in contrast to Levinas’s emphasis on the experience of responsibility. Asymmetrical responsibility plays a more foundational role as a critical counterpoint to ‘mean‐spirited’ reciprocity than Darwall’s laudable distinction between accountability and revenge, and responsibility even founds this distinction. The experience of being summoned to asymmetrical responsibility amplifies the meaning of ‘authority’, which is a presupposition for Darwall. Finally, asymmetrical responsibility helps develop decentred reasoning, invites risk beyond the boundaries of reciprocity at moments when autonomy appears endangered, reconciles respect and care at the experiential level, and presses to extend the scope of moral obligation.