第二届中国医学伦理学国际跨学科讨论会将在上海召开

由德国汉堡亚洲事务研究所、德国埃森ＨｅｌｍｕｔＳｔｏｒｚ博士基金会、上海第二医科大学和中国国家人类基因组南方研究中心联合赞助的“第二届中国医学伦理学国际跨学科讨论会”将于１９９９年１０月１９～２３日在上海第二医科大学举行,出席讨论会的特邀代表将来自我国大陆、香港、台湾以及美、德等国医学院校和有关研究机构。到会的中外专家将就生殖伦理（遗传咨询与人工流产,计划生育与优生优育）,医疗保健伦理（老年病和精神病的医学伦理）,死亡伦理（临终关怀,安乐死）以及遗传资源的收集、研究与保护等领域提出案例展开讨论。…     

从生命伦理到生命法

20世纪下半叶以来,生命科技的发展极大地增进了人类的福祉,但也引生了大量伦理与法律问题,使得生命科技的伦理调整与法律规范成为必然。在生命科技发展的过程中,生命伦理发挥了重要的引领作用,它以其自身特定的机制保障着生命科技的健康发展。生命伦理与生命法存在着明显区别,这些区别使得生命伦理在现代生命科技社会中无法独立承担引领生命科技健康发展的使命,而必须与生命法共同在生命科技社会治理中发挥作用。在现代生命科技社会中,生命法具有不可取代的重要作用,正是基于此,20世纪70年代以来,各国兴起了一场生命伦理法律化的运动,纷纷强化了本国的生命法制建设,改变了以往单纯依赖生命伦理调整生命科技活动的历史,使法律也参与到生命科技的规制中来。人类生命科技治理必然要经历一个由单纯依赖生命伦理到依赖生命法与生命伦理相结合的发展阶段。当前,我国生命立法还存在诸多不足,难以适应生命科技发展的现实需要,需要采取相应的完善对策。     

医学研究伦理学的发展现状与前景

创新技术的开展和转化医学的注重给医学的发展注入了新的活力,但同时,也带来了一系列社会伦理问题和法律问题。生命医学伦理学的兴起和发展催生了医学研究伦理学分支学科形成,目的在于推进解决涉及人体的医学研究的伦理问题。当前,面临的最突出的伦理问题在于,对医学研究合法性、先进性及伦理性的把握,对医学研究伦理审查必要性的认知,对医学研究方案设计与伦理道德的匹配,对医学研究知情同意的告知,对医学研究风险与受益的平衡。逐步与国际接轨,加强伦理委员会制度建设;提高伦理审查能力建设,形成高水平的伦理审查队伍;学术组织和团体共同努力,推进医学研究伦理学的发展,这将助推医学研究伦理学的发展。     

医学功能学科实验融入动物伦理教育的思考与探究

医学功能学科实验是医学实验课程体系的重要构成,主要研究对象为实验动物。针对动物实验中不符合动物伦理的现象,基于实验动物伦理教育的内涵和要求,探究将其融入医学功能学科实验的必要性、路径和措施,把实验动物法制化、标准化管理与知识育人、立德树人有机结合,引导学生遵守法纪和技术标准、恪守科技伦理规范要求、善待敬畏生命和关心关爱患者。     

什么是生命伦理学？——从历史发展的视角

生命伦理学是20世纪60年代兴起于美国的一门新兴学科,旨在应对生命科学和生物技术的发展或医疗保健的演变使人类面临的种种伦理难题。生命伦理学的兴起有着特殊的社会历史背景。它在发展过程中出现的一些里程碑式的案例,对生命伦理学的发展产生了深远的影响。从其发展特征上看,生命伦理学和医学伦理学紧密联系,有着更为广泛的研究内容和独特的专业特性。生命伦理学要有效回应现代医学和生命科学的发展给人类带来的伦理难题,既要准确地界定伦理问题,又要以适当的方式将伦理学基础理论应用到具体问题当中。对生命伦理学的基本理论进行概述。     

生命伦理学委员会

生命伦理学委员会是从伦理学角度审查人体试验研究,保护受试者权益的决策咨询组织。该委员会一般由来自法学、伦理学、医学、药学等领域的专家学者组成,其审查遵循的重要依据是世界医学会制订的《赫尔基辛宣言》。近年来,伦理委员会快速发展,但各伦理委员会审查质量参差不齐。因此,相关部门尚需加强对伦理委员会成员的培训,并加强对伦理委员会的监管,方能促进我国伦理委员会的良性发展。     

伦理管理在人类辅助生殖技术中的应用与价值

辅助生殖技术（assisted reproduction technique,ART）的飞速发展给社会带来了复杂伦理难题。因此,在ART全过程中加强伦理管理并对其后果进行评价,具有深刻的内涵价值和深远的社会意义。只有发挥生殖医学伦理委员会作为一个工作机构的职能,在医患人群中加强ART技术基本原理及相关伦理原则的宣传教育,强化医学伦理的监督机制,落实充分的知情同意等措施,才能促使医患人群都能够自觉遵守优良的医学伦理道德规范,保证人类辅助生殖技术的健康发展,使ART发挥积极的、革命性的意义。     

涉及人的医学科研项目伦理审查实践体会

本文就国内涉及人的医学科研项目伦理审查现状进行了简要介绍,并结合武汉大学中南医院医学伦理委员会近年来伦理审查的工作实际,对涉及人的医学科研项目伦理审查中存在的共性问题进行了初步探讨,提出管理部门和伦理委员会应加强对研究人员伦理知识的宣传教育,加强科研项目伦理行为的过程监督,保护受试者权益,保证医学科研的健康发展。     

生命伦理学融入组织学与胚胎学实验教学初探

组织学与胚胎学是学习其它医学理论知识的基础,但是课程内容抽象、难懂,学生总处于被动机械学习状态。为使学生参与课堂教学、成为实验教学的驱动力,我们充分利用新校区显微数码互动实验室,积极转变教学观念,科学调整教学环节,尝试生命伦理学融入组织学与胚胎学实验教学模式的探索,激发学生的学习兴趣。通过引导性提问,启发学生独立思考,体现以学生为中心的教育理念。在基础课程学习过程中逐步培养医学生临床诊疗思维,帮助每一位医学生及早建立正确的生命伦理价值观,促进医学科学与医学人文的结合。     

生命健康研究伦理治理中值得关注的三种基本关系——对《涉及人的生命科学和医学研究伦理审查办法》的思考

<正>生命健康领域的研究事关人类福祉，“伦理先行”是生物医学研究的基本要求。早在1964年，第18届世界医学协会联合大会就通过了生物医学伦理的“基本法”——《赫尔辛基宣言》，明确规定“医学研究必须遵守的伦理标准是：促进和确保对人类受试者的尊重，并保护他们的健康和权利”。2016年，国际医学科学组织理事会(Council for International Organizations of Medical Sciences, CIOMS)发布了《涉及人的健康相关研究的国际伦理准则》(简称“CIOMS伦理准则”)，把伦理规范从医学研究扩大到涉及人的健康相关研究。     

Anti-infective therapy at the end of life: ethical decision-making in hospice-eligible patients

Clear guidelines addressing the ethically appropriate use of anti-infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti-infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant pathogens, (5) placing unreasonable costs on a capitated hospice system. Although anti-infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision-making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti-infectives. In this article we articulate important elements in ethical decision-making in the application of anti-infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases.     

Medical ethics and education for social responsibility.

The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor''s responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization.     

Aspects du care et de « l’éthique du care » en psychiatrie

The debate about care and its different forms has developed a lot in social sciences and in moral philosophy, since Carol Gilligan, arguing in a feminist perspective against the prejudices of moral development psychology, has defined an “ethics of care” and claimed that it should be recognized as of the same value as the dominant ethics (Kantian or utilitarian). Following this claim, a variety of researches have been carried out concerning the activity of caring that goes beyond the field of medical practice. However, in the medical field, in which “care” has to be distinguished from “cure,” the development of a theory of care has a strong impact on the conception of treatment (of its organization, its assessment, and the way it is taught). We will focus particularly on what is implied in psychiatry by such a characterization of care.     

Mortal exposure: on the goodness of writing medical ethics

Abstract:Narrative ethics has recently been advanced as an alternative to more "principled" and "theoretical" approaches to medical ethics. This turn prompts reflection on the distinctive activity of writing medical ethics. When writing medical ethics is recognized as a distinct activity, the forms of care it accomplishes can be distinguished from medical care. This distinction enables analysis of how caring for one's own needs as a writer of medical ethics is in productive tension with the ends of caring in medicine. One important good of writing medical ethics is that the act of writing forces one to reflect on the common mortal reality that is a condition of medical experience. Because it provides occasions for reflection on one's own mortality, medical ethics may no longer need immediate medical application in order to claim its contribution to caring.     

Great Expectations: Teaching Ethics to Medical Students in South Africa

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves.     

When a physician and a clinical ethicist collaborate for better patient care

Bioethics is a relatively new addition to bedside medical care in Arab world which is characterized by a special culture that often makes blind adaptation of western ethics codes and principles; a challenge that has to be faced. To date, the American University of Beirut Medical Center is the only hospital that offers bedside ethics consultations in the Arab Region aiming towards better patient‐centered care. This article tackles the role of the bedside clinical ethics consultant as an active member of the medical team and the impact of such consultations on decision‐making and patient‐centered care. Using the case of a child with multiple medical problems and a futile medical condition, we describe how the collaboration of the medical team and the clinical ethics consultant took a comprehensive approach to accompany and lead the parents and the medical team in their decision‐making process and how the consultations allowed several salient issues to be addressed. This approach proved to be effective in the Arab cultural setting and indeed did lead to better patientcentered care.     

Visual Ethnography in an AIDS Hospice for the Socially Abandoned and Terminally Ill

Hospices for people with AIDS and neuropsychiatric complications present themselves as unique case studies of the institutional behavior of patients and caregivers, as well as the effective implementation of public health policy. Using a mix of visual ethnography and first-hand narratives, I explore the workings of a hospice, Philip AIDS Centre, in rural Gujarat, India, and the daily life of its residents. I also consider the ethics and challenges of photographing people with mental illnesses, drawing my examples from the popular media and photography, while mentioning their role in palliative care.     

Spécificité des dilemmes éthiques résultant des travaux développés en neurosciences: émergence d’une neuroéthique

As neurosciences improve our knowledge about the brain for defining behaviour, medical ethics and social policy, what are the implications of new possibilities of technical intervention on our brain? Neuroethics defines a new field of ethics where scientists and ethicists, and also journalists and politicians, are beginning to reflect on social issues resulting from applications of the work of neuroscience in areas such as moral vision, decision-making, conduct and policies. It is likely that the potential application of new knowledge to human behaviour will generate a great deal of ethical and public policy concern in many aspects of everyday life, from child care and school programs to improvements or maintenance of adult capabilities. Neuroscience will also challenge social fields as diverse as forensic psychiatry, sports, corporate hiring and the judiciary. As neurosciences advance, it is important to have a framework that might help to guide the utilization of the new knowledge.     

Sick autonomy

Complex social and economic forces have placed patient autonomy at the center of medical ethics, and thereby displaced an older ethic of physician beneficence. This development arose, and is sustained, by waning trust in the traditional doctor-patient relationship. As patients have increasingly become clients and consumers, a contract basis for medical care has put the ancient covenant of care in jeopardy. Here, a philosophical approach to harmonize the apparent conflicting claims of patient autonomy and physician beneficence is offered by demonstrating that autonomy need not be understood as protecting a threatened identity. If persons are regarded as atomistic, certain defensive notions of individualistic rights-based autonomy prevail; if a relational construction of personal identity is employed instead, then respect for autonomy becomes part of a wider morality of relationship and care. By reconfiguring trust within this latter understanding of personhood, bioethics better balances its concerns over choices and actions with those of relationship and responsibility. Neither atomistic autonomy nor the ethics of responsibility can claim hegemony, for they are mutually interdependent, and a complete account of medicine's moral axis requires that they be integrated. This reorientation is crucial for reasserting the ethos of clinical medicine, whose fundamental mandate remains the care of others.