生命伦理学及其文化、学术和技术氛围

生命伦理学发端于西方发达国家,已经被打上鲜明的西方文化印记,这对该学科的发展是不利的。为此,本文提出以下可供选择的建议。1．加强东西方文化的交流与沟通,为生命伦理学创造坚实的多元文化基础。如美国的伦理学有宗教观念世俗化移植的气息,中国的传统伦理观念有政治渗透的气息,它们都不是尽善尽美的,不能简单地成为生命伦理学的理论基础。2．重视生命伦理学“底线”的研究,为其提供相对宽松的学术氛围。将西方发达国家的伦理信条简单移植到发展中国家是难以奏效的。应该制定通用的伦理学底线,让不同的国家根据自己的实际情况研究制定适宜的伦理法规,特别是注重防堵与疏导相结合,才能促进生命高科技的健康发展。3．生命伦理学应该鼓励科学家采取多种技术路线,探索生物医学领域的难题。如组织工程学、自体干细胞移植、诱导细胞转化等方法有可能比胚胎干细胞更早取得突破性进展,生命伦理学同样应该给予关注和鼓励、支持。     

医学伦理学与生命伦理学研究和教育实践的回顾与展望——庆祝中国医学伦理学与生命伦理学研究30周年

在庆祝中国医学伦理学与生命伦理学研究30周年之际,回顾并展望广东省医学伦理学研究中心、广州医学院医学伦理学和生命伦理学的发展历程,其主要经验是：提高认识,把医学伦理学作为重点课程、学科来建设;建立研究机构进行专题研究与学术交流,举办骨干培训班;关注热点问题,开展生命伦理学研究。     

走出生命伦理的两难困境

两难困境是生命伦理的一个重要特征,需要理性面对。这种两难首先是由科技自身的发展所引起的,同时也与文化差异和利益冲突密切相关,其实质是价值选择。走出生命伦理的两难困境,在理念层面要促进科学与伦理的良性互动;在实践层面要切实加强生命伦理委员会建设,但两难困境不会消失。     

当代中国生命伦理学研究与发展的思考

生命伦理学在我国有近20多年的发展历史.虽然它的发展取得了一些成果,但也存在许多问题,直接影响到生命伦理学在我国的茁壮成长.分析我国生命伦理学研究与发展存在的问题,并提出我国生命伦理学发展的对策,是我国的生命伦理学研究需要迫切解决的问题.     

How should doctors approach patients? A Confucian reflection on personhood

The modern doctor-patient relationship displays a patient-centred, mutual-participation characteristic rather than the former active-passive or guidance-cooperation models in terms of medical decision making. Respecting the wishes of patients, amounting to more than mere concern for their welfare, has become the feature central to certain modern bioethics theories. A group of ethical principles such as respect for autonomy, beneficence, non-maleficence, and justice has been proposed by bioethicists and widely adopted by many medical societies as an ethical guide to how doctors, in their daily practice, should treat their patients. However, seeing patients as persons who are rational, self-conscious beings capable of valuing their own lives, and who are consequently entitled to the liberty and rights to choose for themselves, is in general the backbone of Western bioethical principles. Since Confucian philosophy has long been a representative of the East-Asia cultural tradition and Confucian bioethics has recently been developed as a theory of applied ethics, examining Confucius's idea of "persons" may shed some light on the current bioethical debates. Confucius's concept of persons, which is best interpreted via his theories of "chun-tze", (the morally ideal person) encapsulating a two-dimensional approach, (the "autonomous person" and the "relational person"), provides a more comprehensive model regarding what a person is and how he/she should be treated. This two-dimensional approach sees a person not only as a rational, autonomous agent but also as a relational, altruistic identity whose self actualisation involves incessant participating in and promoting of the welfare of his fellow persons. Hence this may balance the current bioethical trend whereby "respect for autonomy" often triumphs.     

生命伦理学视野中的儒家伦理及其当代价值

中国传统儒家伦理可以为生命伦理学提供深厚的文化根基。从生命伦理学的视野探讨儒家的生死观、天人整体观、人伦秩序原则和儒家的见利思义原则,吸取儒家传统文化中的有益成分,剔除其糟粕,为当代生命伦理学研究提供借鉴。     

生命伦理学及其相关公共政策的研究现状

生命伦理学是始于20世纪70年代的一门交叉学科,主要研究生命科学给人类社会生活和伦理道德带来的诸多后果与负面影响.本文综述了中国生命伦理学的研究现状,有关遗传学和克隆技术争论的一些国内外学术研究成果,对国内外相关政策制定情况做了简要比较,并提出我国政府在考虑生命伦理学问题和制定公共政策时需注意的一些问题:正视争论存在、立足本国国情、加强中外交流、重视公众参与以及增加决策过程透明度.     

促进科学与伦理的良性互动——国家人类基因组南方研究中心伦理学部工作体会

介绍了国家人类基因组南方研究中心伦理学部自成立以来开展的主要工作：开展生命伦理前沿研究,为主管部门制订政策和规范提供参考;普及生命伦理知识和理念;参与伦理评审,推进伦理委员会建设;开展国内外学术交流。并表达了工作体会,科学家与伦理学家需要携手合作,共同促进科学技术与伦理道德的良性互动。在伦理审查和监督中,尽可能地把科学与伦理统一起来,确保研究的科学性。     

儒家生命伦理之方向与实践：同情共感与理性分析并进之路

在中国传统中,儒释道三家都对生命有不同的体认和重要的观点。而儒家从仁心或不忍人之心建立道德之根源,正视人之存在实况,重视伦常中的个人与家庭、社会、国家以致天下都能有和谐平衡的考虑,在生命伦理学的基本取向上,儒家是以人作为一道德行动者,人间世界是一道德社群为出发点。这些观念不但对我们有重要的生命伦理的意义,对于调整西方生命伦理学的方向,也有重要的启示。故尝试结合西方理性分析的方法,引论儒家关怀生命受伤害之同情共感的道德取向,申论当代儒家的生命伦理学的基本论点。     

Moral experience: a framework for bioethics research

Theoretical and empirical research in bioethics frequently focuses on ethical dilemmas or problems. This paper draws on anthropological and phenomenological sources to develop an alternative framework for bioethical enquiry that allows examination of a broader range of how the moral is experienced in the everyday lives of individuals and groups. Our account of moral experience is subjective and hermeneutic. We define moral experience as "Encompassing a person's sense that values that he or she deem important are being realised or thwarted in everyday life. This includes a person's interpretations of a lived encounter, or a set of lived encounters, that fall on spectrums of right-wrong, good-bad or just-unjust". In our conceptualisation, moral experience is not limited to situations that are heavily freighted with ethically-troubling ramifications or are sources of debate and disagreement. Important aspects of moral experience are played out in mundane and everyday settings. Moral experience provides a research framework, the scope of which extends beyond the evaluation of ethical dilemmas, processes of moral justification and decision-making, and moral distress. This broad research focus is consistent with views expressed by commentators within and beyond bioethics who have called for deeper and more sustained attention in bioethics scholarship to a wider set of concerns, experiences and issues that better captures what is ethically at stake for individuals and communities. In this paper we present our conceptualisation of moral experience, articulate its epistemological and ontological foundations and discuss opportunities for empirical bioethics research using this framework.     

Principles of ethics review on traditional medicine and the practice of institute review board in China

As one of the significant parts of medical science research in China,the research on Chinese medicine(CM) reflects the essence of healthcare tradition in the country both theoretically and clinically, and embodies the values of Chinese culture.Therefore,in the practice of ethics review on CM research protocols,besides abiding by the contemporary prevalent international principles and guidelines on bioethics, which emphasizes the scientific and bioethical value of the study,we should also stress the CM theoretical background and relevant clinical experience in the framework of Chinese culture and values.In this paper, we went over the traits of CM clinical research and the experience from the practice of ethics review by the institution review board for bioethics,and then attempted to summarize the key points for the bioethics review to CM researches in China,so as to serve as reference for the bioethics review to traditional and alternative medicine researches.     

Bioethics in the public square: reflections on the how

As bioethics gains more prominence in public policy debates, it is time to more fully reflect on the following: what is its role in the public square, and what limitations relate to and barriers impede its fulfilment of this role? I contend we should consider the how of bioethics (as a policy influencer) rather than simply focus on the who or what of bioethical enquiry. This is not to suggest considerations of latter categories are not important, only that too little attention has been paid to parallel or resulting policy involvement-involvement that will require specialised skills and knowledge that we can develop with a proactive (vs reactive) stance. Moreover, and equally critically, this how of public policy involvement will require more transparency regarding influences (eg, philosophical, ideological, cultural, socio-political) on what bioethicists bring to the table and what constituency base each represents-a humility as to the scope of one's role. In this vision, bioethics is not one single person or belief system for a policymaker to call to guide or give support to a position; rather, it offers tools-formed and utilised by a diverse disciplinary range of individuals-to help guide ethical analysis of biomedical endeavours, with the goal of infusion and diffusion of ethical enquiry and prioritisation in health policymaking, and greater humility among bioethicists who inform this discussion.     

临床生命伦理分析的经验主义视角

在当今国际世界,生命伦理学已从20世纪中叶问世的新学科发展成一种国际性的“社会运动”。在临床生命伦理学实践中,西方学者最为关心的是临床生命伦理分析的方法论问题,简要地介绍分析当代欧洲临床生命伦理分析的经验主义视角,探讨生命伦理学与自然主义之间的互动,借助当代主流伦理学的发展,回答临床生命伦理分析中的“是”与“应当”问题,以期对我国的临床生命伦理理论和实践的发展提供借鉴。     

生命伦理学学科发展的回顾与展望

中国的生命伦理学作为从西方引进的一门年轻学科，在近三十年来取得了巨大的发展成就；然而，其在思想本源和学术发展等方面也一直存在着一定的困惑。观察西方生命伦理学学科成长的趋势和当代社会生活的变化，中国的生命伦理学应当转向对大众生命质量的关注，在关注现实中体现其思想深度和学术价值。     

疼痛：生命伦理学的一个重要话题

疼痛是生命伦理学的一个重要话题。疼痛——这一看似简单的身体症状却蕴涵着沉重而深厚的生命价值承载。西方生命伦理学对疼痛已有数十年的研究和讨论，但在我国相关的研究却很薄弱。从对于疼痛的理解，关于疼痛的生命伦理学争论，关于疼痛与疾病的叙事，以及疼痛——生命伦理学深层研究的一个进路四个方面展开对于疼痛的生命伦理学的研究。     

Should post-trial provision of beneficial experimental interventions be mandatory in developing countries?

The need for continuing provision of beneficial experimental interventions after research is concluded remains a controversial topic in bioethics for research. Based on the principle of beneficence, justice as reciprocity, concerns about exploitation and fair benefits, participants should be able to have continuing access to benefits beyond the research period. However, there is no consensus about whether or not post-trial provision of beneficial interventions should be mandatory for participants from developing countries. This paper summarises recommendations from international and national guidelines. Ethical principles and practical issues relating to post-trial provision are also discussed. In conclusion, post-trial provision is not necessary in all situations and a set of criteria are proposed to identify the situations that beneficial interventions should be provided beyond the research period. However, mandatory post-trial supply of beneficial experimental interventions should be assured for those who still need and are able to benefit from them but have no alternative access. Mandatory provision is based on universal bioethical principles such as beneficence and justice. Furthermore, difficulties associated with implementation of post-trial provision are not unmanageable. Careful advanced planning and a comprehensive partnership among relevant parties would be very helpful in solving these difficulties in practice, which therefore should not be taken as an excuse to escape post-trial responsibility.     

知情同意原则与文化背景——中美生命伦理学比较研究之一

通过回顾中美知情同意原则的历史发展认为;由于两国存在着深刻的文化背景差异。因而在执行知情同意原则时具有不同的行为主体。进而指出：这种文化背景差异所造成的民众心理差异是很难跨越的。这必然导致中美生命伦理学进行比较研究时的某种不可通约性。     

和而不同:生命伦理的世界性与民族性

和而不同,可以理解为多样性的统一,或多样性的协调.它对认识和处理生命伦理的世界性与民族性极富教益：一方面,充分考虑生命伦理的世界性,通过交流和协商,求得共识、达成协议.即使不能达成协议,也要增进相互的了解和理解;另一方面,它允许各个国家和民族从自身的国情和文化传统出发,允许对生命伦理问题有不同的理解和做法.     

Theoretical resources for a globalised bioethics

In an age of global capitalism, pandemics, far-flung biobanks, multinational drug trials and telemedicine it is impossible for bioethicists to ignore the global dimensions of their field. However, if they are to do good work on the issues that globalisation requires of them, they need theoretical resources that are up to the task. This paper identifies four distinct understandings of 'globalised' in the bioethics literature: (1) a focus on global issues; (2) an attempt to develop a universal ethical theory that can transcend cultural differences; (3) an awareness of how bioethics itself has expanded, with new centres and journals emerging in nearly every corner of the globe; (4) a concern to avoid cultural imperialism in encounters with other societies. Each of these approaches to globalisation has some merit, as will be shown. The difficulty with them is that the standard theoretical tools on which they rely are not designed for cross-cultural ethical reflection. As a result, they leave important considerations hidden. A set of theoretical resources is proposed to deal with the moral puzzles of globalisation. Abandoning idealised moral theory, a normative framework is developed that is sensitive enough to account for differences without losing the broader context in which ethical issues arise. An empirically nourished, self-reflexive, socially inquisitive, politically critical and inclusive ethics allows bioethicists the flexibility they need to pick up on the morally relevant particulars of this situation here without losing sight of the broader cultural contexts in which it all takes place.     

The Olivieri debacle: where were the heroes of bioethics?

All Canadian bioethicists need to reflect on the meaning and value of their work, to see more clearly how the ethics of bioethics is being undermined from within. In the case involving Dr Olivieri, the Hospital for Sick Children, the University of Toronto, and Apotex Inc, there were countless opportunities for bioethical heroism. And yet, no bioethics heroes emerged from this case. Much has been written about the hospital's and the university's failures in this case. But what about the deafening silence from the Canadian bioethics community? Given the duty of bioethicists to "speak truth to power", this silence is troubling. To date, nothing has been written about the silence. This article is intended as a partial remedy. As well, the article pays tribute to heretofore unsung heroes among Dr Olivieri's research colleagues.