种植义齿修复的医学伦理问题

种植义齿是一项新的修复缺失牙方法，本文从医学伦理学的角度出发，探究种植又齿修复过程中应遵循的医德原则，医师高度的责任心、精湛的医术和正确的口腔宣教是保证种植义齿修复成功的关键。     

从病情危重度与住院费用的关系看卫生服务的公平性

公平合理地分配卫生资源是制定卫生政策的重要医学伦理学原则之一。作者在对高血压患者危重度分级的基础上，通过分析患者危重度等级与住院费用的关系，揭示了住院患者的资源消耗量与实际医疗需求相脱节的现象，提示我国卫生资源分配的公平性有待进一步提高。     

Droit à mourir et suicide assisté : état des lieux et analyse critique

ObjectivesIn the context of the present re-examination of the French bioethical laws by the National Advisory Ethics Committee (“Comité consultatif national d’éthique”: CCNE), a recent survey indicated a request of the public opinion to obtain a medical aid in end of life and a so-called “assisted suicide”. This led psychiatrists to re-consider their role and deontological position which usually led them to consider a request for an assistance in suicide as – a priori – a pathological demand, occurring within a suicidal crisis. The present article intends to: 1) describe the laws and practices of countries which allow medically assisted end of life help procedures; 2) clarify the definitions of “assisted suicide”, “assistance to suicide” and “euthanasia”; 3) consider available epidemiological data and the roles given to doctors and, more specifically psychiatrists, in these procedures; 4) analyse the rationale behind these demands. These considerations should enable French psychiatrists to clarify their position when facing requests for a medical aid in dying.MethodsFour European countries (Switzerland, the Netherlands, Belgium, Luxemburg) and Oregon (the first US state to introduce legislation) were considered, since they accumulated and published a large amount of experiences and data about “assisted suicide” and medical help in dying. In total, 127 articles were selected, mainly from PubMed and Cairn databases, published between 1997 and 2020. These articles deal with legal considerations, epidemiological data, ethical and sociological considerations.ResultsLaws and practices differ notably according to the state/country. In Belgium, the Netherlands and Luxemburg, as in Oregon, the medical help in dying has been de-criminalized, as long as certain legal criteria are met. In Switzerland, where no specific law exists in the penal code, non-governmental associations have benefited from the legal vacuum and organized the practice of “assisted suicide” for “altruistic motives”. In the scientific and legal literature, the terms used to describe and define the medical help in dying upon request differ greatly. In France, the National Advisory Ethics Committee defines euthanasia (“euthanasie”), assisted suicide (“suicide assisté”) and suicide assistance (“assistance au suicide”). Available epidemiological data, whatever the country considered, indicate that requests for a medical aid in dying are expressed mainly by patients aged over 60 years and suffering from cancer. Psychiatric diseases account for only 1% to 3%. Most often, systematic assessment by a psychiatrist is neither requested nor made, when the demand does not occur during a primary psychiatric illness. In the case of an existing primary psychiatric pathology, a psychiatrist assesses the case against formal legal predefined criteria. This latter practice was only recently introduced, after some feedback and after legal actions had been brought to Court. When the underlying motivations of the request are considered, it appears that, even in the absence of an evolving psychiatric condition, several psychological or psychopathological reasons prevail such as spirituality, attachment style, social isolation, despair, depression… which should greatly benefit psychiatric exploration, investigation and expertise.ConclusionIn some countries, the request for medically assisted help in dying has become a legal and social reality. In France, where the public debate is still open, it should be emphasized that a psychiatric assessment and interview should be systematically provided to any person requesting medical assistance to die or commit suicide. It is the commitment of psychiatrists to understand the implicit demands and unexpressed motives underlying this request which have strong links with the unique life-events and emotional experiences of the person. The psychiatrist has a unique role in the contextualization of such a request.     

Demise of the stethoscope

Medical practice has undergone a massive drift over the past several years. With the advent of modernization and technical advancements in both diagnostic and therapeutic fields, bedside clinical skills have suffered a setback. Increasing patient load in the hospitals, administrative commitments of the physicians, and need to get superspecialty fellowships are some of the factors which preclude resident teaching, which, in-turn hamper their long-term clinical skills and influence the patient–doctor relationship. In this perspective, I narrate my own experience regarding changing attitude of the younger generation of doctors toward patient care and also describe the role of a mentor in shaping the believes and practices of his medical students. Using real-world examples, I further discuss the obstacles which hamper good medical practice and suggest possible ways to overcome some of them.     

研究生阶段医学伦理学教育相关问题的调研

医学伦理学在培养合格的高级临床/科研型医学人才过程中起着非常重要的作用。本科生阶段教育和专业背景的不同可能导致研究生对医学伦理学的认识存在差异，并可能影响所参与的医学研究项目。针对这一情况，作者通过书面问卷的方式，对某校2012级研究生进行了医学伦理学知识和实践水平的初步调查。结果发现调查对象的医学伦理学素养距离实现医学院校普遍的培养目标，以及社会对高级临床或科研人才的需求，仍然存在较大差距。当前转化医学研究方兴未艾，医学伦理学知识和能力的缺乏可能会带来非常负面的影响。因此，作者认为医学研究生的培养过程中亟需强化医学伦理学的补救性教育，并且以案例分析为主的讲座或讨论模式应该是实施过程中的有效手段。     

病案管理中的医学伦理

病案管理是现代医疗质量管理的重要组成部分,医学伦理原则体现在病案管理的各个环节.病案管理要求各项病案管理操作满足符合患者利益、保护患者隐私权、尊重患者知情权及遵守法律等医学伦理要求.医学伦理贯穿于病案管理的始末,包括病案书写中的住院问诊、临床检查、诊疗计划、手术治疗、日常查房,病案归档中的纸质病案和电子病案的收集、整理、汇总和保存等,病案提供中的患者或第三方对病案资料的获取、临床或科研人员对病案资料的获取等方面.     

建立网络化医德档案管理系统实践

基于网络技术设计开发医德档案管理系统，分析系统需求和技术特点，阐述其功能实现，包括员工管理、医德事项管理以及权限管理，并对应用效果进行评价。     

从天价医药费事件折射出当前我国医疗机构存在的问题

目前，我国许多医院的医疗卫生工作人员在为患者进行医疗卫生服务的过程中，为了医院和个人的经济利益，存在着过度医疗消费现象。最典型的是哈尔滨医科大学第二附属医院发生的天价医药费事件。导致这种现象出现的原因是由于法律的不健全、制度的不完善等而导致的监督力度不够，加之有些医务工作者在经济利益的驱使下使自己的职业道德滑坡，从而导致了老百姓看病贵现象的出现。