情境、问题和伦理学进路的变化：《应用伦理学百科全书》--从第1版到第2版

自1998年第一版《应用伦理学百科全书》出版以来,世界发生了变化。千禧年和“9·11”后的情境使得应对恐怖主义变为重点,例如对生物识别技术等技术手段的关注越来越多。然而不仅社会政治情境发生了改变,在科学领域,人类基因组测序、干细胞科学的展望以及合成生物学的兴起都引发了相当大的争论。伦理学问题也日益具有全球意义。第二版百科全书处理了1998年的版本中没有或只略微涉及的问题。然而,它仍然保留了那些被视为“经典”的文章,并在必要时进行更新,以反映对应用伦理学进路思考的进展。在这里,试图勾勒出这期间争论进展的主要趋势和途径。这些途径可分为三类,由于情境的变化,问题的变化和伦理学进路的变化所引起。     

墨西哥全民健康覆盖发展历程及对我国的启示

2003年墨西哥启动卫生改革,建立了覆盖非正式就业人群的大众健康保险,实现全民健康覆盖。为了保证不同健康保障制度的一致性,墨西哥政府为非正式就业人员提供补助,保证他们与正式就业人员健康保障筹资水平相同,进而享有同样的卫生服务。尽管改革取得了很大成效,但依然存在一些问题:卫生系统碎片化、缺少激励提供者改进服务的机制、不同健康保障制度间及不同州之间依然存在不公平、患者自付费用仍然很高、州政府资金未能及时到位。墨西哥卫生改革经验对我国有一定的借鉴意义:医疗保险制度与卫生服务体系改革应同步推进,尽快实现不同医疗保险制度之间的一致性,加强不同部门之间的协调,明确各级政府的筹资责任。     

Big Data : amélioration technique,dégradation ou transformation du modèle de solidarité ?

Big Data, the production of a massive amount of heterogeneous data, is often presented as a means to ensure the economic survival and sustainability of health systems. According to this perspective, Big Data could help save the spirit of our welfare states based on the principles of risks-sharing and equal access to care for all. According to a second perspective, opposed to the first, Big Data would fuel a process of demutualization, transferring to individuals a growing share of responsibility for managing their health. This article proposes to develop a third approach: Big Data does not induce a loss of solidarity but a transformation of the European model of welfare states. These are the data that are now the objects of the pooling. Individual and collective responsibilities are thus redistributed. However, this model, as new as it is, remains liberal in its inspiration; it basically allows the continuation of political liberalism by other means.     

解决移植用器官来源的第三条道路

供体器官来源不足是目前我国人体器官移植领域的主要问题之一。造成这种现象的原因是现存的获取移植器官的框架有着严重的缺陷。对公民大力加强器官移植方面的教育，改变人们对于自身器官的认识，提倡人类团结互助的精神、实行叉务回应原则、同时明确规定给予器官捐献者及其家属以经济和精神上的补偿，可能不失为解决中国大陆供体器官来源比较好的方法，这也是除了现存框架、器官买卖以外的第三条道路。     

反对活体器官移植的伦理论证

针对活体器官移植在我国有日渐增加的趋势，旨在通过活体器官移植的伦理依据的分析，以及考查反对活体器官移植的论证，提出以鼓励活体器官捐赠来增加器官的来源。是一种本束倒置的做法。弥补器官供应的缺口。关键在于合理地利用尸体器官。这就需要对现有的器官移植伦理框架进行调整，构建新的框架。     

Les coûts du handicap au Québec : que font les ménages et comment les soutenir équitablement ?

This article presents the findings of a research about disability costs conducted in the province of Quebec, Canada. It also addresses issues related to social policy. Our findings encompass a wide variety of life activities experienced by different categories of disabled people and their families. Using this qualitative framework, we surveyed over two hundreds types of expenses, but three domains came out strongly: housing, health or personal care, and transportation. Disability costs vary according to types of disability but also relate to socioeconomic status and family configuration. Disability costs, general or specific, are good indicators of special needs and may be useful to design social programs, but they underestimate “deprivation” amongst the poorest. Overall, they underline the limitations of our current social security system and appeals for a new regime of solidarity in order to attain equality.     

Genetic ‘Risk Carriers’ and Lifestyle ‘Risk Takers’. Which Risks Deserve our Legal Protection in Insurance?

Over the past years, one of the most contentious topics in policy debates on genetics has been the use of genetic testing in insurance. In the rush to confront concerns about potential abuses of genetic information, most countries throughout Europe and the US have enacted genetics-specific legislation for insurance. Drawing on current debates on the pros and cons of a genetics-specific legislative approach, this article offers empirical insight into how such legislation works out in insurance practice. To this end, ethnographic fieldwork was done in the underwriting departments of Belgian insurance companies. Belgium was one of the first European countries introducing genetics-specific legislation in insurance. Although this approach does not allow us to speak in terms of ‘ the causal effects of the law’, it enables us to point to some developments in insurance practice that are quite different than the law’s original intentions. It will not only become clear that the Belgian genetics-specific legislation does not offer adequate solutions to the underlying issues it was intended for. We will also show that, while the legislation’s focus has been on the inadmissibility of genetic discrimination, at the same time differences are made in the insurance appraisal within the group of the asymptomatic ill. In other words, by giving exclusive legal protection to the group of genetic risks, other non-genetic risk groups are unintendedly being under-protected. From a policy point of view, studying genetics-specific legislation is especially valuable because it forces us to return to first principles: Which risks deserve our legal protection in insurance? Who do we declare our solidarity with?