Liver,pancreas and small bowel transplantation: Current ethical issues

We describe the medical state of the art in liver, pancreas and small bowel transplantation, and portray the ethical issues. Although most ethical questions related to these transplantations are not specific for liver, pancreas and small bowel, they do challenge ethical analysis as well as new policies and clinical procedures. Firstly, outcomes continue to be of utmost concern, as information is only limited available, is developing over time and is surrounded by many uncertainties. Secondly, characteristics of donors and recipients should be carefully evaluated. The question of what qualifies a donor and a recipient should be considered against the background of a quest for extended criteria, embracing marginal cases, and a judgment with regard to what counts as a good enough outcome. Thirdly, ethical principles of autonomy and fairness are pushed, given the circumstance of severe scarcity, towards limits that can easily be crossed.     

The temporal course of the influence of anxiety on fairness considerations

This study investigated the potential causes of anxious people's social avoidance. The classic ultimatum game was utilized in concert with electroencephalogram recording. Participants were divided into two groups according to levels of trait anxiety as identified by a self‐report scale. The behavioral results indicate that high‐anxious participants were more prone to reject human‐proposed than computer‐proposed unequal offers compared to their low‐anxious counterparts. The event‐related potential results indicate that the high‐anxious group showed a larger feedback‐related negativity when receiving unequal monetary offers than equal ones, and a larger P3 when receiving human‐proposed offers than computer‐proposed ones, but these effects were absent in the low‐anxious group. We suggest anxious people's social avoidance results from hypersensitivity to unequal distributions during interpersonal interactions.     

Fairness concerns predict medial frontal negativity amplitude in ultimatum bargaining

Abstract

Despite evidence that anterior cingulate cortex (ACC) activity is related to social exclusion, rejection and unfairness, evidence that medial frontal negativity (MFN), which has its source in the ACC, reflects these constructs remains unforthcoming. In the present study, subjects participated as recipients in an ultimatum game, while we recorded their electro-encephalogram (EEG). Participants responded to fair and unfair offers from different human proposers. In addition, participants rated themselves on a measure evaluating their concern for fairness. Results showed that MFN amplitude was more pronounced for unfair offers compared to fair offers. Moreover, this effect was shown to be most pronounced for subjects with high concerns for fairness. Our findings suggest that the MFN not only reflects whether outcomes match expectations, but also reflects whether the process by which these outcomes came about matches a social or even a moral norm. In addition, the present results suggest that people in bargaining situations are not only concerned with their own outcomes, but are also concerned with the fairness of the process that resulted in these outcomes.     

情绪诱导对孤独症儿童公平决策的影响

研究通过视频诱导的方式,诱导出孤独症儿童悲伤的情绪,探讨被诱导的情绪对孤独症儿童在最后通牒任务中决策行为的影响。被试为13名情绪诱导组孤独症儿童及13名情绪控制组孤独症儿童参与实验。结果发现,孤独症儿童作为接受者时,诱导出悲伤情绪的孤独症儿童比控制组的孤独症儿童在面对2：8、3：7、4：6的不公平分配比例时,表现出更多的负性情绪,并倾向于做出拒绝的决策。但是面对极端的0：10、1：9不公平分配时,视频诱导的情绪对决策是没有作用的,两组被试之间不存在显著差异。通过呈现视频的方法诱导出与最后通牒任务无关的情绪也会影响孤独症儿童在最后通牒任务中的表现。     

El médico frente a la COVID-19: lecciones de una pandemia

Apart from its enormous health and economic impact, the COVID-19 pandemic has changed the way of practicing medicine and medical education. It is likely that this effect may accelerate the transformation that both activities are experiencing. The present article, written at the peak of the crisis, sets out some thoughts on four topics: 1) the publication of false and sensationalist news; 2) the risks of taking medical decisions not based on the evidence; 3) the bioethical implications when there are sufficient resources available for everybody and; 4) the possible effects of the crisis on the teaching of medicine.This crisis should enable doctors, teachers and, students of medicine to draw conclusions and be better prepared for the future. Firstly, it is essential to maintain critical thinking that may protect against the ‘infodemic’. Furthermore, the scientific and ethical standards learned in the faculty, should not be forgotten. Lastly, it should be remembered that, in a devastating pandemic like the current one, apart from scientific medicine, which is practised with the brain, the other medicine that is practiced with the heart must also be practised.     

精神病专科医院应以人文理念体现社会责任

公立医院改革进入攻坚之年,作为以收治精神疾病为主的精神疾病专科医院该如何推进,这无疑是一个亟需解决的问题。本文通过对人文理念与社会责任的关系进行探讨,并分析了精神病专科医院的社会责任与价值,希望能在精神病专科医院如何发展这一问题上给予一定的借鉴意义。     

乡镇卫生院产权制度改革中的政府职能

从十七大报告中看出，在现有国情下，为达到“为群众提供安全、有效、方便、价廉的医疗卫生服务”，“鼓励社会参与”仍然必要。乡镇卫生院产权制度改革就是“社会参与”的一种体现，但“参与”过程中存在的问题要求政府在实现其职能过程中紧掌公平之舵：乡镇卫生院产权制度改革的目标是实现人人享有卫生服务的公平；过程要确保参与各主体的公平得利。     

Patient characteristics and fairness

This study examines the fairness concept of health care professionals, and asks whether they are willing to use a patient’s age and other potential fairness characteristics rather than health benefits as relevant arguments in the allocation of health care resources? The patient characteristics in the health care professionals’ survey encompass age, productivity and lifestyle. The study is a replication of a much older study from the 1970s. The present study finds that the understanding of fairness among health care professionals differs from concepts of fairness in legislation. The status of various patient characteristics as rationing arguments has remained much the same, although nowadays health care professionals are expected to be more aware of moral dimensions and also legislation on patients’ rights. The fairness concept of health care professionals may lead to resource allocation decisions that deviate from the intention of such legislation.     

医学生诚信教育与公正团体策略

借鉴科尔伯格的公正团体策略,以班级为实施团体,学校、家庭和社会通力合作：在医学生诚信教育中以自主性、选择性道德人格教育为教育理念;贯彻公正民主参与的核心内容;以道德责任感教育为落脚点,构建民主参与的诚信氛围;注重日常生活中的诚信教育,促进医学生诚信品质的培养。     

村级卫生人力资源配置的伦理问题分析——基于B市M县村卫生室的实地观察研究

实地观察研究发现,目前B市M县村卫生室的设置状况和村医的配置存在以下伦理问题:基于服务人口数量的村卫生室配置无法保障公平;公共产品的市场运作方式导致公共卫生服务提供不足;职业素养趋弱的村医队伍影响农民卫生服务利用的可及;基本药物落地制度现状影响村民对村医的选择与信任;新农合定点医疗机构的纳入与否影响参合农民的均等受益.