Justice and medical ethics

Justice, in the sense of fair adjudication between conflicting claims, is held to be relevant to a wide range of issues in medical ethics. Several differing concepts of justice are briefly described, including Aristotle's formal principle of justice, libertarian theories, utilitarian theories, Marxist theories, the theory of John Rawls, and the view--held, for example, by W.D. Ross--that justice is essentially a matter of reward for individual merit.     

Fault and the allocation of spare organs.

This paper argues that rectificatory justice should supplement distributive justice in allocating priority of access to scarce medical resources. Where a patient is at fault for the scarcity of healthy organs a principle of restitution requires that she should give priority to the faultless. Such restitution is non-punitive, and is akin to reparation in civil law, not criminal law. However, it is doubtful whether such a principle can be fairly applied within the present culture of governmental complicity in cigarette advertising.     

灾后重建过程中卫生资源配置的伦理学探讨

在灾后重建工作中,卫生系统的重建占有举足轻重的地位,其核心问题是卫生资源的重新配置,其应遵循的伦理原则有公益性原则、公平性原则、效率性原则。卫生系统重建过程中的公平性包括健康保障的公平性、资源配置的公平性、政策制度的公平性。     

由傅彪的两次肝脏移植引起的伦理反思——稀缺卫生资源分配公正问题

处于肝癌晚期的病人傅彪进行了两次肝脏移植手术后死亡，这一事件引起了广泛的伦理关注。关于分配，存在四种实质性的分配原则：平等原则、需要原则、贡献原则、努力原则。我国在进行稀缺卫生资源分配时，应该首先基于生命价值平等的考虑，坚持医学标准优先，同时体现效用原则和平等原则，以期达到分配公正。     

Beneficence: doing good for others

Gillon's essay on beneficence is one in a series of British Medical Journal articles on philosophical medical ethics. The duty of beneficence, or doing good for others, figures more prominently in medicine than in most other professions. As important as beneficence is in the physician patient relationship, however, it must be tempered by respect for the patient's autonomy; by the duty of nonmaleficence, or of doing no harm; and by a concern for justice, especially in the allocation of scarce medical resources.     

诚实信用原则的价值考察与内涵界定

诚实信用原则在民法中具有重要地位,被称之为“帝王条款”。其功能在于弥补了成文法的局限性,当实质正义与形式正义相冲突时,法院可行使自由裁量权运用诚实信用原则对实质正义进行微调。而在我国,诚实信用更重要的意义在于要求个人、企业遵法纪,以公平正义约束自身行为的妥当性。     

我国医疗资源配置公正的必要性和有限性原因探析

分析医疗资源公正的必要性:人的平等健康权必然要求医疗资源配置公正、农村和城市中低收入阶层医疗需求的增长、市场调节的趋利性导致卫生资源占有的差距;探讨医疗资源公正的有限性:平等的有限性、医疗资源的有限性、社会转型期和城乡二元经济结构的影响等,为提高医疗政策的合理性以及医疗服务的可及性提供参考.     

药物经济学概论

药物经济学是将经济学的基本原理、方法和分析技术运用于临床药物治疗过程,以求最大限度的合理利用卫生资源的一门新兴边缘学科。随着澳大利亚和加拿大安大略省政府要求对药物进行经济学评价,药物经济学研究开始被越来越多的国家所鼓励和采用,主要被应用于药品定价、决定药品补偿和共付状况、制定医院用药目录或诊疗规范以及促进合理处方等方面。药物经济学研究仍需进一步的规范,应从多方面评价其质量。     

Bioethics for clinicians: 13. Resource allocation

Questions of resource allocation can pose practical and ethical dilemmas for clinicians. In the Aristotelian conception of distributive justice, the unequal allocation of a scarce resource may be justified by morally relevant factors such as need or likelihood of benefit. Even using these criteria, it can be difficult to reconcile completing claims to determine which patients should be given priority. To what extent the physician's fiduciary duty toward a patient should supersede the interests of other patients and society as a whole is also a matter of controversy. Although the courts have been reluctant to become involved in allocation decisions in health care, they expect physicians to show allegiance to their patients regardless of budgetary concerns. The allocation of resources on the basis of clinically irrelevant factors such as religion or sexual orientation is prohibited. Clear, fair and publicly acceptable institutional and professional policies can help to ensure that resource allocation decisions are transparent and defensible.     

论卫生改革面临的医德冲突及医德价值导向

分析了卫生改革面临的5个方面的医德矛盾冲突;界定医德价值导向的内涵,指出深化医疗卫生改革必须以集体主义和全心全意为病人服务作为医德价值导向;为培育正向的医德价值导向机制,在今后的医疗卫生改革中应注意:正确认识医疗卫生改革与医德建设的辩证关系,坚持“两手抓”;充分发挥医德教育的利益导向功能;坚持社会主义公正原则;正确引入社会主义竞争机制;实行利益分割原则,建立利益趋向疏导机制。     

利用门诊挂号信息探索区域医疗资源情况

目的 对某地区的基层医疗机构的门诊挂号信息进行回顾性分析，从不同维度对该地区医疗资源进行讨论，便于行政医疗机构动态了解该区域医疗资源发展情况，以便合理进行优化调度和科学发展。方法 通过基层平台收集该地区2022年3月至5月的门诊挂号信息，利用Python语言对数据进行预处理后，从不同维度探索该区域的医疗资源信息。结果 该地区基层医疗卫生资源十分匮乏且不平衡，基层医疗机构注重业务发展而忽略信息化的建设。结论 该地区基层医疗资源配置不容乐观，应借助信息化手段，进行科学、合理规划该区域内医疗资源信息，为区域内城乡居民提供更好的医疗卫生服务。     

日记所见清代士人就医行为的地域差异

由《寻乐堂日录》、《甲初日记》、《康复日记》、《李文清公日记》等几种日记可知,清代身处不同地域的士人由于医疗资源的差异而有着不同的“就医行为”。经济发达的城市中从医人员数量多,医疗资源易于获取,所以病患倾向于有病即刻求医,甚至频繁更换医者,期望获得最佳诊疗效果,医患双方的关系也相对简单。县域中由于医者数量较少,医疗资源获取不易,所以病患就医往往费时费事,有可能迁延很久,因而不得不自我诊疗,而一旦选定医生,医患双方会维持着相对稳定的密切联系。由于整体医疗水平的限制,不同地域的不同士人在无助时也往往寻求于外在的神秘力量。     

Teaching medical students about fair distribution of healthcare resources

Healthcare package decisions are complex. Different judgements about effectiveness, cost-effectiveness and disease burden influence the decision-making process. Moreover, different concepts of justice generate different ideas about fair distribution of healthcare resources. This paper presents a decision model that is used in medical school in order to familiarise medical students with the different concepts of justice and the ethical dimension of making concrete choices. The model is based on the four-stage decision model developed in the Netherlands by the Dunning Committee and the discussion that followed its presentation in 1991. Having to deal with 10 medical services, students working with the model learn to discern and integrate four different ideas of distributive justice that are integrated in a flow chart: libertarian, communitarian, egalitarian and utilitarian.     

Availability of mental health resources for residents in academic medical centers

In a survey on the availability of mental health resources for medical students and residents in academic medical centers, the author found that most centers offer some mental health assistance to medical students but few centers provide any formal mental health assistance to house officers. The structures and limitations of the programs for residents are described in this paper. Therapists lacking comprehensive training are frequently employed in these programs. The author concludes that the emotional needs of residents are not being adequately addressed.     

A philosophical approach to rationing

Rationing, the equitable allocation of medical resources, is both an economic and moral challenge--economic, because the various components of healthcare must be budgeted; moral, because the prioritisation of these resources is a value-laden decision. The moral debate about rationing pits individual choice against communal interests. The advocacy of equitable distribution of healthcare resources originates in arguments for distributive justice and a revised version of individual autonomy. If autonomy is defined strictly in terms of atomistic individuality, then the social obligations and duties of persons are subordinated to their individual rights. Alternatively, when people are defined by their relationships, "relational autonomy" balances responsibilities against the claims of individual rights to maximise distributive justice. The concept of relational autonomy provides medicine with a philosophical basis for communal rationing of healthcare resources.     

区域内检查检验结果共享的实现

为有效降低医疗费用,缓解患者“看病难、看病贵”问题,从检查、检验结果共享互认标准规范研究,共享数据采集系统的研发,检查、检验结果互认原则的研究,检验结果共享平台的研发和实验室间质量控制评价体系的研究等五个方面,详细阐述了如何通过网络平台和信息技术,建立区域内病人的检查、检验结果共享数据中心,达到检查、检验结果互认,以减少重复检查、检验,充分合理利用医疗资源、简化就医环节,切实体现以人为本的服务理念。     

瘀热相搏证的系列研究(二)

瘀热相搏证的提出充实和发展了中医的病机辨证和治疗学内容,文章主要内容包括:瘀热的概念、瘀热的形成、瘀热的主要病理变化、瘀热的临床表现、瘀热的类型、瘀热的治疗原则、瘀热相搏证的系列研究、瘀热学说的意义,并附医案2则.     

人类辅助生殖中的卵子分享模式研究

人类卵子具有精密性?稀缺性?人身性和伦理性等特征,在人类辅助生殖中价值独特?受卵子来源限制和研究用卵子需求增加等影响,辅助生殖治疗用卵子供不应求?为缓解卵子供需矛盾,一些国家努力探索适合本国国情的卵子供给模式?卵子分享模式较之于无偿捐赠模式和买卖模式,更符合公平?有利的伦理原则,是增加卵子供给的理想选择?目前我国已在实践卵子分享模式,但制度建构尚不完善?我国应积极借鉴国外有益做法,构建适合我国国情的卵子分享制度?     

瘀热相搏证的系列研究（二）

瘀热相搏证的提出充实和发展了中医的病机辨证和治疗学内容，文章主要内容包括：瘀热的概念、瘀热的形成、瘀热的主要病理变化、瘀热的临床表现、瘀热的类型、瘀热的治疗原则、瘀热相搏证的系列研究、瘀热学说的意义，并附医案2则。     

Five ethical doctrines for medical education.

In recent years a relative barrage of journal articles has surfaced concerning the formal instruction of medical ethics in our medical schools. Philosophical debates usually ensue over either the conspicuous absence (or, in some cases, the questionable need (I) (2) of a formal ethics course, or the manner and method by which ethics is to be taught (3). There is, however, a paucity of literature as to what constitutes ethical medical 'pedagogy'. Germane is the principle that the physician-teacher should strive to be ethical both in what he or she teaches as well as the manner in which it is taught. This is also to review medical ethics from a broader perspective including the institution of instruction itself. The following discourse focuses upon five doctrines which would augment the medical curriculum by adding to the mere instruction of facts and skills a respect for the human values and rights innate to the practice of medicine.