ART医学伦理调控与医疗机构伦理委员会

解决ART应用中引发的伦理问题、难题的基本对策之一是加强医学伦理调控，推进医学伦理精神对医学过程的渗入，这是医学伦理学的一项重要使命。ART医学伦理调控的主要形式有伦理调节、导向、教育、辩护、制约等。医学伦理委员会是医学伦理调控体制化的表现和实现这种调控的重要途径。建立ART医疗机构伦理委员会对相关医学过程进行伦理监督已成为国际惯例，我国ART的应用及其健康发展，呼唤医疗机构伦理委员会伦理调控作用的有效发挥。     

我国人类辅助生殖技术机构伦理委员会操作规程(建议稿)

目的:为规范我国ART医疗机构伦理委员会的伦理监督行为,建立我国ART伦理委员会操作规程或指南提供参考;方法:条文归纳法.按科学实施的要求将委员会职责行为规范以条文依次归纳概括;结论:该建议(稿)以伦理委员会实践探索为基础,适当接轨国际惯例和借鉴国外经验,具有较强操作性和借鉴意义.     

基于案例分析生殖医学伦理委员会在供精人工授精技术实施中的指导功能

通过对所选案例的分析讨论,提出了目前在临床实践中常常遇到的关于供精人工授精技术实施过程中出现的一些伦理问题,并针对这一现状讨论研究了生殖医学伦理委员会在供精人工授精技术实施中的指导功能：一是为需求者提供相关性伦理咨询,二是对辅助生殖技术及相关性研究开展全程监督和指导。     

我国医学伦理委员会监管机制研究

随着新兴医疗科技的飞速发展,国内医学伦理委员会的设立数量不断增加,如何对其进行有效的监管成为一个重要问题。通过对伦理委员会现有监管机制进行剖析发现,认证制度构建缺失,自身建设不完善,相关法律位阶较低,医学伦理意识有待增强等是造成现有监管机制不健全的主要原因。未来应在现有监管机制的基础上不断进行完善,设立伦理委员会准入制度与认证机构,明确监督机构及其权限,完善健全相关法律制度,强化伦理委员会内部监管机制建设。     

我国辅助生殖技术中性别选择的伦理审视

从伦理的角度审视辅助生殖技术中的性别选择问题，分析了它在社会应用中的善与恶问题，及其应用中游在的社会危害。因此，我们应对辅助生殖技术中的性别选择给予足够关注。     

我国"医学伦理委员会"的成立背景、功能和建设建议

医疗机构、大学、学术期刊和卫生行政机构建立医学伦理委员会，是国际医学界的常规做法。为了与国际接轨，我国已经在这方面开展了大量的工作。但目前，存在其建制行政化、建设无章程、功能发挥不够甚至流于形式等问题，需要对其成立背景、主要功能进行研究，并加强其建设。     

医学伦理委员会伦理审查程序、内容与方法述评

本文对医学伦理学委员会伦理审查的程序、内容与方法进行了评述。从已有文献来看,关于伦理审查的程序国内外已有成熟的研究,但如何对试验项目进行全过程监督,如何保障医学伦理委员会的独立性是亟待深入研究的问题。在伦理审查的内容方面,今后理论研究的趋向是研究问题的进一步细化和专门化。在伦理审查的方法方面,如何应用临床经济学和药物经济学的原理和方法,开展人体试验中风险与受益分析与评估是今后一项重要的基础性研究。     

医学伦理委员会是医学发展的必然产物

建立健全医学伦理委员会是我国生物医学领域尚未解决的重大课题。本文依据对医学伦理的重新定位及其国内外发展趋势、对现代科技双刃剑作用的避害选择的理论探讨与实例、我国生物医学研究急需全面规范及其现状分析，说明医学伦理委员会是医学发展的必然产物，探讨了IRB、HEC与MEC对于医学发展不可获缺的重要性。     

生殖医学技术进展的文化遐想

提要生殖医学技术的进展给人类带来巨大的利益和福音,特别是20世纪下半叶以来,生殖医学技术取得了突飞猛进的发展。人工授精(Artifacial insemination)、“代理母亲”(Surrogate mother)、性别选择(Sexselection)等生殖医学的高新技术,为人类解决了一个又一个难题。但是生殖医学又不可避免地与人类的婚姻行为、家庭关系、伦理道德、法律规范、传统观念等社会文化因素发生冲突,并由此衍生出种种社会问题。人类要正确认识、认真研究这些由于生殖医学技术进展而出现的社会问题,这无论对生殖医学的进步、还是对于社会和谐、健康发展都是有意义的。     

完善医学伦理委员会工作机制的思考

目的:分析医学伦理委员会在工作实践中出现的问题,为促进医学伦理委员会工作的发展提供建议。方法:对上海10家医疗机构的部分伦理委员会委员、医院管理者进行调查访谈。结果:医学伦理委员会存在着名称不统一,缺乏监管体系,无标准化操作规程,专业人才系统的培训不足等多个问题。结论:通过构建我国医学伦理委员会认证体系;统一名称,规范伦理委员会的定位与职能;加大伦理专业人才的培养;构建伦理委员会监管体系等措施来推动我国伦理委员会的科学发展。     

Hospital medical ethics committees: a review of their development

The history of hospital ethics committees (HECs) since the early 1970s is reviewed through literature citations and reports of the experiences of functioning committees. Other types of hospital review committees and their relationship to HECs are described, as well as the problems and successes of early ethics committees. The influence of the American legal system on medical decision making and the formation of ethics committees is discussed, and reasons are given for hospitals' reluctance to establish committees, or to utilize those already in existence. Rosner concludes with a discussion of a proposed model for ethics committees, and urges caution in evaluating the role of committees in resolving ethical dilemmas.     

医德对医院可持续发展的促进作用

随着社会主义市场经济的发展和医疗卫生事业的繁荣,倡导以德治院、规范医德医风更是亟待解决的重大问题.     

Focus: current issues in medical ethics: The drawbacks of research ethics committees

Research ethics committees, while in many ways an excellent innovation, do have some drawbacks. This paper examines three of these. The first problem of such committees is that their approval of specific projects in their own institutions acquires intrinsic value.

The second problem relates to the possible devolution of responsibility from the investigator to the committee. The committee approves, the investigator feels relieved of some responsibility and things can be done to patients which neither the committee nor the investigator might countenance if they had sole responsibility.

The third problem arises directly from the bureaucratic nature of the committee itself. And one consequence of the resulting rigid guidelines is the insistence, by most committees, on the written consent of patients. Demanding this can, in some circumstances, mean giving the patient very disturbing information. The paper suggests that in patients with a fatal disease where trials compare two accepted therapies committees dispense with written consent.

There is a commentary on this paper by Dr D J Weatherall of the Nuffield Department of Clinical Medicine, University of Oxford.

     

Bridging problems and models in medical ethics: four images of local ethics committees

In the context of the continuing debate about how ethics committees in Italy should be structured (see Bulletin 160) Professor Incorvati, from the Comitato Nazionale per la Bioetica in Rome, considers four theoretical models of how such committees may be arranged, and why one in particular looks better placed to face the growing ethical problems that are emerging as a result of current developments in medicine.     

以“望闻问切”创新医院管理模式弘扬医疗卫生职业精神的探索简

创新医院管理是弘扬医疗卫生职业精神的重要途径。邯郸市中心医院在贯彻落实党的十八大关于加强社会主义核心价值体系建设的战略部署,进一步弘扬医疗卫生职业精神活动中,进行了以“望闻问切”创新医院管理模式,弘扬医疗卫生职业精神的探索。既继承了中医“大医精诚”和西医尊重生命的优良传统,又发扬了救死扶伤的革命人道主义精神和新时期医学创新精神。在全面加强医疗队伍建设、提升医疗服务水平、塑造医院文化品牌、实现医院科学可持续发展等方面起到了积极的促进作用,取得了显著成效。     

Hospital ethics committees in Israel: structure,function and heterogeneity in the setting of statutory ethics committees

OBJECTIVES: Hospital ethics committees increasingly affect medical care worldwide, yet there has been little evaluation of these bodies. Israel has the distinction of having ethics committees legally required by a Patients' Rights Act. We studied the development of ethics committees in this legal environment. DESIGN: Cross-sectional national survey of general hospitals to identify all ethics committees and interview of ethics committee chairpersons. SETTING: Israel five years after the passage of the Patients' Rights Act. Main measurements: Patients' rights and informal ethics committee structure and function. RESULTS: One-third of general hospitals have an ethics committee, with committees concentrated in larger facilities. Hospitals without committees tended to lack any structure to handle ethics issues. Committees tend to be interdisciplinary and gender-mixed but ethnic mix was poor. Confidentiality is the rule, however, legal liability is a concern. One-third of patients' rights ethics committees never convened and most committees had considered fewer than ten consults. Access to the consultation process and the consultation process itself varied substantially across committees. Some patients' rights ethics committees attempted to solve cases, others only rendered decisions. Informal committees often refused to consider cases within Patients' Rights Act jurisdiction. CONCLUSIONS: Despite statutory requirement, many Israeli patients and clinicians do not have access to ethics committees. The scant volume of cases shows serious discrepancies between practice and Patients' Rights Act regulations, suggesting the need for education or revision of the law. Heterogeneity in committee function demonstrates need for substantial improvement.