临床医学留学生生命观调查及其生命教育路径探索

医学留学生作为未来的国际化医务工作者,肩负着构建人类卫生健康共同体的重要使命。通过调查临床医学留学生生命观,分析其与医疗活动相关的对生命价值及生命意义的认知情况,主要评价留学生是否尊重自己与他人甚至实验动物的生命,是否有正确的死亡观与医学捐献意识,是否具有“以患者为中心”的医患共情与医患互动能力,是否有作为医者的责任与担当,是否有献身医学的职业追求与不断提升执业能力的职业精神。基于此调查结果,从医生职业精神、留学生活动、特色导师制度三个切入点对医学留学生生命教育的路径进行探索。     

卫生类高职院校生命德育的探索与研究

随着社会加速转型,学生的身心问题也越来越多,以人为本的生命德育已成为德育改革和发展的趋势。卫生类高职院校必须引导学生在探讨生命内涵的过程中认识生命、欣赏生命、尊重生命、珍惜生命、敬畏生命,重视自己和他人的生命质量与价值,维护患者的生命权与健康权。     

敬畏：护理伦理的核心要素之一

“敬畏”是护理伦理的核心要素之一，主要体现在对生命的敬畏、对良知的敬畏和对职业的敬畏三个方面。护士在临床护理行为中应当恪守敬畏伦理原则，维护和尊重患者的生命权利，守持自我的良知，公正仁慈地对待每一位患者，充分认识到职业的神圣价值并自觉维护职业的声誉，从而构建和谐的护患关系。     

高血压脑出血患者护理的伦理困境和对策

高血压脑出血因其致死率和致残率高,导致预期治疗效果与患者实际状况之间、医院诊疗结果与传统死亡观之间、患者亲属之间产生一系列伦理冲突,也使密切和他们接触的护理人员不得不面对伦理困境。建议护理人员尊重生命,尊重患者和家属的价值观和信仰,加强护理管理,合理安排护理人员编制,加强伦理知识的学习和应用,促进护患和谐,提高患者和家属的生活质量。     

我国临终关怀发展现状及应对策略

临终关怀是指为临终患者及其家属提供医疗、护理、心理、社会等全方位的关怀照顾,使临终患者的生命受到尊重、症状得到控制、生命质量得到提高、家属的身心健康得到维护,帮助患者舒适而有尊严地走完人生的最后旅程.临终关怀是为生命即将结束的病人及其家属提供全面的身心照顾与支持,它不同于传统医学也不同于安乐死.临终关怀既不促进也不延迟病人的死亡.临终关怀的服务对象狭义上指患有恶性和非恶性疾病的病重垂危病人,广义上还包括病重垂危病人的家属,其具体内容主要包括三个方面:控制症状、支持病人、支持家属.     

略论中医药文化中的生命伦理意蕴

中医药文化发扬了中国传统文化中敬畏自然、遵循规律的原则,又从“医”之独特视角将人文情怀与科学精神相结合,嬗变出具有中医药特征的文化模式.在这种文化模式下,既有对自然生命之发展的透视,又有对生命价值和人性完美的引导.在中医药文化背景下开展生命伦理教育,需要在课程设置上加大医学人文教育课程的比重;挖掘中医药文化中的生命伦理教育资源,使中医药生命文化渗透于教学之中;将中医药文化纳入中医入学教育,培养学生中医药文化的认同感.     

大医情怀 北京大学第三医院外科主任医师徐智印象

医者行医,医治的真正意义不仅仅是对患者体征、功能、器官等的检查和疗救,同时是对一个个痛苦病体的情怀关爱,对一个个充满期冀的患者的生命慰藉。缓解他们的痛苦、了解他们的渴望,就是对他们生命和精神世界的尊重。坦诚、纯朴的医者徐智说起话来,经典而睿智。[第一段]     

社区卫生服务中心对晚期肿瘤患者的临终关怀

临终关怀指的是对肿瘤晚期患者、各种疾病终末期、治疗无效及生命即将结束的患者所实施的全面关怀与照料，是对临终患者和家属提供姑息性和支持性医护措施，把患者和家属作为护理的整体。临终关怀的宗旨是将临终阶段看成是一种特殊类型的生命阶段，减少临终癌症患者的痛苦，增加患者的舒适程度，提高患者的生命质量，维护临终患者的尊严，同时希望赋予患者家属精神上的支持，给予他们承受所有事实的力量，进而坦然接受死亡的问题。     

体验教育在医学生生命观教育中的应用

当前,生命教育在家庭教育、学校教育、社会教育中普遍缺失。体验教育作为一种新型的教育理念和教育模式,契合生命观教育的内在诉求,符合医学生自身特点和需求,是培养医学生素质的一次新探索。体验教育应用于医学生生命观教育,并从“敬畏一切生命、珍惜自我生命、善待他人生命、提高生命价值”4个维度出发,实施“生活体验、活动体验、专业体验、社会体验、家庭体验”5个模块教育,提高新时期医学生生命观教育的针对性和实效性,更好地促进医学教育目标的实现,进而为促进我国医疗卫生事业的健康和谐发展,具有十分重要的意义。     

医学人文教育的德性内涵与启示

医学人文教育承载着培养医学生人文精神和对患者实施生命关怀意识的任务。从生命关怀的深层次上看,医学院校人文教育的教育内涵是一种包含着对生命与死亡的理解、价值的诉求、痛苦的关切等因素的精神教育与道德教育,所以在教育过程中应该更加突出超越性、内在性和实践性等德性的内涵。因此,医学院校应从生命意义体验、生命敬畏情感、生命关怀实践等层面,以加强医学人文教育的效果,这是医学生人文素质培养工作中不可或缺的内在要求。     

孕妇对胎儿畸形认知、选择的伦理分析

目的探讨胎儿畸形的超声诊断与干预处理中的伦理学问题。方法对广州市妇女儿童医疗中心经产前超声诊断胎儿畸形的120例孕妇进行问卷调查。结果 91例(76%)的孕妇能明白胎儿畸形的情况,特别是胎儿心脏畸形和体表畸形,共有68名孕妇因为胎儿畸形选择终止妊娠。结论在产前诊断与干预处理中,医师应该遵循病人利益第一和尊重孕妇自主权的伦理学原则,也应遵循"敬畏生命"的伦理思想,还应普及孕前检查知识。     

“医者仁心”的解读

"医者仁心"是对医学人文内涵和人文价值的生动概括。针对当今的医疗现状和医患关系表现,从生命认知、生命敬畏和医患交往三个维度上来解读这句话的丰富蕴涵,是培养医德境界和医德智慧的必要视角。这三个维度体现在由"仁心"所发展出的爱心:对生命的尊重和同情;智心:对生命的智慧与觉解;诚心:医患交往中的推己及人。     

“敬畏生命”伦理视域下的医学生职业道德教育

＂敬畏生命＂的伦理思想是由诺贝尔和平奖获得者法国医学家、哲学家阿尔贝托.施韦泽提出的,通过对人与自然关系的深入反思提出人应当敬畏包括动物和植物等一切生命。在医学生职业道德教育过程中注重＂敬畏生命＂伦理思想的渗透和强化,对于医学生树立生命重于一切的伦理意识,提高自身修养和加强职业道德教育具有积极的现实意义。     

Does it matter that organ donors are not dead? Ethical and policy implications

The "standard position" on organ donation is that the donor must be dead in order for vital organs to be removed, a position with which we agree. Recently, Robert Truog and Walter Robinson have argued that (1) brain death is not death, and (2) even though "brain dead" patients are not dead, it is morally acceptable to remove vital organs from those patients. We accept and defend their claim that brain death is not death, and we argue against both the US "whole brain" criterion and the UK "brain stem" criterion. Then we answer their arguments in favour of removing vital organs from "brain dead" and other classes of comatose patients. We dispute their claim that the removal of vital organs is morally equivalent to "letting nature take its course", arguing that, unlike "allowing to die", it is the removal of vital organs that kills the patient, not his or her disease or injury. Then, we argue that removing vital organs from living patients is immoral and contrary to the nature of medical practice. Finally, we offer practical suggestions for changing public policy on organ transplantation.     

Physicians as healthcare surrogate for terminally ill children

The parents of some terminally ill children have reported that being asked to authorise removal of life-sustaining measures is akin to being requested to sign a "death warrant". This dilemma leaves families not only enduring the grief of losing a loved one, but also with feelings of ambivalence, anxiety and guilt. A straightforward method by which the parents of terminally ill children can entrust the role of healthcare surrogate to the treating physician is presented. The cornerstone of this paradigm is parental awareness that the physician will act in the child's best interest, even if that means discontinuing life-sustaining measures. The goal is to mitigate parental guilt and fear of misperception, by self and others, of having given up on their child. From a moral standpoint this concept is an appealing option as it conforms to the four basic principles of medical ethics. While laws in the USA and several European nations prevent members of the medical team from taking on the responsibilities of healthcare surrogate for terminally ill patients, formal and informal precedence for this option already exists in France, The Netherlands, Norway, Sweden, Switzerland, and the Canadian province of Manitoba.     

Gaps in end-of-life care

End-of-life care is an important aspect of medical practice. Individual physicians and the medical community must be committed to the compassionate and competent provision of care to dying patients and their families. Patients rightfully expect their physicians to care for them and provide them with medical assistance as they are dying. To care properly for patients near the end of life, the physician must understand that palliative care entails addressing physical, psychosocial, and spiritual needs and that patients may at times require palliative treatment in an acute care context. To provide palliative care, the physician must be up to date on the proper use of opioids and the legality and propriety of using high doses of opioids as necessary to relieve suffering. Good symptom control; ongoing involvement with the patient; and physical, psychological, and spiritual support are the hallmarks of quality end-of-life care. Care of patients near the end of life, however, has a moral, psychological, and interpersonal intensity that distinguishes it from most other clinical encounters. With appropriate education, physicians can play a key role to improve care for patients and families who are living with advanced life-threatening illness. Although some issues (e.g., the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, nonmaleficence, beneficence, autonomy, and justice.     

浅谈大面积烧伤患者的"社会化康复"

主要从四个方面来阐述一种新的烧伤医学康复新概念即大面积烧伤患者的"社会化康复":烧伤患者"社会化康复"的内涵及其意义;"社会化康复"医学是现代烧伤医学领域的延伸和发展;烧伤患者的心理康复是"社会化康复"的重要内容;烧伤患者的心理康复是"社会化康复"的重要内容。并认为,烧伤患者尤其是大面积烧伤患者的"社会化康复"工作会随着现代医学领域与其它科学全面发展,将为减轻患着痛苦促进患者康复,让其回归社会作出越来越大的贡献。     

癌症患者希望水平的研究现状和展望

癌症是严重威胁人类生命的重大疾病,是我国居民的首位死亡原因。癌症患者既要承受经济上的巨大负担,又要忍受生理、心理等方面的痛苦,极易导致降低其希望水平。多项研究证实希望水平直接影响癌症患者的生活质量,医护人员帮助患者和家属提高希望水平是非常有意义的事情。因此,本文对癌症患者希望水平的影响因素和干预措施进行了综述,并在此基础上对未来的研究方向进行展望,以期为临床工作者提高患者的希望水平及生活质量提供参考和建议。     

Normalities are not the Only Answer for Amyotrophic Lateral Sclerosis Patients

Because our actions change, our responsibility is modified; because our responsibility is modified, we need to question the ethics of the action. Our action is situated right there between announcing a diagnosis, the theoretical and practical result of identification, the determining and naming of a fact and voicing the disease which is a human action where medical and technical expertise comes up against a life and its story. Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s disease, is a degenerative disease of the motor neurons leading to paralysis. In the absence of any curative treatment, the natural course always results in death. Since 1989, progress in the management of this disease in France has been exponential, resulting in the creation of 17 expert centres throughout the country in 2003. Guidelines have been drawn up through consensus conferences and coordination meetings. For the delicate stage of the announcement, three requirements have been adopted: the quality of receptiveness of the medical practitioner and his team, their ability to listen and to adapt to the particularities of the patient in their care; their commitment with regard to legal obligations as to how and to whom to transmit information; and the need for a multidisciplined approach to be able to rapidly support the patient and his family. Questioning in the field of applied ethics has led us to examine whether having a benevolent and non-harmful attitude towards these patients, respecting their autonomy and legal rights are parameters required in this specialized practice. Through a transversal thematic analysis of the experiences of the medical practitioners at the Centres, we would like to explore a hypothesis of the remarkable epistemological progression of the neurologist in this form of care in the pure Hippocratic tradition. Through the compassionate experience of the other by these committed doctors and their teams, we will try to outline the view of anthropological phenomenology with regard to the ALS patient, their awareness of the future paralysis of the body that is being announced, their awareness of the temporality and will characteristic of the ALS patient and of his finality that they will be accompanying.