The Internet doctor and medical ethics Ethical implications of the introduction of the Internet into medical encounters

In this article, consultation via the Internet and the use of the Internet as a source of medical information is examined from an ethical point of view. It is argued that important ethical aspects of the clinical interaction, such as dialogue and trust will be difficult to realise in an Internet-consultation. Further, it is doubtful whether an Internet doctor will accept responsibility. However, medical information via the Internet can be a valuable resource for patients wanting to know more about their disease and, thus, it is a means to enhancing their autonomy. This revised version was published online in July 2006 with corrections to the Cover Date.     

论医德的评判

医德评羊是医学伦理原则和规范赖以发生作用的“杠杆”。在医疗活动中具有调节、规范、激励医务人员言行的作用。文章着重论述了医德评判的客观标准并对其进行了客观分析,认为从历史发展趋势和社会转型期的整体高度评判,当前医德水准在向更高的目标迈进。还指出,新的医德价值体系必须以市场关系为基础,同时不能忽略思想教育和宣传,使物质文明和精神文明有机结合,构建良好的医德价值体系基础。     

当代中国公共健康伦理研究

我国对公共健康伦理的研究尚处于起步阶段。目前公共健康伦理的研究主要涉及公共健康伦理的定义,公共健康伦理与医学伦理、生命伦理的联系与区别,公共健康伦理研究的内容和目的,公共健康伦理的原则等等。但是,我国公共健康伦理研究尚未形成完整的学科体系,没有自己独特的理论视角和宏观的价值目标。     

Judging the ethics of qualitative research: considering the "ethics as process" model

Decision-making about the ethics of qualitative research is problematic where the research design is emergent, and the balance between risks and benefits for research subjects are difficult to ascertain prior to study implementation. The discourses of health/medical research ethics and those of social research are shown to be divergent and, furthermore, where ethics committees tie themselves to the health/medical model of ethical decision-making, qualitative research approaches can be disadvantaged. Having demonstrated the dual discourses and their relevance to qualitative research ethics, a critical review of current approaches to maximising the success of qualitative research proposals being considered for approval by ethics committees is undertaken. This leads to a call for a system of monitoring qualitative research so that the "benefit to risk" ratio is always on the side of benefit. This has implications for the ways in which ethics committees are organised and the ways in which they function.     

Does fear of retaliation deter requests for ethics consultation?

Background Reports suggest that some health care personnel fear retaliation from seeking ethics consultation. We therefore examined the prevalence and determinants of fear of retaliation and determined whether this fear is associated with diminished likelihood of consulting an ethics committee. Methods We surveyed registered nurses (RNs) and social workers (SWs) in four US states to identify ethical problems they encounter. We developed a retaliation index (1–7 point range) with higher scores indicating a higher perceived likelihood of retaliation. Linear regression analysis was performed to identify socio-demographic and job characteristics associated with fear of retaliation. Logistic regression analysis was performed to determine whether fear of retaliation was associated with less likelihood of seeking consultation. Results Our sample (N = 1215) was primarily female (85%) and Caucasian (83%) with a mean age of 46 years and 17 years of practice. Among the sample, 293 (48.7%) RNs and 309 (51.3%) SWs reported access to an ethics consultation service. Amongst those with access, 2.8% (n = 17) personally experienced retaliation, 9.1% (n = 55) observed colleagues experience retaliation, 30.2% (n = 182) reported no experience with retaliation but considered it a realistic fear, and 50.8% (n = 305) did not perceive retaliation to be a problem. In logistic regression modeling, fear of retaliation was not associated with the likelihood (OR = 0.64; 95% CI = 0.22–1.89) or frequency of requesting ethics consultation (OR = 0.81; 95% CI = 0.27–2.38). Conclusion Fear of retaliation from seeking ethics consultation is common among nurses and social workers, nonetheless this fear is not associated with reduced requests for ethics consultation.     

The Ground of Dialogical Bioethics

Dialogical ethics are a procedural alternative to substantive ethics such as consequentialism, deontology, principlism, casuistry, virtue ethics and care ethics. Dialogical ethics are procedural in that they do not establish goods in advance, unlike substantive ethics, but rather determine goods through a procedure enacted by the actual parties involved (although some substantive notion of justice may still be required); and they are dialogical in that the procedure is that of dialogue, involving both empathic critical discussion and negotiation. A fundamental tenet of dialogical ethics may be the use of appropriate rules of order regulating dialogue among the parties involved. Some of the central characteristics of such rules of order are that they are reciprocally regulated by dialogue, that they override other ethical considerations, and that they institute empathic critical discussion and negotiation within the ethical dialogue. Dialogical bioethics are the application of dialogical ethics to ethical problems in medicine. The approach of dialogical bioethics has proven fruitful for resolving bioethical problems such as that of medical futility, where approaches of substantive ethics have reached an impasse. There is room for further study of special challenges within dialogical bioethics, such as the incompetence of some involved parties, conflicts of interests of third parties, and the cost-effectiveness of this ethical approach.     

儒家文化与医德建设初探

儒家文化中包含着系统的道德理论和伦理规范,其中很多理论和观点可供我们今天的医德建设所用.本文从三个方面探讨儒家文化与医德建设的关系:一、"仁"、"人伦"观,医德建设之基础;二、"患不知人也"观,医德建设的根本;三、"养气"观,医德建设的最高追求.     

REFLECTIONS OF A SOCIAL WORK ADMINISTRATOR ON THE OPPORTUNITIES OF CRISIS

The climate of crisis in which hospital social work departments currently operate is contemplated by an undaunted administrator. Social workers as planners and innovators are able to move ahead in such a climate. Constructive approaches that benefit the hospital and its consumers and enhance job gratification are discussed.     

《执业医师法》与医德教育

新世纪之初、卫生改革与发展进入了攻坚阶段，面临城镇职工医疗保险制度改革中的卫生机构的配套改革，卫生监督体制改革，加强医德教育，树立医疗单位良好的社会形象，正确处理医患关系，是每一个医务人员和医德教育工作者必须思考的问题。《执业医师法》的贯彻实施，使道德与法律得到衔接，顺应了医疗职业道德建设的需要，在倡导传统医德，加强医务人员的医学伦理学的继续教育中，发挥着不可替代的作用。     

美国“医德碗”教育活动对我国医学生医德教育的启示

"医德碗"活动作为美国部分高校开展临床前阶段医学生医德教育的新形式,以建构主义学习理论、合作学习理论、需求层次理论为依托,契合了低年级医学生心理需求,有效调动了学生学习医德的主动性,培养了医学生团队精神,更重要的是培养学生更实用的医德能力,为进一步的医德教育提供了可靠的评价依据。通过对"医德碗"活动的分析,文章认为应从构建"医德碗"活动体系、优化医德教育理念、大力提倡形成性评价三个方面加以学习借鉴,进一步完善我国医学生医德教育工作。     

医学伦理原则在医学实践中的作用

医学伦理对规范、约束、指导、监督医学行为,保护患者权益,调节医患关系起着越来越重要的作用。本文通过阐述医学伦理的基本原则,探讨如何加强医院医学伦理建设。要着眼职能作用发挥,强化医院伦理委员会的机构建设;要着眼医学实践应用,全面把握医学伦理原则的规范体系;要着眼行业特点需求,构建患者至上医者仁心的医院文化。     

An Argument for the use of Aristotelian Method in Bioethics

The main claim of this paper is that the method outlined and used in Aristotle’s Ethics is an appropriate and credible one to use in bioethics. Here “appropriate” means that the method is capable of establishing claims and developing concepts in bioethics and “credible” that the method has some plausibility, it is not open to obvious and immediate objection. It begins by suggesting why this claim matters and then gives a brief outline of Aristotle’s method. The main argument is made in three stages. First, it is argued that Aristotelian method is credible because it compares favourably with alternatives. In this section it is shown that Aristotelian method is not vulnerable to criticisms that are made both of methods that give a primary place to moral theory (such as utilitarianism) and those that eschew moral theory (such as casuistry and social science approaches). As such, it compares favourably with these other approaches that are vulnerable to at least some of these criticisms. Second, the appropriateness of Aristotelian method is indicated through outlining how it would deal with a particular case. Finally, it is argued that the success of Aristotle’s philosophy is suggestive of both the credibility and appropriateness of his method.     

The phenomenological ethics of K. E. Løgstrup – a resource for health care ethics and philosophy?

Abstract This paper gives a presentation and critical assessment of the phenomenological philosophy and ethics of the Danish theologian and philosopher K. E. Løgstrup (1905–1981). It is argued that although the ethics of Løgstrup contain valuable insights, an uncritical appropriation as the main source for a health care ethics or a philosophy of caring, is problematic. Løgstrup's philosophy contains a number of internal problems, and does not adequately deal with some problems raised by work in the modern health care setting.     

Helping patients with ethical concerns about COVID-19 vaccines in light of fetal cell lines used in some COVID-19 vaccines

Many persons with religious convictions report hesitancy about COVID-19 vaccines, in part due to ethical concerns that fetal cell lines are used in the development of certain vaccines. The issue of abortion is contentious and, given the potential impact on COVID-19 vaccination, it is important for clinicians to be aware of this issue, whatever their personal beliefs. I provide four responses that clinicians may offer their patients: 1) Ethical analyses of moral complicity and COVID vaccines. 2) Altruism and protecting others from a virus that is often transmitted while asymptomatic or pre-symptomatic. 3) Religious texts and many religious leaders support prevention and, therefore, vaccination. 4) Administration of vaccines not developed in fetal cell lines. Although I wish for all my patients to be vaccinated, I respect their autonomy to make the choice to be or not to be vaccinated and understand that many have a deep regard for fetal life.     

Artificial Intelligence and Robotics in Nursing: Ethics of Caring as a Guide to Dividing Tasks Between AI and Humans

Nurses have traditionally been regarded as clinicians that deliver compassionate, safe, and empathetic health care (Nurses again outpace other professions for honesty & ethics, 2018). Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Along with caring, nurses are expected to undertake ever‐expanding duties and complex tasks. In part because of the growing physical, intellectual and emotional demandingness, of nursing as well as technological advances, artificial intelligence (AI) and AI care robots are rapidly changing the healthcare landscape. As technology becomes more advanced, efficient, and economical, opportunities and pressure to introduce AI into nursing care will only increase. In the first part of the article, we review recent and existing applications of AI in nursing and speculate on future use. Second, situate our project within the recent literature on the ethics of nursing and AI. Third, we explore three dominant theories of caring and the two paradigmatic expressions of caring (touch and presence) and conclude that AI—at least for the foreseeable future—is incapable of caring in the sense central to nursing and caregiving ethics. We conclude that for AI to be implemented ethically, it cannot transgress the core values of nursing, usurp aspects of caring that can only meaningfully be carried out by human beings, and it must support, open, or improve opportunities for nurses to provide the uniquely human aspects of care.     

Motivating Donors to Genetic Research? Anthropological Reasons to Rethink the Role of Informed Consent

In this article we explore the contribution from social anthropology to the medical ethical debates about the use of informed consent in research, based on blood samples and other forms of tissue. The article springs from a project exploring donors’ motivation for providing blood and healthcare data for genetic research to be executed by a Swedish start-up genomics company. This article is not confined to empirical findings, however, as we suggest that anthropology provides reason to reassess the theoretical understanding of autonomy as generally defined by Beauchamp and Childress. Careful consideration of the trust expressed by donors through the act of donation, furthermore, suggests that there is reason to redirect the ethical scrutiny from informed consent to issues concerning institutional arrangements and social responsibility. In particular, we suggest that an anthropological approach could facilitate a reconsideration of the political implications of using informed consent as a regulatory practice in tissue-based research.     

医德重建:传统医德危机及其解决途径探析

目前,我国面临的医德危机是非常严重的。如何解决这一危机就成了一个不容回避的重大课题,不少学者提出要用传统医德来规范医务人员,并以此作为解决该危机的良方。然而,这种以人格伦理为特质的传统医德尽管有其一定的合理性,但其在实践中的有效性却受到了人们的质疑。为此,试图从传统医德自身的局限性、医务人员利益意识的觉醒以及因社会失范而导致的越轨三个方面来分析我国医德危机产生的根源,并为此提出了三条对策。     

Scepticism about the virtue ethics approach to nursing ethics

Nursing ethics centres on how nurses ought to respond to the moral situations that arise in their professional contexts. Nursing ethicists invoke normative approaches from moral philosophy. Specifically, it is increasingly common for nursing ethicists to apply virtue ethics to moral problems encountered by nurses. The point of this article is to argue for scepticism about this approach. First, the research question is motivated by showing that requirements on nurses such as to be kind, do not suffice to establish virtue ethics in nursing because normative rivals (such as utilitarians) can say as much; and the teleology distinctive of virtue ethics does not transpose to a professional context, such as nursing. Next, scepticism is argued for by responding to various attempts to secure a role for virtue ethics in nursing. The upshot is that virtue ethics is best left where it belongs – in personal moral life, not professional ethics – and nursing ethics is best done by taking other approaches.