自主性、他者与安乐死

自愿而积极的安乐死的实现必须有“他者”的介入才具有现实性。完全的自主性是个抽象的理论原则，在实践中存在着逻辑困难。“他者”在生命态度、家庭关系、社会关系和医师方面对自主性构成了限制，也使安乐死的实现有了现实根据。个体在自主选择安乐死意愿时，应当坚持尊重原则、协商原则和自主原则。这些原则也是未来安乐死立法中应当坚持的原则。     

医疗决策中自主性审视及临床实践策略 ——以肾病综合征患者为例

以肾病综合征为例对慢性病患者医疗决策中的自主性进行了分析,发现患者存在信息、表述、功能、决策以及执行五大维度的自主性;尊重患者自主性可以让患者作出符合其最大利益的决定,是相关医疗决策制定的基础,但慢性疾病医疗决策中尊重患者自主性也面临着部分慢性病患者自主性受限、医疗信息沟通不畅或资源匮乏弱化慢性病患者医疗决策自主性以及健康素养和健康管理能力的差异影响患者自主性发挥等问题。以肾病综合征患者为例,提出认清慢性病患者自主性的局限性,灵活运用不同方式尊重患者自主性;提升临床医务人员沟通能力与共同决策经验,实现充分尊重患者自主性;提升患者健康素养和健康管理能力,以实现对患者自主性的尊重的临床实践策略。     

从医患关系模式的角度分析中国医疗领域中的“自主性原则”

通过调研和访谈从医患关系的模式角度分析了当前中国医疗领域中的“自主性原则”,对医生来说,虽然医生对患者的自主性表示尊重和接受,但很多时候仍将患者自主式作为医生履行职责的障碍;对患者来说,患者也没有将自主视为理想医患关系的要素,反而认为自主在很多情况下会损害自身的利益,提出在西方医疗实践的影响下,医患关系的模式处于传统的家长制和西方的消费主义两种极端模式相重叠的阶段,自主性原则在两种模式中被赋予了截然不同的价值,因而导致了自主性原则在当前中国医疗实践中的两难处境.     

乳腺癌患者手术方式选择的伦理学分析

探讨乳腺癌患者手术方式选择现状,提出乳腺癌患者是否有切除乳房的必要等伦理学思考,进而分析乳腺癌患者手术方式选择中应遵循的伦理学原则:以患者为中心原则,包括尊重患者自主性、知情同意、有利无害、尊重关怀;提高医务工作者的自身水平原则,包括加强医患沟通、正确对待经济效益与患者自身利益、提高医务人员专业水平;医疗最优化原则.     

医方应保障患者知情同意权的实现

尊重患者的知情同意权是患者和社会对医方所提出的要求,也是医方应尽的法律和伦理义务.医方应充分尊重患者的自主性,积极、有效地履行注意和告知义务,并将法律调整与道德调整相结合,以切实保障患者知情同意权的实现.     

院前急救护理过程中的患者自主性研究

目的 研究以院前急救护理过程中患者自主性为研究目的,进一步提升患者的获得感和幸福感.方法 采用目的抽样的方法,运用半结构式访谈法进行.本研究共访谈患者20例,患者家属20例,护士40例.访谈资料采用描述性研究的方法进行分析.结果 访谈结果显示,患者对健康的认识更加科学;患者在院前急救过程中有强烈的安全感需求;患者的自主性增强;护士群体能够在院前急救中尊重患者的自主性.同时,充分的医患沟通是缓解分歧的重要途径.结论 为构建和谐医患关系,在院前急救过程中,需要提高护理人员综合业务能力,充分尊重患者自主性,健全医患共同决策机制.     

精神刺激对老年心肌梗死的诱发作用及其干预方法

尊重患者的知情同意权是患者和社会对医方提出的要求,也是医方应尽的法律和伦理义务,医方应充分尊重患者的自主性,积极有效地履行注意和告知义务,切实保障患者知情同意权的实现.     

院前急救护理过程中的患者自主性研究

目的 研究以院前急救护理过程中患者自主性为研究目的,进一步提升患者的获得感和幸福感.方法 采用目的抽样的方法,运用半结构式访谈法进行.本研究共访谈患者20例,患者家属20例,护士40例.访谈资料采用描述性研究的方法进行分析.结果 访谈结果显示,患者对健康的认识更加科学;患者在院前急救过程中有强烈的安全感需求;患者的自主性增强;护士群体能够在院前急救中尊重患者的自主性.同时,充分的医患沟通是缓解分歧的重要途径.结论 为构建和谐医患关系,在院前急救过程中,需要提高护理人员综合业务能力,充分尊重患者自主性,健全医患共同决策机制.     

护理专业技术实训改革体会

在护理专业技术实训中运用开放式教学法,让护生参与教学的全过程,实施课前开放、课中开放、课后开放教学法,护生主体意识明显增强,自主学习能力特别是独立操作能力明显提高,取得了良好的教学效果.教师在教学过程中充分发挥主导作用,调动护生学习的积极性和主动性,高度重视护生的参与过程,尊重其自主性和自由选择性,将护生独立操作能力的培养放在首位,提高其综合职业能力.     

大学之精神——学术自由

学术自由是根源于“思想自由”的一种特殊形式的自由。现代意义上的学术自由观念产生于十九世纪的德国。深受启蒙运动和理性主义影响的洪堡，在其初创柏林大学时即把“尊重自由的科学研究”和“教学和学习自由”作为现代大学的基本原则，赋予大学教师传授、教研的自由权利。根据国际大学联合会1998年4月发表的题为“关于学术自由、     

Informed consent in neurosurgery--translating ethical theory into action

OBJECTIVE: Although a main principle of medical ethics and law since the 1970s, standards of informed consent are regarded with great scepticism by many clinicans. METHODS: By reviewing the reactions to and adoption of this principle of medical ethics in neurosurgery, the characteristic conflicts that emerge between theory and everyday clinical experience are emphasised and a modified conception of informed consent is proposed. RESULTS: The adoption and debate of informed consent in neurosurgery took place in two steps. Firstly, respect for patient autonomy was included into the ethical codes of the professional organisations. Secondly, the legal demands of the principle were questioned by clinicians. Informed consent is mainly interpreted in terms of freedom from interference and absolute autonomy. It lacks a constructive notion of physician-patient interaction in its effort to promote the best interest of the patient, which, however, potentially emerges from a reconsideration of the principle of beneficence. CONCLUSION: To avoid insufficient legal interpretations, informed consent should be understood in terms of autonomy and beneficence. A continuous interaction between the patient and the given physician is considered as an essential prerequisite for the realisation of the standards of informed consent.     

Autonomy, problem-based learning, and the teaching of medical ethics.

Autonomy has been the central principle underpinning changes which have affected the practice of medicine in recent years. Medical education is undergoing changes as well, many of which are underpinned, at least implicitly, by increasing concern for autonomy. Some universities have embarked on graduate courses which utilize problem-based learning (PBL) techniques to teach all areas, including medical ethics. I argue that PBL is a desirable method for teaching and learning in medical ethics. It is desirable because the nature of ethical enquiry is highly compatible with the learning processes which characterize PBL. But it is also desirable because it should help keep open the question of what autonomy really is, and how it should operate within the sphere of medical practice and medical education.     

Ethics needs principles--four can encompass the rest--and respect for autonomy should be "first among equals"

It is hypothesised and argued that "the four principles of medical ethics" can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can't be explained by one or some combination of the four principles. This approach is argued to be compatible with a wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as "first among equals", not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism.     

现代医学创新性研究的自由与伦理制约

生命科学的发展突飞猛进,对伦理形成巨大的冲击,伦理学也给医学的创新性研究自由造成了一定程度的限制。从医学研究的本质与其服务性特征,人文和医学伦理是社会文明的准则,伦理评定标准的社会性以及伦理与医学创新性研究的关系,探讨伦理在医学研究中的作用,祈盼现代医学伦理准则能引导我国医学创新性研究的更好发展。     

Confidentiality

The principle of medical confidentiality is described as a venerable moral obligation of medical ethics. It has been defended by utilitarians and deontologists alike, not as a moral end in itself, but as a means to a desirable end such as the general welfare, respect for autonomy, or respect for privacy. Neither philosophers nor codes of medical ethics consider confidentiality to be an "absolute" principle. Great Britain's General Medical Council recognizes eight legitimate exceptions to the rule of confidentiality, among them patient consent, the "best interests" of the patient, statutory obligations, and medical research that has been approved by a "recognized ethical committee." Gillon discusses the ethical justifications for these various exceptions, rejecting appeals to medical paternalism or the benefits of medical research as general grounds for not soliciting patient consent.     

医德教育评价体系的建立研究与实践

通过对医德教育评价体系现状的分析,根据医德教育评价体系遵从的科学性原则、目标性原则、完整性原则、实用性原则和多那比第安原则,从体系结构、教育过程、教育结果三方面建立了医德教育评价体系。该体系分为3个一级指标、12个二级指标、37个三级指标,并进行了理论考证和实践应用。该医德教育评价体系的建立,能考核院校在医德教育方面的重视程度和所做的大量具体工作,对医德教育评价起到促进作用,为各医学院校在医德教育评价方面提供借鉴。     

手术治疗中坚持知情同意原则的重要性

知情同意原则是医院医生必须一贯坚持的医德原则。手术治疗中，手术医生坚持这一医德原则显得尤为重要，它是病人自主原则的具体体现，符合医院尊重病人的医德一般规范，是 手术治疗的道德要求，同时也是有效减少医疗纠纷发生的重要措施之一。     

Justice and allocation of medical resources

In one of a series of short articles on philosophical medical ethics, Gillon examines the principle of justice as it applies to adjudicating competing claims for the distribution of scarce medical resources. He describes Aristotle's theory of justice--with its demands of formal equity, impartiality, and fairness--and then considers various substantive criteria that have been proposed to justify choosing among competing candidates for scarce resources. In the absence of an acceptable way to give consistent moral priority to any of the criteria, he concludes, practical systems should be set up to resolve conflicts by taking into account the fundamental moral values of respect for autonomy, beneficence, and nonmaleficence while incorporating Aristotle's formal principle of justice.     

Comments on an obstructed death -- a case conference revisited: commentary 1

The paper comments on Scott Dunbar's "An obstructed death and medical ethics," arguing contra Dunbar that we should not view truth-telling to the terminally ill as primarily governed by principles of veracity and respect for autonomy. All such rules are of limited value in medical ethics. We should instead turn to an ethics deriving from the centrality of moral relationships and virtues. A brief analysis of the connections between moral relationships and moral rules is offered. Such an ethics would lower the value that philosophical fashion places on truth-telling and autonomy and leave decisions about truth-telling and the terminally ill more dependent on the circumstances of particular cases.     

Autonomy and the akratic patient.

I argue that the distinction which is current in much writing on medical ethics between autonomous and non-autonomous patients cannot cope comfortably with weak-willed (incontinent) patients. I describe a case involving a patient who refuses a blood transfusion even though he or she agrees that it would be in his or her best interests. The case is discussed in the light of the treatment of autonomy by B Brody and R Gillon. These writers appear to force us to treat an incontinent patient either as autonomous, just like a rational agent whose decisions are in accordance with his beliefs or as non-autonomous, like comatose patients or children. Though neither is entirely satisfactory I opt for describing such patients as autonomous but point out that in cases like this the principle of respect for autonomy does not give a determinate answer about how the patient ought to be treated.