Patients' ethical obligation for their health.

In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine because it fails to appreciate that medicine's basis as a moral enterprise is oriented towards health values. A naturalistic model for medical ethics is proposed which builds upon biological and medical values. This perspective clarifies ethical obligations to ourselves and to others for life and health. It provides a normative framework for the doctor-patient relationship within which to formulate medical advice and by which to evaluate patient choice.     

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.     

An obstructed death and medical ethics -- a case conference revisited: commentary 2

The dilemma of whether or not a doctor should tell a patient dying of cancer the truth remains a difficult one, as the disagreement between the two previous writers shows. One favours giving priority to patient autonomy, the other feels the doctor's duty of beneficence should be the overriding principle governing such decisions. To this contributor it seems both approaches have something to offer. By being sensitive to what and how much the patient wishes to know and by learning from the insights provided by the study of medical ethics, doctors can learn how to make better moral decisions in this and in other areas. Both lying and truth-telling carry risks of harm to the patient. Learning to work with and balance these risks is part of clinical practice. So is minimising risks by clear thinking.     

论作为"德性"的医学职业道德

规范伦理学是一种重要的道德理论形式,当前的医学伦理学体系普遍以规范伦理学作为基础.但是,这种道德理论在有效指导医学职业道德实践的同时,也显出一定的局限性.这种局限性主要表现为道德规范间的内部冲突性和道德要求的绝对性,这使医务人员的医疗实践经常处于两难之中,并会影响到他们的职业热情.德性伦理学以其不同的学术视野为我们完善医学伦理学体系提供了另外的理论空间.德性精神的内在统一性、稳定性和灵活性使其成为规范伦理的有益补充.如果我们想使一种以"仁爱"和"正义"精神为核心的医学德性在医务人员身上得到普遍化的实现,就需要我们深入反思我们的医学职业道德教育形式并努力建设一个良好的外部环境.相信在医学德性伦理得到普遍实现的时候,我国医疗领域的职业道德状况将得到很大改善.     

The right to die in the minimally conscious state

The right to die has for decades been recognised for persons in a vegetative state, but there remains controversy about ending life-sustaining medical treatment for persons in the minimally conscious state (MCS). The controversy is rooted in assumptions about the moral significance of consciousness, and the value of life for patients who are conscious and not terminally ill. This paper evaluates these assumptions in light of evidence that generates concerns about quality of life in the MCS. It is argued that surrogates should be permitted to make decisions to withdraw life-sustaining medical treatment from patients in the MCS.     

医德教育有效性缺失原因分析及对策

医德教育有效性问题是当前医学伦理学研究面对的一个重点和难点。以有效性概念界说为基点，分析医德教育有效性缺失的深层原因，并从医德教育应回归现实生活、适应心理规律和贯通临床阶段等方面探讨了医德教育有效性的实现规律。     

Jewish and secular medical ethics share themes but diverge on issues such as heroic measures

An american expert on Jewish medical ethics explained the nuances of these rules during a recent address in Ottawa. Although Jewish and secular rules concerning medical ethics often coincide, they diverge in several important areas, including the subject of patient autonomy.     

"Primum non nocere" and the principle of non-maleficence

The physician's duty of "primum non nocere," or avoiding harm to the patient, has often been given moral priority over other duties in discussions of medical ethics. In this article in a British Medical Journal series written for nonphilosophers on the philosophical foundations of medical ethics, Gillon takes issue with the prominence given the obligation of nonmaleficence over that of beneficence. He argues that risking harm is often necessary to obtain therapeutic benefit, and that always giving nonmaleficence priority over beneficence in clinical decision making results in "therapeutic nihilism." These two important principles should counterbalance one another in medical care, with due respect for patient autonomy.     

论医学伦理学的自主性原则

自主性原则是对个人的自主和自由的尊重,其核心是对人权的尊重,包含有知情同意、保密、隐私等具体规则.自主性原则根源于强调个性自由和选择的自由主义道德传统,虽为西方医学伦理学所倡导,但我国古代哲人也提出过相近乃至相同的看法.     

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.     

护理伦理学教学体会及对策

护理道德是护理伦理学的基础,是护理实践中的各种道德关系及处理这些关系的规则。培养护生良好的护理道德情感能够提高他们的护理道德认知水平,使之能够主动参与到护理学及护理伦理学的学习中,并在工作中选择符合护理伦理的言行。基于对护理道德情感应在伦理教学中贯穿的认知及在教学中如何有效培养护生的护理道德情感等问题,本文从护理道德情感的内涵及外延、培养模式、人文、环境要求及舆论导向等几个方面阐述了作者在护理伦理学教学中的体会及相关对策,提出护理伦理的道德情感培养是一项长期的任务,尚需多方合作,持之以恒,方有成效。     

On lying and deceiving.

This article challenges Jennifer Jackson's recent defence of doctors' rights to deceive patients. Jackson maintains there is a general moral difference between lying and intentional deception: while doctors have a prima facie duty not to lie, there is no such obligation to avoid deception. This paper argues 1) that an examination of cases shows that lying and deception are often morally equivalent, and 2) that Jackson's position is premised on a species of moral functionalism that misconstrues the nature of moral obligation. Against Jackson, it is argued that both lying and intentional deception are wrong where they infringe a patient's right to autonomy or his/her right to be treated with dignity. These rights represent 'deontological constraints' on action, defining what we must not do whatever the functional value of the consequences. Medical ethics must recognise such constraints if it is to contribute to the moral integrity of medical practice.     

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.     

Ethics

This article is from the 1989 CONTEMPO issue of the Journal of the American Medical Association, the purpose of which is to keep physicians informed of recent developments in different areas of medicine through brief overviews by specialists in each field. In his article on ethics, Pellegrino focuses on the issues of euthanasia and fetal research. The practice of active, voluntary euthanasia raises questions about the difference between killing a terminally ill patient and withholding or withdrawing life-prolonging treatment, the limits of patient autonomy, the compatibility of active euthanasia with professional ethics, and the social consequences of legalizing euthanasia. The debate over the use of fetal tissue for research and treatment centers on the issue of induced abortion.     

关于新形势下加强医学新生医德教育的若干思考

在市场经济迅速发展的新形势下，医学院校应加强医学新生的医德教育，使之树立正确的人生观、价值观，成长为德才兼备的医学人才。     

论大众健康传播医学伦理评价的四个关键问题

在分析健康传播属性的基础上,认为大众健康传播活动既是传播活动,也是医疗保健活动,既要符合传播伦理,更不能违背医学伦理规范,必须进行医学伦理评价。应当由以医学伦理学专家为核心的专业评价队伍作为评价主体——社会公众的代言人,以不伤害、有利、尊重和公正四大医学伦理学原则为标准,对大众健康传播活动的动机和结果进行价值确定和道德决断。     

历史上道德与法律兼融思想的考察

法律虽然从道德中分化出来乃至与道德分离成为独立的学科 ,但是由于两者都属于社会公共规范体系 ,所以在很多方面有交叉点和重叠点。法律的前提和基础离不开道德观念、道德标准 ;对法的解释和实施以特定历史阶段社会公认的道德规范为范围 ;判决、辩护、推理、程序设定等全部过程都与伦理价值观有一定的联系 ;法的权威性、稳定性和可信度也受道德标准的影响。研究中外历史上法律与道德兼融的思想资料 ,可以得出如下启示 :道德伦理是人立身处世的基本准则 ,所有违反法律的行为都不合伦理规范 ,因此 ,对社会成员进行法制教育必须与道德伦理教育并行 ;依法治国和以德治国兼融并用。道德伦理的生命在于知行合一 ,道德伦理首先是对自己言行的约束 ,不是用来对付别人的 ;而个人是否遵守道德伦理 ,需要整个社会的监督。道德强调自觉性 ,道德教育应避免枯燥的说教方式 ,应将历史上和现实生活中的生动事例 ,提到理论的高度加以阐述 ,使道德成为可爱可亲的东西 ,成为社会生活和个人生活中须臾不可离开的精神养料     

关于限制使用医疗技术管理的道德建设思考

医疗技术违规使用的现象比较突出。我们要以医疗技术的快速发展为契机,提升道德建设的内涵,促进道德观念的转型,促进工具理性与价值理性的和谐。为了规范医疗技术的使用,在理想信念教育的同时,应重视责任伦理的建设;既要重视个体道德建设,也要重视制度伦理建设;改变运动式的治理方式,重视医学伦理委员会的建设,把对医疗技术的伦理评估制度化、机构化。     

Compassion as a basis for ethics in medical education

The idea that ethics is a matter of personal feeling is a dogma widespread among medical students. Because emotivism is firmly rooted in contemporary culture, the authors think that focusing on personal feeling can be an important point of departure for moral education. In this contribution, they clarify how personal feelings can be a solid basis for moral education by focusing on the analysis of compassion by the French phenomenologist Emmanuel Housset. This leads to three important issues regarding ethics education: (1) the necessity of a continuous attention for and interpretation of the meaning of language, (2) the importance of examining what aspect of "the other" touches one and what it is that evokes the urge to act morally and (3) the need to relate oneself to the community, both to the medical community and to collectively formulated rules and laws. These issues can have a place in medical education by means of an ethical portfolio that supports students in their moral development. First, keeping a portfolio will improve their expression of the moral dimension of medical practice. Second, the effects of self-knowledge and language mastery will limit the pitfalls of emotivism and ethical subjectivism and will stimulate the inclination to really encounter the other. Third, it will show medical students from the start that their moral responsibility is more than following rules and that they are involved personally.     

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.