中国医院伦理委员会的职能与建设

医院伦理委员会皂铸造医学人文关怀的组织形式,其宗旨是为了保护病人的生命健康权益和受试者的人格尊严。针对我国医院伦理委员会建设和运行中存在的缺陷,从机构设置、资质认定、工作章程、完善机制等方面规范医院伦理委员会建设,促进其在临床实践和医学研究中充分发挥医德教育、伦理审查、伦理咨询等职能。     

医院伦理委员会的制度化建设

该院成立伦理委员会以来，在制度化建设方面的体会是：医院领导的重视程度对医院伦理委员会的建立和发展起重要作用；普及医学伦理学教育可为伦理审查工作奠定工作基础；只要强调生物医学研究课题申报与伦理审查工作协调一致才能保证伦理审查工作不流于形式，认为建立健全的医院伦理委员会相关制度是更好和更有效地开展医院伦理委员会工作的基本保证。     

医院伦理委员会建设探讨

鉴于目前国内外对临床研究的伦理重视程度日益提高,结合医院伦理工作实际,从伦理委员会的工作模式、标准化流程（SOP）、档案管理和队伍建设等有关方面,探讨医院伦理委员会的建设及应当注意的问题,认为医院伦理委员会工作应形成书面规范文件,以提高伦理委员会运行的规范性,需建立健全伦理审查制度,以体现伦理委员会运作的程序性。     

药物临床试验中的伦理学相关问题探析

我国医院伦理委员会建设起步较晚,在伦理委员会组织和审查过程等方面还存在很多问题.例如:伦理委员会成员组成不合理;伦理委员会成员的资质不足,培训力度不够;伦理审查标准和规范不够完善;药物临床试验的跟踪审查不够等.     

医院伦理委员会的职能与建设探讨

文章论述了国内外伦理委员会发展及现状、工作模式及存在问题,如缺少标准化的操作规程和专门的监管机构。针对问题提出要加强国内医院伦理委员会组织和制度建设、人员构成及培训、严格按照标准执行审查、加快与国际接轨,并引进SIDCER认证操作平台对伦理委员会操作规程进行规范,科学合理指导医院伦理委员会正确行使职责,有力保护受试者和患者的安全和权益。借鉴国外伦理委员会审查职能,在涉及患者伦理方面的病例讨论,术前讨论等各种临床诊疗过程中发挥伦理审查作用进行了探索,提出建设符合本国的伦理委员会论证体系,以便更好的保护受试者的医疗安全、质量和权益。     

医院伦理委员会建设若干问题的探讨

通过介绍上海几家有代表性医院的伦理委员会建设成就,阐明了我国的医院伦理委员会建设应具有自己的特点。对人才培养成为医院伦理委员会建设的瓶颈、缺乏针对伦理委员会委员的系统化培训、缺乏可操作性强的操作指南、伦理委员会的建设发展不平衡、伦理委员会的工作缺乏较高的独立性和透明度、缺乏利益冲突的管理机制等医院伦理委员会建设中存在的问题进行了探讨,提出了加快医学伦理学的人才培养、探索实行伦理委员会注册和伦理委员资格认定、尝试建立联合伦理委员会、广泛开展保护受试者和患者安全和权益的社会宣传、明确利益冲突的防范和管理原则等对策。     

医院伦理委员会组织规程

1.医院伦理委员会是在医院党政领导下的关于医学道德的咨询、监督和群众性的自我教育组织.2.医院伦理委员会的宗旨是:团结教育广大医务工作者,促进医学道德水平的提高,密切医患关系,使医学科学技术更好地为公众的健康服务,为医院两个文明的建设服务.3.医院伦理委员会坚持“救死扶伤,防病治病.实行社会主义的人道主义,全心全意为人民服务”的基本道德原则.     

山西省地市级医院伦理委员会建设实证研究

通过调研伦理委员会建设和运行现状,进而分析影响山西省地市级医院伦理审查工作的主要因素,为完善伦理委员会工作提出建议。采用问卷调查和访谈的方式调查山西省地市级24所医院伦理委员会人员组成、制度和标准操作规程、人员培训情况及审查项目方式、时限情况等。分析结果发现,地市级三级医院伦理委员会设置及制度基本合理,能够积极发挥伦理委员会的职能。目前大部分医院对伦理委员会工作不够重视,缺乏专职人员及系统化的培训,伦理审查能力不足。二级医院伦理委员会建设流于形式,未开展实质性工作。建议通过加强上级部门的监管,加大伦理委员和研究者培训力度,完善伦理委员会信息化管理,进一步提高伦理审查能力和效率。     

论我国医院伦理委员会的功能定位与体系构建策略

自国内外医院伦理委员会建设的历史沿革着手,从政策、法律、技术以及医患关系等角度重新审视,提出医院伦理委员会可以具备研究伦理、临床伦理、医院管理伦理等多元功能,并从建立组织与监督体系、统一内部管理规范与流程制度、分步实施委员资格认定与考试制度、加快人才梯队培训机制等方面对医院伦理委员会建设提出建议.     

关于建立医院伦理委员会的再思考

改革开放的深入,市场经济的建立以及科学技术的进步,极大地推动了医学科学事业的迅猛发展,但同时也不断演绎出许多新的医患矛盾和医德难题.从而在客观上越来越迫切地要求基层医疗单位建立专门机构——医院伦理委员会,来协调医患矛盾,研究和解决在临床实践中不断出现的医德难题,加强医德医风建设.本文试从医院伦理委员会的产生发展、性质特征和地位作用等方面再作一些阐述.1 医德难题的出现和医院伦理委员会的产生     

《医学伦理学》临床教学模式研究及思考

探索研究采用学校一医院联合教学的模式,以学校《医学伦理学》教研室学科带头人为教学核心、以附属教学医院伦理委员会为依托,进行《医学伦理学》延伸临床实践教学。探索三种教学方式相结合：理论讲授——实际案例分析——多角色讨论（医生、患者组织、医学伦理工作者）,使教学更具实践性、可操作性。面对当下医院医疗环境不佳的困局,让医学伦理学及医学人文教育走进临床医院和其他医疗机构,显然要好于仅加强医院治安防范。     

Ethical reasoning in mixed nurse-physician groups.

OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning.     

The cultural specifity of research ethics--or why ethical debate in France is different

In the search for a globally binding ethical minimal consensus in dealing with research on human beings the awareness of the cultural specificity of such questions will be of central importance. France provides a good example of such cultural specificities. Three basic structures of French discussion on research ethics can be enumerated: first the particular weight placed on therapeutic benefit, second a particular accentuation on freedom and voluntarism, and third its lesser attention to the aspect of ability to give consent. The weak emphasis on the ability to give consent is rooted as much in the traditionally paternalistically imbued physician-patient relationship as in the French legal system, in which the doctrine of consent is not given the fundamental position of importance found in the Anglo-Saxon countries. As an important Roman country, a different accentuation in the ethical discussion on research on humans can be recognised, a discussion in which for a long time the right of self determination was less of a criterion for decision than the teleology of medical action. It is precisely this aspect of latent cultural influence in ethical convictions which is of decisive importance for future discussion on research on humans.     

Thinking ethically about genetic inheritance: liberal rights, communitarianism and the right to privacy for parents of donor insemination children

The issue of genetic inheritance, and particularly the contradictory rights of donors, recipients and donor offspring as to the disclosure of donor identities, is ethically complicated. Donors, donor offspring and parents of donor offspring may appeal to individual rights for confidentiality or disclosure within legal systems based on liberal rights discourse. This paper explores the ethical issues of non-disclosure of genetic inheritance by contrasting two principle models used to articulate the problem--liberal and communitarian ethical models. It argues that whilst the latter provides a more constructive avenue to providing an ethics for donation than the competing and contradictory positions represented in a liberal rights approach, it raises issues of ethical judgement and authority that remain problematic. This ethical discussion is supported by a field study, funded by the Wellcome Trust, exploring the perceptions and experiences of recipients of donor sperm and their partners towards donor anonymity. The field study provides the empirical basis of an argument for making ethical judgements on the grounds of the community good rather than individual rights, that nevertheless recognises that both are inherently problematic.     

Ethical practice in internet research involving vulnerable people: lessons from a self-harm discussion forum study (SharpTalk)

The internet is widely used for health information and support, often by vulnerable people. Internet-based research raises both familiar and new ethical problems for researchers and ethics committees. While guidelines for internet-based research are available, it is unclear to what extent ethics committees use these. Experience of gaining research ethics approval for a UK study (SharpTalk), involving internet-based discussion groups with young people who self-harm and health professionals is described. During ethical review, unsurprisingly, concerns were raised about the vulnerability of potential participants. These were dominated by the issue of anonymity, which also affected participant safety and consent. These ethical problems are discussed, and our solutions, which included: participant usernames specific to the study, a closed website, private messaging facilities, a direct contact email to researchers, information about forum rules displayed on the website, a 'report' button for participants, links to online support, and a discussion room for forum moderators. This experience with SharpTalk suggests that an approach to ethics, which recognises the relational aspects of research with vulnerable people, is particularly useful for internet-based health research. The solutions presented here can act as guidance for researchers developing proposals and for ethics committees reviewing them.     

Metaphysics and medical ethics: a reply.

The total longitudinal form view of human beings is a metaphysical view which aims to locate our moral judgements about human embryos in a broader set of attitudes and characterisations. On this basis it has explanatory power and a real function in that it grounds our ethical discussion of embryos in other discourses. Contra Leavitt, this grounding suggests a broader criterion of relevance for metaphysical discussion than asking 'what comes out of' such a discussion for a particular ethical dilemma.     

The physician charter on medical professionalism: a Jewish ethical perspective

The physician charter on medical professionalism creates standards of ethical behaviour for physicians and has been endorsed by professional organisations worldwide. It is based on the cardinal principles of the primacy of patient welfare, patient autonomy, and social welfare. There has been little discussion in the bioethics community of the doctrine of the charter and none from a Jewish ethical perspective. In this essay the authors discuss the obligations of the charter from a Jewish ethical viewpoint and call on other cultures to develop their own unique perspectives on this important document.     

加强伦理审查委员会实效性的对策探讨——基于黑龙江省伦理审查委员会现状的调研

通过对黑龙江省部分伦理审查委员会的问卷调查分析,发现目前伦理审查委员会的整体效果不甚理想,主要存在伦理审查内容混杂、伦理审查的全程性未得到相应重视、组织建设有待完善等问题.其制约因素有：现行相关法律位阶较低、监管制度不完善、操作流程不规范.在对制约因素进行分析的基础上,提出了加强伦理审查委员会实效性的对策：提高有关法律位阶并完善相关规定,建立统一的监管主体,完善伦理审查程序,改善组织建设.     

Ethical reflection on the harm in reproductive decision-making

Advances in reproductive technologies continue to present ethical problems concerning their implementation and use. These advances have preoccupied bioethicists in their bid to gauge our moral responsibilities and obligations when making reproductive decisions. The aim of this discussion is to highlight the importance of a sensibility to differences in moral perspective as part of our ethical inquiry in these matters. Its focal point is the work of John Harris(i), who has consistently addressed the ethical issues raised by advancing reproductive technologies. The discussion is aimed at a central tenet of Harris's position on reproductive decision-making-namely, that in some instances, giving birth to a worthwhile life may cause harm and will therefore be morally wrong. It attempts to spell out some of the implications of Harris's position that the author takes to involve a misplaced generality. To support this claim, some examples are explored that demonstrate the variety of ways in which concepts (such as harm) may manifest themselves as moral considerations within the context of reproductive decision-making. The purpose is to demonstrate that Harris's general conception of the moral limits of reproductive autonomy obscures the issues raised by particular cases, which in themselves may reveal important directions for our ethical inquiry.