非医学目的基因增强：赞成与反对

以非医学目的基因增强的安全性和有效性为假设前提，分析了赞成与反对非医学目的基因增强的各种主要观点，指出各种观点的合理性和不足之处，认为各种观点间的分歧是一种善与善的冲突。但在资源约束的情况下，避苦之善优先于增福之善，应把非医学目的基因增强局限在科学研究的范围而不应用于人类。     

“专科门诊”的“三字经”

打开电视，翻阅报刊，不难发现一个问题：仿佛一些世界医学难囊均已被国人“攻克”。而这些“攻关”的单位和个人，既非国内有名蔓的研究所、医学院或医院，也非专家、教授或他们的高足，而是些口称握有“祖传秘方”的“专科门诊”。笔者悉心收集了一些资料，在进行一番研究后，发现这类专科门诊几乎都有一个共同的特征，即在骗人的“三字经”上做文章。     

科技美学疑难辨析——兼论医学美学的性质与对象

科学理论美、技术功能美“有没有”、“是什么”的问题 ,至今还是美学界争论不休的一个话题。本文从实践本体论的视角 ,对科技美学的这些理论疑难作了探索性回答 ,从而论证了科技美学 (包括医学美学 )作为一门全新的现代美学可以成立、能够独立。本文还进一步探讨了医学美学的性质与对象 ,强调在医学美学学科建设上应注意独立性与交叉性同举、基础研究与应用研究并重。     

科技美学疑难辨析——兼论医这美学的性质与对象

科学理论美、技术切能美“有没有”、“是什么”的问题，至今还是美学界争论不休的一个话题，本文从实践本体论的视角，对科技美学的这些理论疑难作了探索性回答，从而论证了科技美学（包括医学美学）作为一门全新的现代闰 可以成立，能够独立。本文还进一步探讨了医学美学的性质与对象，强调在医学美学科建设上应注意独立性与交叉性同举，基础研究与应用研究并重。     

融合杂交瘤细胞单克隆抗体工程

当前,在生物学和医学领域内有两项最基本和最引人入胜的重大研究课题,即“基因工程”和“融合杂交瘤细胞单克隆抗体工程”(简称“单克隆抗体工程”)。从最基本的研究发展水平上来说,基因工程从一个方面把生物学和医学推向了一个崭新的时代—基因工程时代;而单克隆抗体工程则又     

浅谈产科学理论教学的体会

随着医学的不断进步，对医疗工作者的综合素质要求越来越高，医学人才必须具备深厚的基础医学知识和扎实的专业医学知识，在产科教学中，如何抓好“教”与“学”对助产士学生及教师来说，无疑是一个极具有挑战性的问题。笔者几年来的教学经历积累了以下几点体会。     

医学科研论文科学性的把握

医学科研论文的科学性 ,就是指其内容实事求是 ,论文的观点、内容、资料、结论等都符合医学规律 ,不夹杂主观臆断和伪科学成分 ,做到“言之有据 ,言之有理”。科学性是评价一篇医学论文质量的首要条件 ,是每位医学工作者在从事医学科研和撰写论文的全过程中必须遵循的重要原则之一。然而在审稿过程中 ,我们不时发现一些医学科研论文存在有科学性不强的诸多问题。归纳起来主要有 :一是科研设计不严谨 ,二是统计学处理方法不正确 ,三是论证不合逻辑等等。为了能较有效地解决医学论中存在的上述问题 ,笔者拟从以下三个方面对论述医学论文科学性…     

关于医学生同理心的实证研究

目的 对医学生的同理心进行对比分析研究,以加强对医学生同理心的培养.方法 采用问卷法,调查了413名学生的医学同理心水平和一般同理心水平,其中医学生208名,非医学生205名,采用独立样本T检验分析法.结果 在杰斐逊量表中,医学生的医学同理心水平高于非医学生.一般同理心量表结果表明,非医学生的水平与医学生水平没有差异,但是在“幻想力”维度上差异显著.在医学同理心量表中,女生的同理心水平都明显高于男生的同理心水平.不同专业的学生在杰斐逊量表中的“观点选择”、“换位思考”和一般同理心量表中的“幻想力”、“同理心关注”维度上有差异.结论 研究提示,提高医学生的同理心水平,须有针对性地开展工作.     

世界第一所内镜医学研究院在中国长沙成立中南大学内镜医学研究院（中国内镜医师分会内镜医学研究院）招生简报

二十年耕耘、三年论证,内镜医学、理学、工学结合,多学科交叉一个新的里程碑国内外第一所培养“内镜医学领域的理、工、医学高级人才”的高等学校在中国卫生部、中国科技部、中国民政部、中国医师协会的支持下,历经三年论证、调研,批准成立中国内镜医师分会,并与中国教育部的重点高校“中南大学”联合创办了“中南大学内镜医学研究院(中国内镜医师分会内镜医学研究院)”。已列入2006年国家研究生统一招生计划,向世界各国公开招收首届内镜医学研究方向的硕士和博士研究生。这是全世界第一所培养“内镜医学领域理、工、医学高级人才”的高等学…     

“气常有余血常不足”辨

<正> 金元四大家之一的朱丹溪有“阳有余阴不足”之论,他又导出一个推论:“气常有余,血常不足”,在医学界影响颇大。笔者认为,这个推论是难以成立的,对医学的影响也是不利的。《阳有余阴不足论》一开头就说,“人受天地之气以生,天之阳气为气,地之阴气为血,故气常有余,血常不足”,他是从天地日月的阴阳有余不足,得出这个结论的。这种论证方法逻辑学上叫作类比,即根据两种事物某些特征上的相似点,得出这两事物在其它特征上也可能相似的结论。然而,根据逻辑学的一般规律,由于事物各自的特殊性     

Confidentiality: the confusion continues

The author, a regional health authority administrator, argues that `ownership' is a side issue in legal and moral arguments over confidentiality of medical records. Nor is it practicable, he argues, for doctors alone to control all access to the medical records. He proposes the principle of `custodianship' of confidential information, to be accepted by an institution as a whole, as a possible way of resolving the problem. In commentaries on this and the following article an academic lawyer and a practising physician respond.     

Legitimate requests and indecent proposals: matters of justice in the ethical assessment of phase I trials involving competent patients

The death of Jesse Gelsinger in 1999 during a gene therapy trial raised many questions about the ethical review of medical research. Here, the author argues that the principle of justice is interpreted too narrowly and receives insufficient emphasis and that what we permit in terms of bodily invasion affects the value we place on individuals. Medical research is a societally supported activity. As such, the author contends that justice requires that invasive medical research demonstrates sufficiently compelling societal benefit. Many consider this societal benefit to be self evident. However, medical research is a complex activity; it yields new treatments but also creates financial rewards and affects health resource allocation. As research evolves into a multibillion pound, multinational enterprise, justice requires a much broader analysis of societal benefit. Without such evaluation we risk undermining the value of bodily integrity and of research participants.     

Medical confidence.

If medical confidentiality is not observed patients may well be reluctant to disclose information to their doctors or even to seek medical advice. Therefore, argues the author, it is of the utmost importance that doctors strive to protect medical confidentiality, particularly now when it is under threat not only in this country but also overseas. The profession must cease to regard ethical issues to do with confidentiality, and indeed to do with all areas of medical practice, as abstract phenomena requiring no justification. If it does not then it will come under increasing and justified criticism from the community it serves.     

Proxy consent: moral authority misconceived

The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person's best interests and that the new legislation introduces only an advisor, not a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other people's desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other people's thought processes indicates that we are unlikely ever to achieve accurate simulations of others' wishes in making a proxy decision. Third, even if we could accurately simulate other people's beliefs and wishes, the current construction of proxy consent in the Mental Capacity Act means that it has no significant ethical authority to match that of autonomous decision making. Instead, it is governed by a professional, paternalistic, best-interests judgement that undermines the intended role of a proxy decision maker. The author argues in favour of clearly adopting the paternalistic best-interests option and viewing the proxy as solely an advisor to the professional medical team in helping make best-interests judgements.     

Sparrows, hedgehogs and castrati: reflections on gender and enhancement

In a number of papers, including the one published in this journal, Robert Sparrow has mounted attacks on consequentialism using principally what he takes to be an important fact, which he believes constitutes a reductio ad absurdum of consequentialism in its many forms and of this author's approach to enhancement and disability in particular (see page 276). This fact is the current longer life expectancy of women when compared with men. Here the author argues that Sparrow's arguments and entire approach utterly fail. In doing so the author hopes to shed further light on the role of normalcy, normal species functioning and species-typical functioning in debates about enhancement and disability.     

A defence of medical paternalism: maximising patients'' autonomy.

All illness represents a state of diminished autonomy and therefore the doctor-patient relationship necessarily and justifiably involves a degree of medical paternalism argues the author, an American medical student. In a broad-ranging paper he discusses the concepts of autonomy and paternalism in the context of the doctor-patient relationship. Given the necessary diminution of autonomy which illness inflicts, a limited form of medical paternalism, aimed at restoring or maximising the patient's autonomy is entirely acceptable, and indeed fundamental to the relationship he argues. However, the exercise of this paternalism should be flexible and related to the current 'level of autonomy' of the patient himself. An editorial in this issue comments briefly on this paper.     

写作者与读者间的交际互动：篇章模式中的词汇信号

旨在从全新的视角探讨阅读策略,通过对一些篇章模式的认真研究,这些篇章模式具有作者与读者间交际互动的篇章构成特点,科技(包含医学)文献的组成框架中常会出现这些篇章模式。这些发现将在很大程度上提高医学生,包括护理专业学生阅读医学文献的能力。     

Whatever happened to medical politics?

This paper argues the case for coming to see 'medical politics' as a topic or subject within medical education. First, its absence is noted from the wide array of paramedical subjects (medical ethics, history of medicine, the medical humanities, etc) currently given attention in both the medical education literature and in specific curricula. Second the author suggests that 'the political' is implicitly recognisable in the historical roots of medical ethics education, specifically in certain of the London Medical Group's activities, and also that the medical profession, or indeed any profession, cannot be understood as an apolitical form of social organisation either in its institutional or scientific (epistemic) forms. Some brief suggestions for introductory and advanced topics in medical politics are discussed and the degree to which medical politics ought to be taken seriously and delivered as part of medical education is considered. Ultimately the author concludes that medical politics might be considered a useful subject within medical education, but it is perhaps best understood as a perspective or approach that can contribute to the development of a more expansive perspective within the extant paramedical subjects.     

More fiddling with the definition of death?

Stanley contends that G.R. Gillett, in the last paragraph of an otherwise excellent article, "Why let people die?" (Journal of Medical Ethics 1986 Jun; 12(2): 83-86), is "fiddling about" with the definition of death when he argues that the patient in a persistent vegetative state is, in an ethical sense, no longer alive as a person; that what remains is a body in which the former patient has no futher interest. Stanley maintains that the determination of the nonreversibility of decortication is uncertain while brain stem death is not reversible. Furthermore, decorticate patients are still biologically alive and decisions concerning their treatment and who makes the decisions are important questions for the medical profession and for society to address. The author concludes that these problems should not be solved by extending the definition of death to include neocortical death.