高等医学院校医事法律专业教学模式探讨

医事法律是一门新兴的学科．笔者根据对该学科的理论教学体会．提出了改进医事法律教学和提高医事法律专业学生质量的七条途径。认为搞好医事法律教学必须体现人文特色；必须搞好创新；提高教师的业务素质；合理安排课程等。     

In defence of medical ethics.

A number of recent publications by the philosopher David Seedhouse are discussed. Although medicine is an eminently ethical enterprise, the technical and ethical aspects of health care practices can be distinguished, therefore justifying the existence of medical ethics and its teaching as a specific part of every medical curriculum. The goal of teaching medical ethics is to make health care practitioners aware of the essential ethical aspects of their work. Furthermore, the contention that rational bioethics is a fruitless enterprise because it analyses non-rational social events seems neither theoretically tenable nor to be borne out by actual practice. Medical ethics in particular and bioethics in general, constitute a field of expertise that must make itself understandable and convincing to relevant audiences in health care.     

Teaching medical ethics in other countries.

In the past 20 years, around the world, there has been an explosion in the teaching of medical ethics. As the dust begins to settle, it would appear that such teaching is likely to have its most effective impact not during the undergraduate period but at the immediate postgraduate level and in continuing education. Whilst important contributions can be made by teachers of religion, philosophy and law, probably the essential wisdom, capable of standing a doctor in good stead throughout the developments of a lifetime's career, must largely come from those who have studied both medicine and ethics. It would be appropriate if the study of medical ethics were to lead to better international understanding among doctors.     

The dangers of medical ethics

The dominant conception of medical ethics being taught in British and American medical schools is at best pointless and at worst dangerous, or so it will be argued. Although it is laudable that medical schools have now given medical ethics a secure place in the curriculum, they go wrong in treating it like a scientific body of knowledge. Ethics is a unique subject matter precisely because of its widespread familiarity in all areas of life, and any teaching has to start from this shared ethical understanding and from the familiar ethical concepts of ordinary language. Otherwise there is a real risk that spurious technocratic jargon will be deployed by teacher and student alike in the futile search for intellectual respectability, culminating in a misplaced sense of having "done" the ethics module. There are no better examples of such jargon than "consequentialism", "deontology", and the "Four Principles". At best, they cannot do the work they were designed to do and, at worst, they can lead student and practitioner into ignoring their own healthy ethical intuitions and vocabulary.     

The teaching of medical ethics to medical students.

Teaching medical ethics to medical students in a pluralistic society is a challenging task. Teachers of ethics have obligations not just to teach the subject matter but to help create an academic environment in which well motivated students have reinforcement of their inherent good qualities. Emphasis should be placed on the ethical aspects of daily medical practice and not just on the dramatic dilemmas raised by modern technology. Interdisciplinary teaching should be encouraged and teaching should span the entire duration of medical studies. Attention should be paid particularly to ethical problems faced by the students themselves, preferably at the time when the problems are most on the students' minds. A high level of academic demands, including critical examination of students' progress is recommended. Finally, personal humility on the part of teachers can help set a good example for students to follow.     

对医学伦理学教育的反思

目前医学伦理学教育被边缘化,是因为其学科性质、教学目标、教学内容和方法被误解。医学伦理学不是思想政治教育课,培养医学生的德性不是其主要任务,其教学内容中不应包括道德规范教育,教学方法则应适合中国的课堂情况。     

The teaching of medical ethics in the Federal Republic of Germany.

Eduard Seidler sets his discussion of the teaching of medical ethics in the Federal Republic of Germany against an historical background. Immediately after the Second World War the freshness of the memory of the 'Nuremberg Medical Trials' influenced the way in which moral dilemmas were treated in Germany. At the present time no systematic instruction in medical ethics is provided in either undergraduate or postgraduate or continuing medical education. As a result of this, an inquiry was set up in 1977/78. Questionnaires were sent out with a view to collecting information on how subjects referring to medical ethics are treated during medical training. The inquiry showed that no special discipline can claim to be the only competent one for medical ethics, but that everyone has something to contribute. Dr Seidler concludes by stating that basic curricula related to the problems of medical ethics would have to be developed and should be carried on continuously within the training programme.     

Teaching medical ethics symposium. Reflections from New Zealand.

The Medical Faculty of the University of Otago, New Zealand is experimenting with a new approach to the teaching of medical ethics, making it an integral part of several courses in all years of the medical curriculum. During the author's twelve-month period as a visiting professor in the faculty, trial runs in ethics have been introduced in the preclinical sciences, in behavioural science and medical-decision analysis and in every clinical attachment. Proposals for permanent course requirements will be considered by the faculty after a full evaluation of these experiments by both students and teaching staff. If such courses are to be implemented and maintained, medical facilities will need to appoint specialists in ethics, at least on a part-time basis.     

A philosophy of a clinically based medical ethics.

Pellegrino and Siegler have argued that medical ethics must be taught 'at the bedside', or clinically. This paper is an attempt to establish the need for clinical teaching of medical ethics both to medical students and to medical ethicists who are not physicians. Through a critique of six positions regarding the aims of medical ethics, four principles are established which are the basis of a philosophy of education for medical ethics. The need for a clinically-based educational programme in medical ethics is thereby established, not on practical grounds, but on solid philosophical ones. The paper concludes with practical examples of a clinically-based medical ethics programme following from the four principles.     

临床课教学中要强化和渗透新型医德观念

医德教育是医学生职业教育的重要一环.社会经济和医学科学的发展,必将推动医德观念的不断更新,新的医德观念的形成又可以促进医学科学的发展.作为新世纪的医学生,社会要求他们将来成为德才兼备依法行医的高素质人才.在临床课教学过程中,教师自己特别要更新医德观念,重视课堂上的医德渗透.本文作者通过临床课教学中强化和渗透新型医德观念的六个方面的探讨,旨在探索培养适应社会需要的高素质医学人才的方法.     

校园文化中渗透医德教育的研究

通过分析学校医德教育的困扰,提出学校医德教育应多渠道、多途径,多方式,并介绍了笔者学校融医德教育于文体娱乐活动中、社会实践活动中、宣传舆论导向中和争先评优活动中的经验,总结了在校园文化活动中渗透医德教育应遵循娱乐性与思想性,趣味性与知识性,理论性与实践性、典型性与教育性、专业性与创新性的原则.     

医学教育教学研究标准化的提出与探索

随着新技术、新方法、新教学理论的提出与发展,医学教育教学研究也在不断创新并广泛开展。医学教育教学研究的理论、方法和管理模式与时俱进,促进教学能力、医学人才与医学人文培养水平快速提高。然而,当前医学教育教学研究过于关注教学理论、方法和教学管理的创新,而忽视了教学伦理、教学对象知情和潜在获益与风险的评估等方面。此外,教学研究全过程管理中缺乏标准统一的执行和监管规范也是目前亟待解决的问题,尤其体现在教学实证研究中,从而对教学研究的规范化开展带来巨大挑战。本研究通过类比临床试验研究体系,以及对教学研究和教学伦理相关研究总结,首次提出了一套规范化、系统化的医学教育教学研究标准,包括分类、分期、不同阶段等范式。这些标准为医学教育教学研究普适性开展、提高教学对象的教从性、充分保障教学对象获益和避免教学研究风险提供了理论基础,为其他学科的标准化教学研究提供参考。     

试论孙思邈和希波克拉底医德理念与现代医学生医德教育

医学是一门生命科学。医生职业素质和道德水平的高低,直接关系着患者的生命与健康,医学院校的学生应当从理论和实践的结合上理解医学道德的重要性。古今中外,有许多著名的医家,以他们高尚的医德、精湛的医术而流芳百世。在医德方面影响力最大的,当首推中国的孙思邈和希腊的希波克拉底。孙思邈的医德论述,为后世医家所推崇。希波克拉底是西方医学科学之父,其誓言已经成为西方众多医学院校的毕业典礼上的宣誓词。两者的医德观,分别代表了中西方医德的理念,其共同的医德理念认为,品行兼优是作为一名合格医生的准则,对病人必须一视同仁。这些医德理念对于我们今天的医学生培养仍然具有指导意义。在医学教育中,应当通过多种形式将医德教育融人到医学生学习的各个环节。     

医学院校研究生医德的培养

医德培养是医学教育的基石,是临床行为规范的基本准则.目前我国医学院校研究生素质教育的课程安排时间还远不能对研究生进行系统的医德教育.因此如何解决研究生的医德培养问题是摆在教育工作者面前的一个重大课题.笔者从建设育人环境、提高教师素养、培养研究生的博爱精神、交流与沟通能力和人文素质等五个方面探讨我国医学院校研究生的医德培养问题.     

Against medical ethics: opening the can of worms.

In a controversial paper, David Seedhouse argues that medical ethics is not and cannot be a distinct discipline with it own field of study. He derives this claim from a characterization of ethics, which he states but does not defend. He claims further that the project of medical ethics as it exists and of moral philosophy do not overlap. I show that Seedhouse's views on ethics have wide implications which he does not declare, and in the light of this argue that Seedhouse owes us a defence of his characterization of ethics. Further, I show that his characterization of ethics, which he uses to attack medical ethics, is a committed position within moral philosophy. As a consequence of this, it does not allow the relation between moral philosophy and medical ethics to be discussed without prejudice to its outcome. Finally, I explore the relation between Seedhouse's position and naturalism, and its implications for medical epistemology. I argue that this shows us that Seedhouse's position, if it can be defended, is likely to lead to a fruitful and important line of inquiry which reconnects philosophy and medical ethics.     

对以医德实践促进医学生职业责任感培养的新构想

职业责任感是医学生个人素质的重要组成部分,加强职业责任感的培养对于医学生素质的全面提升具有重要的意义。利用心理学、社会学以及教育学的成果,在教学中引入实践机制,以规范化、强制性的课程设置,以操作性更强的医德实习来强化医学生职业责任感的培养,对于改善目前医德教育中只管开课、不问效果的庸碌状况必将起到积极的作用。     

医学伦理学教学目标和教学内容改革的思考

社会经济和医学科学的发展使得医学伦理学在内涵和外延上都有了极大的拓展,若仍以“职业思想品德教育”鉴定学科教学目标和教学内容则过于狭窄。从学科发展和学生的实际需求出发定位教学目标,组织教学内容与教学活动,强化利益观、价值观和法律意识教育,使学生在形成良好的职业道德品质的同时,具有分析与解决医学伦理问题的能力,促进学生医德教育,是当前医学伦理学教学与改革的重要课题。     

Review of the teaching of medical ethics in London medical schools.

The study examined the influence of the Pond Report on the teaching of medical ethics in the London medical schools. A questionnaire was given to both medical students and college officers. All medical colleges reported that ethics was included in the curriculum. However, from students' replies, it seems that attendance of optional courses is low and that not all current final year medical students have had any formal teaching in medical ethics. Stronger guidelines are necessary to ensure appropriate ethical training in London medical schools.     

Ultimate justification: Wittgenstein and medical ethics.

Decisions must be justified. In medical ethics various grounds are given to justify decisions, but ultimate justification seems illusory and little considered. The philosopher Wittgenstein discusses the problem of ultimate justification in the context of general philosophy. His comments, nevertheless, are pertinent to ethics. From a discussion of Wittgensteinian notions, such as 'bedrock', the idea that 'ultimate' justification is grounded in human nature as such is derived. This discussion is relevant to medical ethics in at least five ways: it shows generally what type of certainty there is in practical ethics; it seems to imply some objective foundation to our ethical judgements; it squares with our experience of making ethical decisions; it shows something of the nature of moral arguments; and, finally, it has implications for teaching medicine and ethics.     

Issues in bioethics. Teaching medical ethics to health professionals

New medical technologies, public concern about medical ethics, and the advent of numerous ethical dilemmas in healthcare have led many medical schools to increase their formal teaching of ethics. Ethical issues in healthcare may involve a complex mix of scientific, economic, social, cultural, religious, moral and legal issues. Education in medical ethics will therefore need to be on-going to accommodate changes that periodically occur in healthcare issues, policies, or the changing moral values of the society. This article proposes frameworks within which this process may occur.