从医院等级评审谈医院伦理委员会建设

通过对照医院等级评审标准,阐述了评审标准对医院医学伦理学建设的相关要求,分析了医院伦理委员会建设中存在的问题,提出了推进医学伦理建设的建议。文章强调,推进伦理学教育,加强医德医风建设;严格伦理学督导,提高医疗科研水平;遵循伦理学原则,构建和谐的医患关系。     

初探如何加强医疗器械临床试验的伦理审查

通过对医疗器械临床试验的伦理审查内容、流程进行分析和评述,探讨其审查过程中需要重点关注的几个方面、以及执行过程中可能存在的问题及其解决方案,为医疗机构提高医疗器械临床试验伦理审查的质量和水平提供参考。     

医学研究知情同意过程及信息告知的伦理审查要点

提高伦理委员会审查质量与严格执行知情同意是保障受试者权益的主要措施。伦理委员会应依据国际、国内公认的法规,把握充分告知、特殊告知及获取知情同意过程等审查要点,对知情同意的过程及知情同意书告知信息进行审查,达到维护受试者权益和安全的目的。     

河南省二级医院护士医院伦理氛围感知与隐性缺勤的相关性研究

目的 探讨河南省二级医院护士医院伦理氛围感知与隐性缺勤的现状及相关性。方法 采取多阶段分层随机抽样的方法在河南省抽取二级医院护士594名,采用一般资料调查表、医院伦理氛围量表、斯坦福隐性缺勤量表进行调查,采用相关性分析和多元线性回归分析探究护士医院伦理氛围感知与隐形缺勤之间的关系。结果 护士医院伦理氛围总分为(4.36±0.43)分,隐形缺勤为（14.83±4.76）分;不同科室、聘任方式、夜班数、科室工作年限以及饮食是否规律的护士隐形缺勤得分差异具有统计学意义（P＜0.05）;医院伦理氛围总分与隐性缺勤呈负相关(r = - 0.348,P＜0.001),各维度与隐性缺勤呈负相关（P＜0.001）;回归分析结果显示在去除混杂因素（科室工作年限、是否饮食规律、科室）后,医院伦理氛围可负向预测护士隐形缺勤（β = - 0.296,P＜0.001）。结论 医院伦理氛围可能是二级医院护士隐性缺勤的独立危险因素,医院管理者应关注护士对医院伦理氛围感知情况的变化,以降低隐性缺勤。     

‘Invisible’ young people: The paradox of participation in research

Abstract

Researchers argue that many young people are marginalized or excluded from today's consumer society and invisible to many official agencies and community services. Researchers have also more recently begun to extol the principles of involving young people in their work. Through liaison with one key support agency in the North East of England, six young people aged between 17 and 21 years who were not in employment, education or training were identified as willing to become involved and trained as co-researchers in an action research project to explore their ‘invisibility’. The young co-researchers resisted the original research plan and proposed methods, and instead established their own agenda. This alternative agenda demonstrated their considerable knowledge of and connections with ‘People, Places and Money’. The authors conclude, first, that far from being excluded, on the ‘outside’ of social life, these young co-researchers were involved, informed and thoroughly engaged with it. Secondly, the researchers questioned the ethical implications of ‘involving’ the young people as co-researchers. The significance of these issues for future research is discussed.     

Sexuality in the nursing home,part 2: Managing abnormal behavior-legal and ethical issues

Everyone, regardless of age, needs love, touch, companionship, and intimacy. The 1.6 million elderly in the 20,000 U.S. nursing homes are not an exception. The literature indicates that nursing home residents continue to have an interest in sexual activity regardless of age. Sexuality, however, is frequently overlooked by physicians and staff working with nursing home residents. Many staff members have only a vague understanding of the sexual needs of the elderly. This results in a perception of residents' sexual interests as behavioral problems rather than expressions of need for love and intimacy. Inappropriate sexual behaviors in the nursing home can create an intense burden for nursing home staff. This article discusses ways to dealing with inappropriate sexual behaviors in long-term care settings and the ethical issues involved.     

Ethical issues arising from a research, technology and development project to support frail older people and their family carers at home

The present paper provides an overview of the application of the key ethical issues which arose in an EU-funded research, technology and development project, Assisting Carers using Telematics Interventions to meet Older Persons' Needs (ACTION). The primary aim of the ACTION project was to support frail older people and their family carers in their own homes across England, Northern Ireland, the Republic of Ireland, Sweden and Portugal via the use of user-friendly information and communication technology. Ethical guidelines were developed in the project and used as a tool to enable the multidisciplinary project team to increase their awareness of ethical issues in their everyday work, and to act as a useful ethical framework for regular team discussions at international and local meetings across the partner countries. A range of ethical issues arose during the field-study phases of the project when the ACTION services were introduced into a number of families' own homes. It can be argued that these ethical issues reflect factors relating both to the application of research into practice, as well as those relating more directly to the use of new technology by families and care professionals. Key issues centre upon the ethical concepts of autonomy, independence, quality of life, beneficence, non-maleficence and justice, and more specifically, on ethical issues of security, privacy and confidentiality, increased expectations, and withdrawal of the service. This paper is intended to facilitate dialogue and debate in the area of enabling (assistive) technology in home care for older people and their families.     

Saving lives versus life‐years in rural Bangladesh: an ethical preferences approach

Using a random sample of individuals in rural Bangladesh, this paper investigates people's ethical preferences regarding relative values of lives when it comes to saving lives of individuals of different ages. By assuming that an individual has preferences concerning different states of the world, and that these preferences can be described by an individual social welfare function, the individuals' preferences for life‐saving programs are elicited using a pair‐wise choice experiment involving different life‐saving programs. In the analyses, we calculate the social marginal rates of substitution between saved lives of people of different ages. We also test whether people have preferences for saving more life‐years rather than only saving lives. In particular, we test and compare the two hypotheses that only lives matter and that only life‐years matter. The results indicate that the value of a saved life decreases rapidly with age and that people have strong preferences for saving life‐years rather than lives per se. Overall, the results clearly show the importance of the number of life‐years saved in the valuation of life. Copyright © 2010 John Wiley & Sons, Ltd.     

Experiences of ethical dilemmas in rehabilitation: Swedish occupational therapists’ perspectives

The aim of this study was to describe Swedish occupational therapists’ experiences of encountering ethical dilemmas in rehabilitation and strategies they used to handle the situations. Twelve occupational therapists who work with adults with developmental disabilities were interviewed using a semi-structured interview design. Data were analysed using qualitative content analysis. The results showed that ethical dilemmas were common in the occupational therapists’ daily work within rehabilitation. Many situations that created ethical dilemmas were related to occupational therapists who worked with clients and their relatives, and other healthcare providers. The results showed further that occupational therapists found it difficult to make decisions and to optimize clients’ participation in decision-making, to set limits and act professionally, and to best handle the situation for the client and avoid ethical dilemmas. This study indicates the importance of illustrating experiences of ethical dilemmas within occupational therapy praxis and the meaning of discussing ethical dilemmas with different healthcare providers to reach a divided view of the client in order to develop successful and healthy strategies that will optimize the rehabilitation of clients with developmental disabilities.