医患伦理—医伦教育求新求深的主课题

本文旨在探讨当代中国医学伦理学教育内容体系的出路问题。指出医伦教育内容体系要得到合理发展,必须找准自己的生长点,而医患关系,自始至终都是其核心要点。笔者意在强调,现阶段中国的医学伦理学教育绝不能对矛盾最尖锐的医患伦理采取任何形式的回避,也不能认为这里已没有研究余地,而把主要的甚至全部注意力投向对发达国家的引进和借鉴,投向并不具有广泛实践意义的前沿课题,如果坚持那样搞下去,医学伦理学教育的现实意义和发展前景将受到损害。

医伦的价值取向与客观真理性

如果承认医学伦理学的客观真理性,是否意味着"价值中立"?如果承认其社会、阶级和职业的价值导向,是否否定了其理的客观性?怎样看待价值取向与客观真理的关系?这个问题关系到医学伦理学的生存和发展。

医伦素质培养:医疗卫生改革中的基本建设

全员培养医学伦理素质是当前深化医疗卫生改革的一项基本建设 ,克服关于卫生改革伦理学理念诸多二律背反的唯一出路是 :在改革实践中培育所有改革者的医学伦理素质 ,同时以培育医学伦理素质去推动医疗卫生改革事业。为此 ,我们亟需解决卫生改革政策理念与伦理理念的关系、医学伦理素质与医德医风的关系以及谁更应“进补”医学伦理学理论等基本理论和认识问题 ,并在实践中建立起医伦素质培育的可行机制 ,率先培育管医者 ,办医者的医伦素质 ,从而提高医伦素质全员培育的实效性。

论医学伦理学教学中的几个关系

教学相长是一个常谈常新的话题。那么,医学伦理学教学的生命力何在?怎样提高其教学质量?本文试就此探讨医伦教学中的方向性与科学性、教与学等的关系问题。对其教学中的理论与实践、德育与智育、传授知识与发展能力、教育原则与教学方法等医伦教育问题提出了看法。

正确认识医学伦理学的学科价值是激发学习动力的关键

利益和需要是人的积极性的基础和根源。任何正常的人都不会去追求无价值、无意义的东西。价值就是客观事物对于人的肯定或价值的实现。在医学伦理学的教学工作中,我们深深感到,如何让医学生正确认识其学科的价值,是激发学生学习动力的关键。本文正是想就此问题谈谈自己的初浅看法。对医学伦理学的学科价值,医学生往往有一些片面认识。

《中国医学伦理学》征稿启事

《中国医学伦理学》杂志是中国目前关于医学伦理学、生命伦理学的大型刊物。杂志为国家科技部＂中国科技论文统计源期刊＂（中国科技核心期刊）,被评为＂RCCSE中国核心学术期刊（A）＂;先后获得第二、三、五届中国高校特色科技期刊奖;首批入选世卫组织西太平洋地区医学索引。开设的栏目有：院士论坛、名家访谈、社会主义核心价值观与医德医风建设、生命伦理学发展研究、医疗职业安全伦理。

医学伦理学是现代医学的重要组成部分

在二十世纪七十年代以来的医学和医学教育园地中,医学伦理学这朵奇葩斗放,遍及中西各个国家,已为全世界公认为是培养现代医学人才所不可缺少的学科课程。从认识论上讲,医学伦理学是伦理学的原理在医学领域中的运用,是医学与伦理学的边缘学科。所以,医学伦理学不再具有一般伦理学的社会科学性质,而是自然科学和社会科学相交叉的学科,是现代医学不可缺少的重要组成部分。

一本有助开辟医德教育新径的书——评《医德疑案》

目前,医德教育面临着一个如何深入的问题,其实质是如何更好地理论联系实际的问题,也即是理论联系什么实际?实际从哪里入手?读了近期由何兆雄、曹开宾、邱世昌主编、广西科技出版社出版的《医德疑案》一书,使人耳目一新,给人以有益的启迪。

胎教存在的问题及改进方法

胎教对胎儿几乎没有直接的积极作用,相反,现在的胎教可能会对胎儿产生伤害。医生擅自使用未经科学验证和卫生部门批准的胎教方法进行临床试验,是有违医学论理的。本文论述了胎教存在的问题,胎教中对胎儿的不良影响,并提出了胎教对母体的心理学价值,同时对现在的胎教改进提出了新的观点。

Foundations of medical decision-making for older adults with cardiovascular disease

In order to help older adults with cardiovascular disease navigate complex decisions, clinicians must know tenets of medical ethics and have good communication skills. The elements of decision making capacity and informed consent are reviewed, using relevant clinical ex- amples to illustrate the basic concepts. The shared decision making model, by which clinician and patient work together to determine the plan of care, is described. Useful communication techniques to implement shared decision making are suggested.

A study of the relationship between professional values and ethical climate and nurses'professional quality of life in Iran

Objective:To explore the relationship between nursing professional values and ethical climate and nurses'professional quality of life.Methods:The present study is a descriptive,cross-sectional work in which 400 nurses from various wards of hospitals in the south-east of Iran were studied.Data were collected using a questionnaire consisting of four sections:demographics,Nurses'Professional Values Scale-Revised(NPVS-R),the Hospital Ethical Climate Survey(HECS),and the Professional Quality of Life Scale(ProQOL).Results:The total mean scores for professional values were 105.29±15.60.The total mean score for the ethical climate was 100.09±17.11.The mean scores for the indexes of compassion satisfaction,burnout,and secondary traumatic stress were 45.29±8.93,34.38±6.84,and 32.15±7.02 respectively.The relationships between professional values and the indexes of compassion satisfaction(r=0.56),burnout(r=0.26),and secondary traumatic stress(r=0.18)were found to be positive and significant(P<0.001).Also,the relationships between ethical climate and the items of compassion satisfaction(r=0.60,P<0.001),burnout(r=0.15,P=0.002)were found to be positive and significant.Conclusion:An understanding of nurses'perception of professional values and improving the ethical climate at work can help nursing administrators identify more effective strategies toward increasing compassion satisfaction and lessening bumout and work-related stress.

Medicine as Profession： An Overlooked Approach to Medical Ethics

This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved using a theory of professional ethics （more or less） absent from medical ethics until now though common outside. Employing a physician--rather than an ordinary officer, some other kind of healer, or scientist--is to enter a sort of ＂Ulysses contract＂ requiring the physician＇s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing （more than is now common） on other fields of practical ethics.

Influential factors and correlation analysis of hospital ethical climate and psychological empowerment of ICU nurses

Background and aims:Objective To investigate the current situation of ICU nurses'hospital ethical climate in China and analyze the correlation and influencing factors of hospital ethical climate.In order to provide a new direction and idea for creating the good hospital ethical climate,relieving the nurses'job burnout and stabilizing the nursing team.Methods:A total of 226 ICU nurses from 6 tertiary Tianjin hospitals were selected as subjects,and the Chinese version hospital ethical climate scale and psychological empowerment scale were used for investigation.Results:The gender and labor relationship of ICU nurses affected the perception of nurses'hospital ethical climate;hospital ethical climate and psychological empowerment were positively correlated;stepwise regression analysis showed that labor relationship and psychological empowerment can explain 58.5%variation rate of hospital ethical climate.Conclusion:We should pay attention to the current situation of the hospital ethical climate of ICU nurses.Managers should create a comfortable working environment not only to provide good material conditions for nurses and transfer of right,but also to pay attention to the nurses'mental state and negative impact of ethical issues.Hospital managers should reasonably allocate human resources,establish effective incentive and assessment standards,reasonable reward and punishment system and promotion mechanism.To provide comprehensive learning resources and channels.To improve nurses'awareness of their own professional value.Creating a harmonious and positive hospital ethical climate,reduce the impact of ethical issues on nurses,improve nurses'enthusiasm and satisfaction.

Cutting-Edge Reproductive Medicine and Ethics in Japan

Although the Japan Society of Obstetrics and Gynecology （JSOG） endorses new-type PGD using CGH for only carriers of balanced chromosomal translocations, it is against the ethical guidelines of the JSOG to decide whether or not embryos should be implanted due to aneuploidy discovered as a result of new-type PGD. In the author＇s opinion, it should be at the discretion of the JSOG＇s own randomized controlled trials, which should involve multiple facilities, whether or not a scientific basis can be found for the value of the new-type PGD in cases of recurrent miscarriage, in cases of implantation failure, and in cases where the women are of advanced maternal age. Dr. Netsu＇s 36 cases of selective reduction may be against the Japanese Maternal Health Protection Law that prohibits abortion due to congenital disease, but with the backdrop that there are many abortions that are performed as a result of parental convenience in Japan, it is difficult to understand the difference between the over 300,000 abortions that are performed every year in Japan and Dr. Netsu＇s prescribed surgery which is designed to selectively reduce fetuses with congenital disease for the purpose of evading physical danger for women with multiple gestations.

Ethical dilemma in Chinese prison hospital

Forensic medical workers are faced with unique ethical challenges in their attempt to deliver medical care in a custodial environment.We first figure out the reasons why the doctor is standing opposed to the patient through questionnaire and interview of the prison doctor in Shanghai,China,which turn to be a bilateral issue.Both sides should take more active approaches and put themselves to the right position to contribute to a better medical environment in the prison hospital,which can reduce medical tangles and help the criminals to accomplish their reform process.

Multiple Vulnerabilities of the Elderly People in Indonesia： Ethical Considerations

A closer look to the state of affairs of the elderly in Indonesia has disclosed the fact that the Indonesian elderly facing what this paper is coined as ＂multiple vulnerabilities.＂ On the one hand, Indonesian demographic is showing that the Indonesian people are getting old. The fertility rate has significantly decreased since 1970 when the total fertility rate decreases from 5.0 to 2.1 in 2025. This alone gives rise to various problems of the elderly, among whom are the dependency ratio, aging index, potential support ratio, and the feminization of aging. These problems show the level of vulnerability of the Indonesian elderly. From the perspective of the dependency ratio, for example, the number of people under the age of 15 and above 65 who depend on the labor force （15-64 years） has increased since 1970, from 7.0 to 29.0 in 2050. Again, this shows the high level of vulnerability of Indonesian elderly given that the dependency ratio itself has influenced on health care, living arrangements and family support, and so on. Aside from that, the economic burden will be very visible in the workforce. On the other hand, the policies on the elderly are still far from maximum realization. Law on the Welfare of the Elderly （13/1998） has recommended that every hospital must have geriatrics and gerontology section, yet only 8 hospitals fulfill the requirement. The situation is worsened due to the lack of adequate medical staff at the health center, which can serve elderly patients in a professional and humane way. Again, this brings forth the other side of the state of the elderly in Indonesia, which indicates the high level of their vulnerability. In this paper I will analyze the state of vulnerability of the elderly people in Indonesia from the perspective of ethics of vulnerability and personalism. I consider these two approaches as representing all ethical discussion about the ethical treatment of the elderly due to their characters of valuing the elderly as persons with dignity. Thus, this paper will show that the elderly in Indonesia is in danger of not being treated humanely.

MR Request Procedures from Chinese Medical Facility vs That from US Medical Facility

A comparison of how MR released to the insurance company Assist Card from a Chinese medical facility Hengyang HP vs from a US facility Stutter Health was roughly displayed. The former MR was for Mafia, a Colombian Assist Card cardholder, worked and got hospitalized in China, the later MR for Kong Lijun, a Chinese StarrChina cardholder, visited and got medical treatments in USA, they shared Assist Card international traveling and insurance assistance. In both cases, Assist Card got MR for the patient from the facilities that gave them treatments. As a third party, Assist Card went through different procedures to claim MR from Hengyang HP vs from Stutter Health. It managed to have got three MRs and three FTF and was pushing a fourth MR from Hengyang HP in about ten days, while it got only one MR from Stutter Health in ten days after twists and turns. The over cooperative or obedient tendency toward Assist Card＇s requests made Hengyang HP vulnerable and controllable, while the strict MR release procedures in Stutter Health made Assist Card passive and helpless.

Conditions for autonomous choice： a qualitative study of older adults＇ experience of decision-making in TAVR

Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.

Analysis of Prognosis and Prognostic Factors of Cervical Adenocarcinoma and Adenosqumous Carcinoma of the Cervix

OBJECTIVE To analyze clinical characteristics and treatment methods of the patients with adenocarcinoma of the uterine cervix （AUC） and adenosquamous carcinoma of the cervix （ASCC）. To compare the survival time of the patients in 2 groups and analyze the prognostic factors. METHODS Clinical data of both 123 patients with AUC and 32 patients with ASCC treated at the Cancer Hospital, Chinese Academy of Medical Science （CAMS） ＆ Peking Union Medical College （PUMC）, were retrospectively analyzed. RESULTS The median age of the AUC patients was 50 years, and that of the ASCC patients was 44, P = 0.019. Poorly-differentiated （grade 3） cases accounted for 59.5% of the total ASCC patients, while only 32.5% of the AUC patients were in grade 3, P = 0.002. In 123 AUC patients, relapse or failure of the treatment occurred in 63 of the patients （51.2%）, and the median relapse time was 6 months （0-59 months）. In 32 ASCC patients, relapse or failure of the treatment occurred in 8 of these patients （51.2%）, with a median relapse time of 4.5 months （0-52 months）. The overall 5-year survival rate of the AUC patients was 49.8%, which was significantly lower than that of the ASCC patients （74.1%）, P = 0.015. The 5-year survival rates of the ASCC patients in Stage Ⅰ-Ⅲ were higher than that of the AUC patients with the same stages. However, statistical significant difference could only be found among the patients in Stage II, P = 0.006. The 5-year survival rates of the ASCC patients with various differential grade were higher than those of the AUC patients with the same differential grade, but statistical significant difference could only be found among the patients in the two groups with moderately differentiation, P = 0.039. It was found by Cox regression analysis that only clinical stage （P 〈 0.001） and histological type （P = 0.046） were the independent prognostic factors. CONCLUSION Clinical stage and histological type were the independent prognostic factors of the AUC and ASCC patients. The prOgnosis of ASCC patients is better than that of the AUC patients.

灵犬巴德的临终遗愿

车子刚在宠物医院的门前停下,艾伦就赶忙抱着自己的狗狗巴德直奔急诊室。"对不起,你送来的太晚了!你还是在最后的时间里好好陪陪它吧!"艾伦噙着满眶泪水,一个人来到巴德的病床前,小心翼翼地握着它的前爪。以前和巴德快乐玩耍的画面就像放电影一样,不断闪过艾伦的脑海。"巴德,你疼吗?"