发展的马克思主义道德哲学问题式下医德教育范式的转型——医德的现实化与“践行性的道德实践能力”

对马克思主义哲学具有价值维度的确认是对马克思主义道德哲学的肯定。挖掘了马克思主义道德哲学的问题式(对现实世界的提问方式),即“道德如何现实化”。从(作为道德现实化为道德实践和“生-生”式的道德关系的根本障碍的)“生存性恐惧”出发,可以在继承马克思主义道德哲学的问题式的基础上将此问题下的研究领域进一步拓展到与“道德现实化的内在条件”和“道德实践的动力、阻力和能力”相关的诸多问题。在此“发展的马克思主义道德哲学问题式”下,呼吁医德教育的范式转换,即从当前主要的“知性医德教育模式”转变为着眼于使医德现实化的“践行性的实践性医德教育模式”。这需要对“跨主体性的能力/践行性的道德实践能力”的培养和对作为其前提的“超越生存性恐惧的勇气”的培养,进而需要对相关的培养路径等问题进行系统性的研究和实践。

当代美德伦理学的缺陷和医德培养的关键

当代伦理学的缺陷在复兴的当代美德伦理学上表现为片面性、“自我—他人不对称”、相对主义、缺乏具普遍性的美德依据和践行性的道德实践能力,即“美德”丢失了古代的能力蕴含而仅指品质,从而使美德难以现实化。从“畏死的恐惧”基础上所重塑的道德基础(即生命本真存在方式的需要)出发,对上述问题给予揭示与超越。马克思以彻底的实践哲学和崭新的问题式,即“道德何以现实化”,使道德走出了纯粹的思维性。从“畏死的恐惧”出发可以继承和发展此问题式,将研究拓展到与“道德现实化的内在条件”和“道德现实化的动力、阻力和能力”相关的领域。在此发展的马克思主义道德哲学问题式下,医德教育的关键是培养“超越畏死的恐惧的勇气”。

孔子仁学理路的内在矛盾:从“家国同构”到“家国错位”

孔子仁学的思想理路的内在矛盾,集中表现在孝与忠的关系上。孝与忠在情感层面的兼容,构成其"家国同构"的社会理想;在践行层面的对立,又构成其"家国错位"的理论偏至,其结果是:一方面社会家庭化了,另一方面家庭社会化了。仁学具有的情感性与践行性矛盾统一的本质特性,决定其思想理路必从"家国同构"走向"家国错位"。

Non-invasive assessment of liver fibrosis in chronic liver diseases:Implementation in clinical practice and decisional algorithms

Chronic hepatitis B and C together with alcoholic and non-alcoholic fatty liver diseases represent the major causes of progressive liver disease that can eventually evolve into cirrhosis and its end-stage complications,including decompensation,bleeding and liver cancer.Formation and accumulation of fibrosis in the liver is the common pathway that leads to an evolutive liver disease.Precise definition of liver fibrosis stage is essential for management of the patient in clinical practice since the presence of bridging fibrosis represents a strong indication for antiviral therapy for chronic viral hepatitis,while cirrhosis requires a specif ic follow-up including screening for esophageal varices and hepatocellular carcinoma.Liver biopsy has always represented the standard of reference for assessment of hepatic fibrosis but it has some limitations being invasive,costly and prone to sampling errors.Recently,blood markers and instrumental methods have been proposed for the non-invasive assessment of liver fibrosis.However,there are still some doubts as to their implementation in clinical practice and a real consensus on how and when to use them is not still available.This is due to an unsatisfactory accuracy for some of them,and to an incomplete validation for others.Some studies suggest that performance of non-invasive methods for liver fibrosis assessment may increase when they are combined.Combination algorithms of non-invasive methods for assessing liver fibrosis may represent a rational and reliable approach to implement non-invasive assessment of liver fibrosis in clinical practice and to reduce rather than abolish liver biopsies.

论人类命运共同体的基本维度是空间性的

空间性存在具有相对静止性、多元一体和肯定性践行等三个基本特征。当今世界在生产方式、社会基本制度等方面具有相对的稳定性,并且具有多样性统一特征和合作共赢条件,因此,人类命运共同体的基本维度是以肯定性、建设性为主的空间性而非以否定性、批判性为主的时间性。应以马克思主义空间维度的共同体、交往、社会有机体等理论指导人类命运共同体的构建;借鉴各种文明构建人类命运共同体,必须明确这种借鉴的前提和边界。