Emancipatory reflection on a nursing practice-based ethical issue about nurses' paternalistic decision-making for patients

Objective: This study aimed to demonstrate and promote the skill of critical emancipatory reflection through reflecting on a nursing practice-based ethical issue about nurses' paternalistic decision-making for patients. Meanwhile, critical awareness will be developed and the underlying issues of paternalism in nursing decision-making will be analyzed. Then, by applying the procedure, improvement in nursing decision-making practice will be expected.Methods: Taylor's model of emancipatory reflection with four steps, including construction, deconstruction, confrontation, and reconstruction, is utilized to guide the author's reflection.Results: Guided by the socialization theory, the author's personal and professional socialization is seen to be associated with the formation of the value of paternalism. The theory of reflexivity is applied to unearth the related issues, including deeper personal value,work environment, as well as historical and cultural contexts. Moreover, the power derived from policy, work relationship, and nursing administration, which could induce paternalism in the author's nursing decision-making practice, was critically debated using the hegemony theory. Finally, new insights into paternalism will be achieved, which enable change in terms of how to facilitate patients' autonomous decision-making.Conclusions: The process of refection makes it clear that respecting patients' right and performing patient-centered caring are the bases to change the paternalism existing in the nursing decision-making practice currently. The reconstruction step assists the author in terms of how to value the patients' autonomy and balance patients' safety and choice, rather than being overprotective; carry out risk assessment, and search for strong evidence to counterbalance the positive and negative aspects of risk-taking; communicate with patients appropriately in a manner that they can comprehend; spend more time to explore patients' preference and choice; make every effort to elevate the patients' decision-making capacity; implement patient-centered care and shared decision-making in nursing practice; consult with other colleagues and obtain the required support when limitations or challenges exist; try to justify and avoid hidden paternalism behind policy or guidelines; deal with the power in hand well and fairly; and also positively face the powers that constrain the author.

An Ethical Approach to Decision Design

This paper describes an approach to ethical decision design. It discusses the use of several mathematical tools applicable to the world of economics and business. It then demonstrates how the tools analogously extend themselves to making ethical decisions as supported by personal values. A review of the mathematics, including the design of a decision tree, the concept of mathematical expectation, and mathematical modeling are included.

Ethical decision-making in older drivers during critical driving situations: An online experiment

The present study examined the impact of aging on ethical decision-making in simulated critical driving scenarios.204 participants from North America,grouped into two age groups(18–30 years and 65 years and above),were asked to decide whether their simulated automated vehicle should stay in or change from the current lane in scenarios mimicking the Trolley Problem.Each participant viewed a video clip rendered by the driving simulator at Old Dominion University and pressed the space-bar if they decided to intervene in the control of the simulated automated vehicle in an online experiment.Bayesian hierarchical models were used to analyze participants’responses,response time,and acceptability of utilitarian ethical decision-making.The results showed significant pedestrian placement,age,and time-to-collision(TTC)effects on participants’ethical decisions.When pedestrians were in the right lane,participants were more likely to switch lanes,indicating a utilitarian approach prioritizing pedestrian safety.Younger participants were more likely to switch lanes in general compared to older participants.The results imply that older drivers can maintain their ability to respond to ethically fraught scenarios with their tendency to switch lanes more frequently than younger counterparts,even when the tasks interacting with an automated driving system.The current findings may inform the development of decision algorithms for intelligent and connected vehicles by considering potential ethical dilemmas faced by human drivers across different age groups.

Ethical Leadership and Moral Imagination: A Moderated Mediation Model of Proximity and Organizational Commitment

Moral imagination is the ability that can help individuals overcome constraints of organizational mental models to develop fresh frameworks and to make ethical decisions on the basis of those frameworks.This study aimed to explore the moderated mediator role of organizational commitment between ethical leadership and moral imagination.Data of 281 employees were collected,and results showed that when the victim of a certain ethical issue is their own company,organizational commitment fully mediated the effect of ethical leadership on moral imagination;however,when the victim is other company,ethical leadership and organizational commitment hadn't any effect on moral imagination.Those results showed the process that ethical leadership uses to influence moral imagination is not a social learning process but a social exchange process.

Grounded theory qualitative approach from Foucault's ethical perspective:Deconstruction of patient self-determination in the clinical setting

This paper aims to explain the construction of the autonomous subject from Foucault's ethical perspective for the qualitative analysis of interprofessional relationships,patient-professional relationships,and moral ethics critique.Foucault tried to break loose from the self,which is merely the result of a biopol-itical subjectivation and constituted an interpersonal level.From this,different elements involved in the decision-making capacity of patients in a clinical setting were analysed.Firstly,the context in which decision-making occurs has been explained,distinguishing between traditional practices involved in self-care and the more modern conceptions that make certain possible transformations.Secondly,an attempt is made to explain the formation of the medicalisation of society using the transformations of what Foucault called"techniques of the self".Finally,the ethical framework for a subject's"self-creation",insisting more on the exercises of self-subjectivation,reinforcing the ethics of the self by itself,the"care of the self",has been explained.The role of the patient is understood as an autonomous subject to the extent that the clinical institution and the professionals involved comprehend how the patient’s autonomy in the clinical environment is constituted.All these elements could generate grounded theory on the qualitative methodology of this phenomenon.The current ethical model based on universal principles is not useful to provide a capacity for patients decision-making,relegating to the background their opinions and beliefs.Consequently,a new ethical perspective emerges that aims to return the patient to the fundamental axis of attention.

护士临床决策能力现状及影响因素研究

目的调查临床护士临床决策能力现状及其影响因素,为改善及提高临床护士正确的临床决策能力提供参考和依据。方法采用方便抽样法,选取陕西300名临床护士为研究对象,采用一般资料调查表、临床决策量表和综合决策风格量表进行调查研究,用单因素分析及多元线性回归等方法分析临床护士临床决策能力的影响因素。结果临床护士临床决策能力总分为(163.85±13.78)分,达到临床决策能力高水平标准(146.68~200.00)分。Spearman秩相关分析结果为:临床决策能力的总得分以及各个维度的得分结果与理智型决策风格得分结果呈现明显的正相关关系(P<0.05);寻找信息或新信息维度的得分情况仅与直觉-冲动型决策风格的得分情况呈负相关关系(P<0.05);回避型决策风格与寻找信息或新信息、明确目标和价值、临床决策能力总分、寻找可选择的方案维度等得分均呈负相关(P<0.05)。多元线性回归结局为:理智型决策风格能够正向影响临床护士临床决策能力,回避型决策风格能够负向影响临床护士临床决策能力。结论临床护士的临床决策能力一直都维持在比较恒定的高水平,他们受理智型和回避型决策风格影响的程度比较大。医疗管理者需要举办针对性培训活动等措施,促进临床护士理智型决策风格的构建,尽量减少回避型决策风格的影响,从而提高临床护士的临床决策能力。

知情同意临床实践的伦理隐忧及其消解

知情同意作为患者权利,成为理解现代临床实践的“金钥匙”。它在中国的规范性建设遵循了制度安排与社会变迁互动的渐进式主线,围绕消解自主与行善冲突的经典命题、医方义务与患者权利走向融合而展开。然而,其临床实践中基于利益分歧、沟通机制不完善而带来告知的家长主义、同意的家庭主义以及全流程的形式主义等伦理隐忧。为消解这些隐忧,需要在角色和行动层面明确医生、患者与家属的价值主体地位,厘清各自的权利责任边界,围绕患者最佳利益弥合分歧达成共识,方可建构权利共享与责任共担的医患共同体。

人工智能中的三支结构

为了从基于认知计算的三支决策(three-way decisions,3WD)理论来解释人工智能(artificial intelligence,AI),从3WD几何结构的角度阐述了人工智能的发展历程、技术分类、关键研究问题以及未来发展方向。这包括人工智能研究中的三大主义、人工智能发展中的3种分类、机器学习的3种方式、智能本质中的三层金字塔结构、智能生成机理中的三支结构、大数据的三V结构、人工智能伦理的三定律以及人工智能中人类与机器关系的三元结构等。通过3WD三元组的几何结构和模式,尝试对人工智能中三元处理进行解释。本文工作可对3WD在大数据分析、知识发现、计算智能、智能信息处理等方面的研究提供参考。

《歧路灯》与“春秋决狱”渊源关系研究

长篇小说《歧路灯》写到谭绍闻因参与赌博而涉讼,导致对簿公堂,但官员在审案时多忽略法律条文,依据儒家纲常伦理或涉案人的身份等来判决,小说中官员审案方式与汉代董仲舒等人“春秋决狱”有异曲同工之处。汉代司法实践中“春秋决狱”的审判方式出现在清代小说中,究其根源,和“以儒释法”、科举制度以及作者所处时代背景、人生经历等相关,从侧面说明儒家思想对社会运转的多方面影响。

小学教师课堂互动决策的伦理考量探析——基于眼动追踪的数据

教学是极具伦理意义的专业实践,特别是在小学教育中,教师教学过程中的伦理性体现尤为重要。目前对教学过程中的伦理研究大多数仍停留在“应然”的层次,本研究以教师在真实课堂佩戴眼动仪所获得的眼动数据为基础,整合视频分析、教师课后访谈及教师评定学生表现的量表数据,对小学教师课堂视觉关注及互动决策的伦理性进行了探析。研究发现,教师在整个课堂教学中的视觉关注具有公平性,教师的互动决策与学生表现特征具有一定的相关性,而这种相关性与教师的伦理考量关系密切。本研究从伦理理论之结果论的视角出发,发展出“教师利益—学生利益”与“集体利益—个体利益”的二维分析框架,并以此对教师课堂互动决策过程中的伦理考量进行了分析。

普外科高危手术医患共同决策面临的困境及对策

普外科高危手术通常风险高、不确定性大,患者可能面临生活和健康状况的重大改变,容易引发医患纠纷。总结普外科高危手术医患共同决策实施的障碍,探索将共同决策纳入临床实践的最佳方式。在决策过程中,存在普外科医生和患者需要共同克服沟通与决策能力欠缺、知情同意与认知能力不足、体制与文化问题等伦理困境。为帮助患者选择最适合的治疗方法,真实作出关于高危手术的决定,建议应加强普外科医生沟通技能培训,开发、运用决策辅助工具,同时多方支撑,为普外科医患共同决策的实施提供良好的环境。

从伦理视角看医患共同决策的多种模式

医患共同决策是一种道德要求,源于医务人员接受患者或患者家属的基本权利,如自主权、知情同意权和选择权。为实现医患共同决策,医务人员和患者担任了不同的角色,医务人员的任务是引入专业知识和具体经验,为患者提供诊断和治疗选择的多项建议,而患者的任务是根据其对治疗效果目标、健康价值、基本权利等医学和伦理知识的理解程度,选择其在共同决策中认可的治疗方案。从伦理视角出发,立足于医患共同决策,深入分析其伦理意义,围绕伦理基本要求,从医生-患者共同参与模式、医生-患者-家属共同参与模式、医生-护士-患者共同参与模式、医务部介入的高风险病例谈话模式、多学科团队共同协作模式等多种实践模式,展开多角度、深层次的探讨,为进一步促进医患共同决策的实现,提供一些参考依据。

基于医生视野的ChatGPT在临床诊疗中的应用与问题

为辩证地看待ChatGPT等人工智能交互在临床诊疗中的应用,基于临床医生视野,分析自ChatGPT上线以来,在不同临床场景中所进行的开发与应用。通过列举对比研究,探讨ChatGPT在分析临床指南、辅助临床诊断、识别罕见疾病、撰写医疗文书、医疗信息咨询等场景给临床医生带来的效率与便利,展望其可能带来医疗模式的转变。但现阶段测试与研究已显示出ChatGPT应用在临床诊疗中难以规避的局限性及风险性,如信息失真、医疗责任、医学伦理等。因此,需要理性认识ChatGPT在临床的应用,并制定与之相适应的预防性行为规则。

出生缺陷新生儿救治相关伦理困境的质性研究

目的 了解出生缺陷新生儿救治相关伦理困境现状,为摆脱伦理困境提供依据。方法 采用质性访谈法对新生儿科13名医护人员进行半结构式深入访谈,采用Nvivo 12.0软件对访谈资料进行编码、分析,提炼相关主题。结果 共提炼出3个主题:出生缺陷新生儿救治相关伦理困境主要包括积极救治与放弃治疗的伦理困境、监护人决策与医护决策的伦理困境;出生缺陷新生儿救治相关伦理困境产生原因与患儿临床病情,主要监护人文化程度、经济水平、价值观,社会经济水平及医疗资源分布等有关;出生缺陷新生儿救治相关伦理困境应对措施包括完善医疗救治体系、形成医患共同决策模式、强化法律法规建设及社会支持。结论 出生缺陷新生儿救治面临多种伦理困境,应采用科学策略摆脱伦理困境。

生成式人工智能对医患共享决策的影响机制探究

随着大型语言模型日臻成熟,以ChatGPT/GPT-4为代表的生成式人工智能(GenAI)有望深度嵌入临床决策之中。然而,GenAI的临床应用同样存在莫拉维克悖论等隐忧,WHO发布的《卫生领域人工智能的伦理与治理:多模态大模型指南》提出了大模型应用于医疗领域时应遵守的六项原则。GenAI参与临床决策需要医患双方的共同参与。临床医生参与到GenAI的研发与推广应用,把控好技术发展方向。GenAI赋能患者参与决策,贴近医疗实际情况,满足患者价值选择偏好。深化GenAI可解释性、责任分配体系,赋能医患共享决策,妥善处理GenAI对传统告知与理解带来的挑战,实现临床效益最大化。

人工智能大模型的隐私保护与数据安全技术研究

随着人工智能(AI)技术的快速发展,AI大模型在各个领域的应用越来越广泛。然而,这些模型在伦理、安全和治理方面面临着诸多挑战。本文旨在探讨人工智能大模型在这些方面的挑战以及相应的应对策略。首先,本文分析了人工智能大模型在伦理方面可能引发的问题,如数据隐私、算法歧视和决策透明度等。针对这些问题,提出加强数据保护、改进算法设计和提高透明度等措施。其次,本文讨论了人工智能大模型在安全方面的挑战,包括对抗性攻击、模型泄露和恶意使用等。为了应对这些挑战,提出加强安全防护、建立安全审计机制和制定严格的使用规范等建议。最后,本文探讨了如何建立有效的监管框架以确保人工智能大模型的合规性和可持续发展,提出推动社区合作等策略,期望通过采取适当的措施,能够在一定程度上降低人工智能大模型在伦理、安全和治理方面的风险。

论科技伦理决策的系统性原则

在当前新兴科技的浪潮下,科技伦理实践正面临着前所未有的伦理挑战。为有效应对复杂多变的伦理问题,科技伦理决策者可以将系统性原则作为科技伦理决策的理论指导。遵循系统性原则,科技伦理决策者能够从全局出发,深入剖析多场域科技伦理风险及其相互影响,在实际决策中更加科学、系统地应对伦理挑战,从而提升科技伦理决策的合理性和有效性。

教育实践中的教师伦理困境与伦理决策

教师伦理是指教师在日常教育教学工作中对“善”的追求、对“恶”的抑制,表现在教师的教学目的、态度、话语与行为中。教师在教育教学工作中不可避免地会遇到诸多伦理冲突。教师在教育实践中主要面临八类伦理困境,包括公平问题、学生行为管理问题、课改与考试的冲突、学校行政管理与教学的冲突、投入与回报的冲突、教师信念与家长观念的冲突、同事之间的冲突、不同原则之间的冲突。面对这些伦理困境,教师采取的专业伦理决策途径主要有三种:一是注重美德的途径,以“人的美德或道德品质为中心”,将个人所具有的美德或品质作为伦理决策和行动的依据;二是基于规则的途径,以“规则为中心”,将一系列伦理规范和原则作为伦理决策和行动的依据;三是预测结果的途径,以“预测行为的结果为中心”,将行为可能产生的结果作为伦理决策和行动的依据。鉴于教师实际面临的专业伦理困境提出三个建议,即师德建设需要关注具体教育情景中的伦理困境及其解决策略;教师的专业伦理决策途径应该从单一走向整合;学校应该建立伦理对话制度。

基于技术调解理论的维贝克伦理建构性技术评估思想研究

维贝克超越建构性技术评估思想和伦理技术评估思想提出伦理建构性技术评估思想。他认为,伦理技术评估思想的局限在于限制技术开辟新道德形式的可能性,其方法也过度依赖清单法,可能导致低估技术的道德复杂性,无法解决超出预期的伦理后果。他以环绕式人技关系为逻辑起点、技术调解为逻辑内核重构技术评估理论,提出一种实质为技术伴随的伦理建构性技术评估思想,不仅在宏观上关注技术对道德框架和社会进程的影响,也在微观上关注技术对用户日常生活的影响,即从人与技术关系的内部解决伦理问题。尽管伦理建构性技术评估方法遭受质疑,认为它简化了人与技术的关系、给技术评估带来新问题,甚至可能颠覆技术评估,但这一评估方法为解决技术评估正面临的结果主义危机提供了一种新思路。

论自动驾驶汽车伦理难题之多数决策道德算法解决

电车难题的本质是行驶中的电车面对不可避免的冲撞时的伦理选择困境。自动驾驶汽车也会面临同电车难题一样的伦理困境。同时,面对自动驾驶汽车伦理难题的变体问题,人们会因为情境的变化而改变自己先前所秉持的伦理原则。基于伦理原则的多数决策道德算法依据“少数服从多数”原则,在尊重各利益相关者伦理原则偏好的基础上,能够有效地解决自动驾驶汽车伦理难题及其变体问题。