THE NEW MILITARY MEDICAL ETHICS: LEGACIES OF THE GULF WARS AND THE WAR ON TERROR

United States military medical ethics evolved during its involvement in two recent wars, Gulf War I (1990–1991) and the War on Terror (2001–). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non‐therapeutic bioactive agents to soldiers were set aside because of the sense of being in a ‘new kind of war’. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articulated a vision for an ongoing military‐civilian dialogue to ensure that standards of medical ethics do not evolve simply in accord with military exigency.     

Great Expectations: Teaching Ethics to Medical Students in South Africa

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves.     

Spécificité des dilemmes éthiques résultant des travaux développés en neurosciences: émergence d’une neuroéthique

As neurosciences improve our knowledge about the brain for defining behaviour, medical ethics and social policy, what are the implications of new possibilities of technical intervention on our brain? Neuroethics defines a new field of ethics where scientists and ethicists, and also journalists and politicians, are beginning to reflect on social issues resulting from applications of the work of neuroscience in areas such as moral vision, decision-making, conduct and policies. It is likely that the potential application of new knowledge to human behaviour will generate a great deal of ethical and public policy concern in many aspects of everyday life, from child care and school programs to improvements or maintenance of adult capabilities. Neuroscience will also challenge social fields as diverse as forensic psychiatry, sports, corporate hiring and the judiciary. As neurosciences advance, it is important to have a framework that might help to guide the utilization of the new knowledge.     

Concepts of Animal Welfare in Relation to Positions in Animal Ethics

When animal ethicists deal with welfare they seem to face a dilemma: On the one hand, they recognize the necessity of welfare concepts for their ethical approaches. On the other hand, many animal ethicists do not want to be considered reformist welfarists. Moreover, animal welfare scientists may feel pressed by moral demands for a fundamental change in our attitude towards animals. The analysis of this conflict from the perspective of animal ethics shows that animal welfare science and animal ethics highly depend on each other. Welfare concepts are indispensable in the whole field of animal ethics. Evidence for this can be found by analyzing the structure of theories of animal ethics and the different ways in which these theories employ welfare concepts. Furthermore, the background of values underneath every welfare theory is essential to pursue animal welfare science. Animal ethics can make important contributions to the clarification of underlying normative assumptions with regard to the value of the animal, with regard to ideas about what is valuable for the animal, and with regard to the actions that should follow from the results of animal welfare science.     

医德视域下医学生医学精神的建构

近些年来,我国十分重视医学生职业道德教育,然而,在医德教学实践中仍存在着观念落后、内容失衡和方法单一等多方面问题。同时,随着我国多元结构社会的形成,医学生的思想状况和价值观趋于复杂化,从业时职业道德水平出现滑坡。针对目前医学生医德教育存在的种种问题,试图从加强和改进医学生医德教育的角度,探索医学生医德教育改革,增强医学生医德教育的实效性。     

The birth of the empirical turn in bioethics

Since its origin, bioethics has attracted the collaboration of few social scientists, and social scientific methods of gathering empirical data have remained unfamiliar to ethicists. Recently, however, the clouded relations between the empirical and normative perspectives on bioethics appear to be changing. Three reasons explain why there was no easy and consistent input of empirical evidence in bioethics. Firstly, interdisciplinary dialogue runs the risk of communication problems and divergent objectives. Secondly, the social sciences were absent partners since the beginning of bioethics. Thirdly, the meta-ethical distinction between 'is' and 'ought' created a 'natural' border between the disciplines. Now, bioethics tends to accommodate more empirical research. Three hypotheses explain this emergence. Firstly, dissatisfaction with a foundationalist interpretation of applied ethics created a stimulus to incorporate empirical research in bioethics. Secondly, clinical ethicists became engaged in empirical research due to their strong integration in the medical setting. Thirdly, the rise of the evidence-based paradigm had an influence on the practice of bioethics. However, a problematic relationship cannot simply and easily evolve into a perfect interaction. A new and positive climate for empirical approaches has arisen, but the original difficulties have not disappeared.     

The forty years of medical genetics in China

Medical genetics is the newest cutting-edge discipline that focuses on solving medical problems using genetics knowledge and methods. In China, medical genetics research activities initiated from a poor inner basis but a prosperous outer environment. During the 40 years of reform and opening-up policy, Chinese scientists contributed significantly in the field of medical genetics, garnering considerable attention worldwide. In this review, we highlight the significant findings and/or results discovered by Chinese scientists in monogenic diseases, complex diseases, cancer, genetic diagnosis, as well as gene manipulation and gene therapy. Due to these achievements, China is widely recognized to be at the forefront of medical genetics research and development. However, the significant progress and development that has been achieved could not have been accomplished without sufficient funding and a well-constructed logistics network. The successful implementation of translational and precise medicine sourced from medical genetics will depend on an open ethics policy and intellectual property protection, along with strong support at the national industry level.     

全球化背景下医学伦理学教学改革的探索

医学伦理学理论和实践根植于一定时期的社会经济、文化和教育,并随之发生改变和发展。随着全球经济一体化的进展完善,不同国家的文化和教育已在全球范围内互联互通并进而影响异乡本土医学文化。从目前我国医学伦理学教育和实践看,医学伦理学教学及评价体系已不能满足日新月异的全球化医学发展进程。本文从传统医学文化和医学伦理学的理论渊源入手,针对我国医学伦理学教学实践中存在的德性培育重视不足、临床决策能力培养缺失、标准化评价体系缺失等主要问题,探析教学改革的路径,以促进医学伦理学教学理论和实践的发展。     

“新工科”背景下开展生物与医学工程伦理课程建设与教学改革

“新工科”建设要求我国工学类高校在工程技术人才培养过程中除了夯实专业基础,也要关注提高人文素养和开展职业道德教育。一个重要的途径就是开展工程伦理教育。通过学习国外案例教学的成熟思路,结合近几年教学过程中积累的实践经验,本文聚焦于生物与医学工程领域的工程伦理教学,提出从案例选择和教学方法创新两个角度进行课程建设和教学改革,介绍了一些可供选择的典型案例素材,并对教学效果进行了问卷调查与分析。     

Islamic medical ethics: a primer

Modern medical practice is becoming increasingly pluralistic and diverse. Hence, cultural competency and awareness are given more focus in physician training seminars and within medical school curricula. A renewed interest in describing the varied ethical constructs of specific populations has taken place within medical literature. This paper aims to provide an overview of Islamic Medical Ethics. Beginning with a definition of Islamic Medical Ethics, the reader will be introduced to the scope of Islamic Medical Ethics literature, from that aimed at developing moral character to writings grounded in Islamic law. In the latter form, there is an attempt to derive an Islamic perspective on bioethical issues such as abortion, gender relations within the patient-doctor relationship, end-of-life care and euthanasia. It is hoped that the insights gained will aid both clinicians and ethicists to better understand the Islamic paradigm of medical ethics and thereby positively affect patient care.     

Theory and practice of clinical ethics support services: narrative and hermeneutical perspectives

In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of 'theory' and show how it is interwoven with 'practice' as we go along. First, we look at theory in its foundational role: in our case 'narrative ethics' and 'philosophical hermeneutics' provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like 'story', 'responsibility', or 'vulnerability' to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice-versa.     

Methodological Problems in Evolutionary Biology. XII. Against Evolutionary Ethics

Evolutionary ethics has recently become popular again. Some of its representatives elaborate new attempts to derive ethics from evolutionary biology. The attempts, like previous ones, fail because they commit the naturalistic fallacy. Premises from evolutionary biology together with normative premises also do not justify ethical principles. Other representatives argue that evolutionary considerations imply that ethics cannot be justified at all. Their arguments presuppose an unacceptable form of foundationalism. In principle, evolutionary biology might explain some aspects of morality, but in practice explanations are hard to come by. All this does not imply that evolutionary theory is irrelevant in normative settings. To the contrary, it may help us devise guidelines in environmental policy and health care policy. It is to be hoped that evolutionary ethicists will divert their research efforts to the elaboration of such guidelines.     

Do Committees Ru(i)n the Bio‐Political Culture? On the Democratic Legitimacy of Bioethics Committees

Bioethical and bio-political questions are increasingly tackled by committees, councils, and other advisory boards that work on different and often interrelated levels. Research ethics committees work on an institutional or clinical level; local advisory boards deal with biomedical topics on the level of particular political regions; national and international political advisory boards try to answer questions about morally problematic political decisions in medical research and practice. In accordance with the increasing number and importance of committees, the quality of their work and their functional status are being subjected to more and more scrutiny. Besides overall criticism regarding the quality of their work, particular committees giving political advice are often suspected of being incompatible with democratic values, such as respect for affected parties, representation of diverse values and transparency in the decision-making processes. Based on the example of the German National Ethics Council, whose inauguration caused a still ongoing debate on the aims and scopes of committees in general, this paper discusses: (1) the requirements of modern democratic societies in dealing with complex scientific-technical problems; (2) the composition and organisation of committees working as political advisory boards; and (3) the appointment procedures and roles of laymen and experts, and here in particular of ethicists, who may legitimately be taken on by a committee. I will argue that bioethics committees do not necessarily endanger democratic values, but can considerably improve their realisation in democratic decision-making procedures--if, and only if, they do not act as substitutes for parliamentarian processes, but help prepare parliamentarian processes to be organised as rationally as possible.     

Issues in clinical ethics consultation: an introduction

Any area that surges ahead as rapidly as this one [clinical ethics] has over the last five years is virtually certain to find that there are many problems which will need to be addressed. There will also be a need for persons working in this field (or studying it) to take some time to reflect on where it is going, as well as to examine some of the possible pitfalls -- both the obvious and the not so obvious -- which lie ahead. The series of papers in this issue of Theoretical Medicine have been written by a group of ethicists who have had a longstanding interest in the field of clinical ethics, and most of whom have spent many years working in the area. While all of the papers focus on the field of clinical ethics, they are very diverse in the topics covered. Some may be viewed as controversial by readers....     

新医改背景下的卫生信息化建设探讨

2009年出台的新医改方案中又将建立实用共享的的医药卫生信息系统作为八大支柱之一。在这样的背景下,新一轮的医药卫生体制改革将给卫生信息化带来怎样的机遇,卫生信息化的发展又将在哪些方面促进新医改目标的实现。探讨新医改背景下我国医药卫生信息化建设状况,描述新医改和卫生信息化建设的相互关系,在此基础上分析我国卫生信息化建设面临的困难以及在新医改背景下的发展前景。     

公立医院医疗服务价格调整难点及推进策略

从政策角度分析医疗服务价格的演变过程、形成机制,研究新医改以来公立医院医疗服务价格调整的进展和问题,以34家国家级试点为例,探讨调整医疗服务价格的解决策略和路径,提出推进策略。文章认为,对于医疗服务价格调整,要深刻认识价格改革在公立医院改革中的地位和作用,坚持基本原则,处理好几个方面关系,并把握好几个技术难点。     

X-rays for medical imaging: Radiation protection,governance and ethics over 125 years

Starting from Röntgen's discovery and the first radiograph of his wife’s hand, the curtain was raised on a new technique with remarkable possibilities for contributing to human health. While growth in applications proceeded rapidly, it was accompanied by significant harms to those involved and by inappropriate opportunistic application. This paper places the attempts to deal with the harms and inappropriate activities side by side with the positive developments. It attempts a narrative on the development of medical radiation protection over the 125-year period and places it in the context of a commentary on governance and ethics. The substance of the narrative is based on the recommendations of ICRP as they developed and altered over time. The governance commentary is based on assessing the independence of ICRP and its attention to medical exposures. In terms of ethics, the recommendations at each stage are reviewed in the light of values that are deemed appropriate to both medical ethics and radiation protection. The paper, while celebrating Röntgen-125, also hopefully provides a perspective for discussion as ICRP’s centenary in 2028 approaches. This is an important part of ensuring continued acceptance and confident use of X-Rays, and helps underwrite the possibility of further developments in the area.     

医学研究伦理学的发展现状与前景

创新技术的开展和转化医学的注重给医学的发展注入了新的活力,但同时,也带来了一系列社会伦理问题和法律问题。生命医学伦理学的兴起和发展催生了医学研究伦理学分支学科形成,目的在于推进解决涉及人体的医学研究的伦理问题。当前,面临的最突出的伦理问题在于,对医学研究合法性、先进性及伦理性的把握,对医学研究伦理审查必要性的认知,对医学研究方案设计与伦理道德的匹配,对医学研究知情同意的告知,对医学研究风险与受益的平衡。逐步与国际接轨,加强伦理委员会制度建设;提高伦理审查能力建设,形成高水平的伦理审查队伍;学术组织和团体共同努力,推进医学研究伦理学的发展,这将助推医学研究伦理学的发展。     

Chinese medical ward: an American's observations

Physicians base their practices on scientific knowledge that varies little from one country to another, but their experience and their careers are shaped by the culture in which they live and work. This essay casts light on medical practice in mainland China, based on three months of field work with an elite group of physicians at a tertiary academic medical center in summer 2009. It is a story of a diverse group of Chinese professionals navigating a demanding profession, and of the foreign college student on whom they left an indelible impact. Many of the normative features of the Chinese medical profession-its chain of command, commitment to medical ethics, and scientific orientation-are highly comparable to the working lives of American physicians.     

IS GLOBAL ETHICS MORAL NEO‐COLONIALISM? AN INVESTIGATION OF THE ISSUE IN THE CONTEXT OF BIOETHICS

This paper considers the possibility and desirability of global ethics in light of the claim that ‘global ethics’ in any form is not global, but simply the imposition of one form of local ethics – Western ethics – and, as such, a form of moral neo‐colonialism. The claim that any form of global ethics is moral neo‐colonialism is outlined using the work of a group of ‘developing world bioethicists’ who are sceptical of the possibility of global ethics. The work of virtue ethicists is then introduced and compared to the position of the developing world bioethicists in order to show that the divide between ‘Western’ and ‘non‐Western’ ethics is exaggerated. The final section of the paper turns to the practical arena and considers the question of global ethics in light of practical issues in bioethics. The paper concludes that practical necessity is driving the creation of global ethics and thus the pertinent question is no longer ‘Whether global ethics?’, but ‘Why global ethics?’.