人类辅助生殖技术临床实践中的伦理问题及对策

????? 人类辅助生殖技术的飞速发展,给众多不孕不育家庭带来希望和幸福的同时,也不可避免地对人类原有的社会伦理观念产生了巨大的冲击。文章分析了在临床工作中如何处理辅助生殖技术与伦理道德的矛盾关系问题,提出了辅助生殖技术伦理问题的应对策略。

     

辅助生殖技术对子代神经发育影响的研究进展

辅助生殖技术(assisted reproductive technology, ART)是近年来生殖医学领域的一项关键技术,为众多不孕不育夫妇提供了实现生育的可能。随着该技术的广泛应用, ART子代的近远期健康受到广泛关注。该文从人群和机制研究两方面综合评述了ART对子代神经发育(包括神经发育表现和神经发育障碍性疾病)的潜在影响。现有证据表明, ART子代早期神经发育表现落后与多胎、早产及低出生体重等因素相关性更强,尚无较强证据表明ART技术本身的直接影响,且随着儿童神经心理的快速发展, ART子代与自然妊娠子代的差异逐渐减小。此外,大量证据表明ART夫妇的不良生殖生育特征和产科不良结局可能是导致子代神经发育障碍性疾病风险增加的主要原因。但已有机制研究提出了ART诱导表观遗传紊乱的观点,表观遗传改变或与ART子代智力障碍、多动症、癫痫等神经发育障碍性疾病的发生有关。该文旨在为患者以及相关临床和科研工作者提供更为全面的相关知识,并持续推动该领域对ART安全性和技术优化的进一步思考。     

人工辅助生殖技术简史回顾

人工辅助生殖技术是20世纪深具影响的一项医学成就,虽然它使许多家庭能够得享天伦之乐,但也在家庭、伦理和法律等方面引发诸多争议。回顾了辅助生殖技术从产生之初到被社会广泛接受的主要发展历程,对辅助生殖技术发展的几个阶段及其衍生技术进行介绍,旨在介绍辅助生殖技术发展的曲折过程,以及该技术在婚姻家庭领域引起的争议和对婚姻家庭的深远影响。     

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。     

涉及人的医学科研项目伦理审查实践体会

本文就国内涉及人的医学科研项目伦理审查现状进行了简要介绍,并结合武汉大学中南医院医学伦理委员会近年来伦理审查的工作实际,对涉及人的医学科研项目伦理审查中存在的共性问题进行了初步探讨,提出管理部门和伦理委员会应加强对研究人员伦理知识的宣传教育,加强科研项目伦理行为的过程监督,保护受试者权益,保证医学科研的健康发展。     

医患沟通技能培养在生殖医学教育中的实践及体会

目的：探讨医患沟通技能培养对生殖医学教育的作用及效果。方法：选择2010 级临床本科专业两个班级共30 人作为观察 组，进行医患沟通技能培养；另选取同年级的两个班级共28 人作为对照组，进行传统生殖医学教学模式培养。运用自行编制的教 学效果调查问卷及SEGUE 量表对两组学生的教学效果及医患沟通技能进行评价及比较。结果：与对照组相比，观察组的教学效 果有明显优势，学生对生殖医学更感兴趣，使生殖医学的教学更富有启发性，学生处理问题的能力显著增强，学生对生殖医学的 知识掌握程度及综合应用能力显著提高，差异具有统计学意义（P<0.05）；与对照组相比，观察组学生在信息收集、信息给予、理解 病人及沟通结束等四个维度的医患沟通能力显著增强，差异具有统计学意义（P<0.05）。结论：在生殖医学教育中加强医患沟通技 能的培养是一种行之有效的教学方法，值得推广。     

阴道微生物群在不孕症发生发展及治疗中的作用CSCD

辅助生殖技术(assisted reproductive technology,ART)为许多不孕不育夫妇带来希望,尽管ART的技术在不断更新,但不孕症患者的临床妊娠率仍处于较低水平。随着“人类微生物组计划”及其他微生物宏基因组学和蛋白质组学等相关项目的开展,阴道微生物群与女性生殖道健康和疾病的研究引起了广泛讨论,并取得了大量成果。本文就阴道微生物群对不孕症及辅助生殖结局的影响进行了讨论和总结,并初步探讨阴道微生物群、生殖道黏膜免疫和子宫内膜容受性对辅助生殖结局的影响。     

转化医学研究中生命伦理学辩护的现况分析与前瞻思考

转化医学作为一门新兴学科,运用多学科交叉策略来推动医学发展,从临床实践中发现问题,将其凝练成科学问题进行基础医学研究,再将研究成果应用到疾病诊断、治疗和预防过程中,使其真正发挥作用,是一个从基础医学到临床应用的双向进程。转化医学已逐步融入各个学科,并在干细胞研究、生物标志物、细胞信号转导、药物及器具研发及个体化医学等各个领域发挥重要作用。随着转化医学研究深入,一些临床试验势必对人体存在一定伤害和潜在危险,存在各种伦理问题。虽说科学研究与伦理道德是一对相互冲击的矛盾,但两者在总体上又是一致的,共同决定着社会前进步伐。科研的重大进步必然会对伦理道德提出更高要求,而伦理道德的高标准又规范、引导、促进科学研究朝着正确方向迈进,两者相辅相成。鉴于伦理辩护对于转化医学研究强有力的支撑,建议在转化医学研究中能进一步完善伦理监管体系,发挥机构伦理委员会的功效,持续加大伦理培训的力度,强化研究人员的伦理道德修养,从而为转化医学的发展夯实人文基础。     

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。     

DNA甲基化与哺乳动物生殖

DNA甲基化是表观遗传水平基因表达调控的重要方式之一,对哺乳动物的生长发育具有重要作用。原始生殖细胞的甲基化水平、胚胎发育过程中甲基化的重排以及胎盘发育过程中异常甲基化都与生殖过程密切相关。男性不育、女性自然流产及辅助生殖技术(assisted reproductive technology,ART)的应用也与DNA甲基化有关,通过引起DNA甲基化变化从而影响表观遗传调控的变化。该文对DNA甲基化与哺乳动物生殖作一综述,并阐述DNA甲基化与男性不育、自然流产及ART过程的关系。     

21世纪医患关系的伦理学评判

随着医疗技术的迅猛发展,医疗水平不断提高,为人们带来福音的同时,使得医患关系的矛盾尤为凸显。21世纪的医患矛盾已经不仅仅是医生和患者之间的矛盾与冲突,而是两大社会群体之间的问题。在法律还无法规范的前提下,医学伦理学的评判标准可以为新时期医患关系提出更根本的指引与解释。     

Teaching Medical Ethics to Meet the Realities of a Changing Health Care System

The changing context of medical practice—bureaucratic, political, or economic—demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.     

Ethical obligation and legal requirements: On informed consent practices in Bangladesh

Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in Bangladesh and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care.     

什么是生命伦理学？——从历史发展的视角

生命伦理学是20世纪60年代兴起于美国的一门新兴学科,旨在应对生命科学和生物技术的发展或医疗保健的演变使人类面临的种种伦理难题。生命伦理学的兴起有着特殊的社会历史背景。它在发展过程中出现的一些里程碑式的案例,对生命伦理学的发展产生了深远的影响。从其发展特征上看,生命伦理学和医学伦理学紧密联系,有着更为广泛的研究内容和独特的专业特性。生命伦理学要有效回应现代医学和生命科学的发展给人类带来的伦理难题,既要准确地界定伦理问题,又要以适当的方式将伦理学基础理论应用到具体问题当中。对生命伦理学的基本理论进行概述。     

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.     

患者的道德权利在医患纠纷中的重要性

近年来医患冲突不断发生,一系列由伦理道德而引发的医疗纠纷事件反映了我国医院管理存在的问题。患者及家属的观念偏移、医患双方信息不对等、医务人员态度不佳以及医疗资源分配不均等问题均是医患冲突的影响因素。我们通过分析患者的道德权利在医患关系中重要地位,认为医务人员应当树立"以人为本"的服务理念,重视患者及家属的社会心理需求,促进医学道德的发展,构建和谐的医患关系。     

[Re]considering Respect for Persons in a Globalizing World

Contemporary clinical ethics was founded on principlism, and the four principles: respect for autonomy, nonmaleficence, beneficence and justice, remain dominant in medical ethics discourse and practice. These principles are held to be expansive enough to provide the basis for the ethical practice of medicine across cultures. Although principlism remains subject to critique and revision, the four‐principle model continues to be taught and applied across the world. As the practice of medicine globalizes, it remains critical to examine the extent to which both the four‐principle framework, and individual principles among the four, suffice patients and practitioners in different social and cultural contexts. Using the four‐principle model we analyze two accounts of surrogate decision making – one from the developed and one from the developing world – in which the clinician undertakes medical decision‐making with apparently little input from the patient and/or family. The purpose of this analysis is to highlight challenges in assessing ethical behaviour according to the principlist model. We next describe cultural expectations and mores that inform both patient and clinician behaviors in these scenarios in order to argue that the principle of respect for persons informed by culture‐specific ideas of personhood may offer an improved ethical construct for analyzing and guiding medical practice in a globalized and plural world.     

干细胞研究伦理

干细胞具有＂分化＂和＂脱分化＂的特点和潜能,干细胞研究有着良好的医学前景,许多人类严重疾病的治疗有了新的希望。伴随着干细胞研究的开展和深入,出现了诸多伦理问题的争论。拟就干细胞研究的希望和现实、伦理争论的主要观点及干细胞研究伦理准则的构建,作一简要介绍,并就加强干细胞管理提出建议。     

The ethics of HIV research in developing nations

This paper discusses a dispute concerning the ethics of research on preventing the perinatal transmission of HIV in developing nations. Critics of this research argue that it is unethical because it denies a proven treatment to placebo-control groups. Since studies conducted in developed nations would not deny this treatment to subjects, the critics maintain that these experiments manifest a double standard for ethical research and that a single standard of ethics should apply to all research on human subjects. Proponents of the research, however, argue that these charges fail to understand the ethical complexities of research in developing nations, and that study designs can vary according to the social, economic, and scientific conditions of research. This essay explores some of the ethical issues raised by this controversial case in order to shed some light on the deeper, meta-ethical questions. The paper argues that standards of ethical research on human subjects are universal but not absolute: there are some general ethical principles that apply to all cases of human subjects research but the application of these principles must take into account factors inherent in particular situations.