Ethical Study on the Reform and Development of Medical and Health Services in China

At an early stage of its foundation, new China became clear about the nature of public welfare and quickly developed medical and health services, which was well received by the World Health Organization. The marketization and the reduction of input into medical and health services from the 1980s created severe adverse consequences. After the SARS' outbreak in 2003, China started to give serious consideration to its medical and health system, and to work at developing medical and health services. The new healthcare reform launched in 2009 re‐emphasizes fairness and public welfare, and China's achievements have been remarkable. Of course, there are still many problems to be solved in the reform, which also paves the way for increasing the reform in future.     

Standard of Care,Institutional Obligations,and Distributive Justice

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. I examine two types of institutional contexts: (1) public research agencies – agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private‐for‐profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private‐for‐profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice‐based account of standard of care.     

基于电子地图兴趣点数据的城市可持续发展水平分析——以绍兴市为例

在当前大数据时代背景下,电子地图兴趣点(POI,Point of Interest)作为地理空间大数据的重要类型,能直接反映城市人口密度、发展程度与强度等各类型要素的聚集状况。基于当前普遍使用的兴趣点数据源,运用ArcGIS软件中的空间分析工具,提取了绍兴市各区(县、市)的POI数据分类信息;结合绍兴市各区(县、市)的面积及人口数据,评估各区(县、市)的单位面积POI和单位人口POI指标,以分析绍兴市各区(县、市)POI的均衡分布水平。进一步利用核密度分析、空间回归分析和近邻分析的手段,从不同角度研究了各类POI在地理空间分布中的特征规律。研究结果表明:从不同区县来看,城市化发展水平较高的地域POI总数明显较高,其核函数密度值也明显较大;从单位面积POI数量及单位人口POI数量来看,各区县发展水平较不均衡,表现为越城区最高,上虞区、柯桥区和诸暨市次之,新昌县和嵊州市较低,其表现在不同区县在提供生活、生产服务的基础设施具有区域间差异性,不符合可持续发展的公平性原则。最后,针对解决这一问题提出一些促进绍兴各区县协调公平可持续发展的城市建设与规划建议。     

Evolution of equal division among unequal partners

One of the hallmarks of human fairness is its insensitivity to power: although strong individuals are often in a position to coerce weak individuals, fairness requires them to share the benefits of cooperation equally. The existence of such egalitarianism is poorly explained by current evolutionary models. We present a model based on cooperation and partner choice that can account for the emergence of a psychological disposition toward fairness, whatever the balance of power between the cooperative partners. We model the evolution of the division of a benefit in an interaction similar to an ultimatum game, in a population made up of individuals of variable strength. The model shows that strong individuals will not receive any advantage from their strength, instead having to share the benefits of cooperation equally with weak individuals at the evolutionary equilibrium, a result that is robust to variations in population size and the proportion of weak individuals. We discuss how this model suggests an explanation for why egalitarian behaviors toward everyone, including the weak, should be more likely to evolve in humans than in any other species.     

HOW DO WE WANT TO GROW OLD? ANTI‐AGEING‐MEDICINE AND THE SCOPE OF PUBLIC HEALTHCARE IN LIBERAL DEMOCRACIES

Healthcare counts as a morally relevant good whose distribution should neither be left to the free market nor be simply imposed by governmental decisions without further justification. This problem is particularly prevalent in the current boom of anti‐ageing medicine. While the public demand for medical interventions which promise a longer, healthier and more active and attractive life has been increasing, public healthcare systems usually do not cover these products and services, thus leaving their allocation to the mechanisms of supply and demand on the free market. This situation raises the question on which basis the underlying preferences for and claims to a longer, healthier life should be evaluated. What makes anti‐ageing medicine eligible for public funding? In this article, we discuss the role of anti‐ageing medicine with regard to the scope and limits of public healthcare. We will first briefly sketch the basic problem of justifying a particular healthcare scheme within the framework of a modern liberal democracy, focusing on the challenge anti‐ageing interventions pose in this regard. In the next section, we will present and discuss three possible solutions to the problem, essentialistic, transcendental, and procedural strategies of defining the scope of public healthcare. We will suggest a procedural solution adopting essentialistic and transcendental elements and discuss its theoretical and practical implications with regard to anti‐ageing medicine.     

Fairness modulates non-conscious facial mimicry in women

In societies with high cooperation demands, implicit consensus on social norms enables successful human coexistence. Mimicking other people's actions and emotions has been proposed as a means to synchronize behaviour, thereby enhancing affiliation. Mimicry has long been thought to be reflexive, but it has recently been suggested that mimicry might also be motivationally driven. Here, we show during an economic bargaining game that automatic happy mimicry of those making unfair offers disappears. After the bargaining game, when the proposers have acquired either a fair or unfair reputation, we observe increased angry mimicry of proposers with an unfair reputation and decreased angry mimicry of fair proposers. These findings provide direct empirical evidence that non-conscious mimicry is modulated by fairness. We interpret the present results as reflecting that facial mimicry in women functions conditionally, dependent on situational demands.     

IS IT ETHICAL TO STUDY WHAT OUGHT NOT TO HAPPEN?1

In the Democratic Republic of Congo, only an estimated 2% of all AIDS patients have access to treatment. As AIDS treatment access is scaled-up in the coming years, difficult rationing decisions will have to be made concerning who will come to gain access to this scarce medical resource. This article focuses on the position, expressed by representatives of Médecins sans Frontières (MSF), that the practice of AIDS treatment access rationing is fundamentally unethical because it conflicts with the ideal of universal treatment access and the human right to health. The conclusion is that MSF's position lacks coherence, has negative practical implications, and is unfair to governments struggling to increase patient's access to AIDS treatment in unfavorable circumstances.     

紫金山蕨类植物区系及其分布特点的研究

根据紫金山的自然条件和植被特点 ,对该区蕨类植物的区系和分布特点作重点分析 ,结果表明 :1)本区有蕨类植物 95种 (含亚、变种隶属 34科、6 0属 ,其中水龙骨科、鳞毛蕨科等 6科的种类占优 ;2 )本区蕨类植物中热带、亚热带属占总属数 88 33% ,具有典型的热带、亚热带性质 ;3)古老植物成分丰富 ,单种分布的种类较多 ;4 )本区系成分与海南最为密切 ,与江西、浙江密切 ,与河北、东北较为疏远 ;5)分布特点表现为具有 5种生态类型 ,种类集中在海拔 340～ 6 50m区域 .     

Getting a Fair Share: Attitudes and Perceptions of Biobank Stakeholders Concerning the Fairness of Sample Sharing

Biobanks are essential tools for furthering a broad range of medical research areas. However, despite the plethora of national and international laws and guidelines which apply to them, the access and sharing policies of biobanks are only sparsely addressed by regulatory bodies. The ‘give and take’ process of biosample sharing is largely left up to biobank stakeholders themselves to oversee; it is therefore both in stakeholders' power, and in their interest, to ensure that sample accessibility is fair. This is an important step in motivating researchers to collaborate and pool samples, and is crucial to fostering trust in the absence of universally accepted standard practices. To date, little attention has been paid to how fairness considerations affect scientific material sharing, and no empirical research has been carried out to determine the role that fairness plays in collaborative studies. In order to begin to gain understanding in this area, we interviewed 36 biobank stakeholders currently working in Switzerland, focusing on their perceptions of current and optimal fair sharing practices. Our findings reveal that fairness is an important feature of exchange situations for these stakeholders, and that they have well‐formed notions about the practical elements of fair sample access, although ideas about the concept of fairness itself are vague. In order to support efforts to network biobanks, attention should be paid to this issue to reassure all involved that they are getting a fair share in their cooperative efforts.     

Assisted Reproduction and Distributive Justice

The Canadian province of Quebec recently amended its Health Insurance Act to cover the costs of In Vitro Fertilization (IVF). The province of Ontario recently de‐insured IVF. Both provinces cited cost‐effectiveness as their grounds, but the question as to whether a public health insurance system ought to cover IVF raises the deeper question of how we should understand reproduction at the social level, and whether its costs should be a matter of individual or collective responsibility. In this article I examine three strategies for justifying collective provisions in a liberal society and assess whether public reproductive assistance can be defended on any of these accounts. I begin by considering, and rejecting, rights‐based and needs‐based approaches. I go on to argue that instead we ought to address assisted reproduction from the perspective of the contractarian insurance‐based model for public health coverage, according to which we select items for inclusion based on their unpredictability in nature and cost. I argue that infertility qualifies as an unpredictable incident against which rational agents would choose to insure under ideal conditions and that assisted reproduction is thereby a matter of collective responsibility, but only in cases of medical necessity or inability to pay. The policy I endorse by appeal to this approach is a means‐tested system of coverage resembling neither Ontario nor Quebec's, and I conclude that it constitutes a promising alternative worthy of serious consideration by bioethicists, political philosophers, and policy‐makers alike.