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Vol.14 No.1 (2016) 歷史敘事 傳統理論以及社會現狀對我們的啟示 Birth, Old Age, Sickness, and Death: A Bioethical Perspective 本期編輯 : 張穎 Issue Editor: Ellen Y. Zhang 張穎 Ellen Y. Zhang 導言 : 歷史敘事 傳統理論以及社會現狀對我們的啟示 Inspirations from Historical Narratives, Traditional Theories and Contemporary Context 程國斌 Cheng Guobin 瘟疫中的道德敘事 The Moral Narrative in a Time of Plague 李建會 李亞明 Li Jianhui, and Li Yaming 儒家視角下的死亡的尊嚴 Dignity in Dying from a Confucian Perspective 陳翠婷 Chen Cuiting 葛賢 雷虹艷 劉東梅 Ge Xian, Lei Hongyan, and Liu Dongmei 曹雋 李精華 東波 Cao Jun, Li Jinghua, and Dong Bo 莊子 生死觀對臨終者的生命關懷 The Wisdom of the Zhuangzi and its Ethical Implications for Hospices Today 臨床護士護理倫理認知 踐行現狀調查及對策分析 Ethical Awareness and Practice in Nursing Care: Interviews and Analysis 中國墮胎氾濫問題的成因與對策分析 基於 H 省 D 市的調查 Widespread Induced Abortion in China: An Investigation of D City in H Province 耿希 田立 關鑫 Geng Xi, Tian Li, and Guan Xin 互聯網 + 時代患者隱私保護的倫理思考及對策 Ethical Considerations and Guidelines concerning the Protection of Patients Privacy in the Information Age

瘟疫中的道德敘事 程國斌 摘要無論是過去還是現在, 重大傳染性疾病 ( 瘟疫 ) 對社會和醫學都構成巨大的挑戰 當代研究已經揭示了醫師的職業倫理責任話語並不足以應對這一挑戰, 因而需要美德的補充 本文通過對清代江南瘟疫中的醫學道德敘事的研究, 指出美德倫理的確能發動社會醫療資源以應對瘟疫, 但其本身依賴於特定的醫學認知 社會組織 倫理關係以及共用價值觀 在當代重建傳統醫學道德需要充分重視這一前提, 注重於傳統倫理生活世界的重構, 而非僅僅進行理論的建構 儒家視角下的死亡的尊嚴 李建會 李亞明 摘要在當代的醫療實踐中, 各種新的醫療技術在臨終階段的應用引發了關於如何維護死亡的尊嚴的激烈爭論 爭論的焦點集中在對什麼是人的尊嚴和什麼是死亡的尊嚴的概念的不同理解上 人的尊嚴概念在當代西方的倫理學中尚沒有得到清晰的闡釋, 死亡的尊嚴概念更是存在混亂 儒家倫理學則可以在這種討論中為問題的解決提供新的思路 本文試圖重建儒家的人的尊嚴和死亡的尊嚴的基本含義, 並對死亡的尊嚴與人的生物學生命的關係, 死亡的尊嚴與人的痛苦的關係, 死亡的尊嚴同人的自主性的關係, 以及死亡的尊嚴同社會公平正義之間的關係做出分析說明 儒家關於人的尊嚴的觀點有助於化解西方死亡倫理研究中出現的概念混亂和理論矛盾

莊子 生死觀對臨終者的生命關懷 陳翠婷 摘要臨終關懷的兩大議題是疼痛和死亡, 對於臨終患者來說, 死亡的話題有為 凸顯, 患者在死亡面前普遍表現出濃重的焦慮和恐懼 本文試圖通過追溯 莊子 的生命哲學, 從中汲取面對死亡的智慧, 揭開死亡的神秘面紗, 消解臨終患者對死亡的恐懼 將死亡從繁複的人倫關係中抽離出來, 以期還原死亡的本真狀態 本文闡述了莊子自然主義思想對人們面對生死問題的啟發, 並進一步論述從 觀化 的角度, 消融狹隘的個體本位, 才能實現形上生命的自我超越 而明瞭生死一條的道理, 將死亡視作一種可能性經驗, 則是對生的最為深刻的覺醒 臨床護士護理倫理認知 踐行現狀調查及對策分析 葛賢 雷虹艷 劉東梅 摘要本文研究目前臨床護士護理倫理認知踐行現狀, 分析相關影響因素, 探討 新形勢下增強臨床護士護理倫理認知實踐的對策 研究採用 臨床護士護理倫 理認知及踐行現狀調查問卷 和 患者對護士護理倫理服務滿意度調查問卷 對 成都市 3 所三甲醫院的 500 名護士以及相應的三所醫院的 209 名患者進行隨機問 卷調查, 並對調查結果進行統計分析 文章建議通過國家政策改善醫院管理 完善教育體制 改善社會環境 加強護士自身學習等方法提高護士護理倫理的認知踐行能力

中國墮胎氾濫問題的成因與對策分析 基於 H 省 D 市的調查曹雋 李精華 東波 摘要中國的墮胎現象日益嚴重, 並引起廣泛關注 墮胎是女性的權利還是一種 犯罪行為一直是一個備受爭議的問題 筆者認為, 胎兒具有生命的意義, 墮胎本身是對胎兒和墮胎者造成傷害的行為, 應當引發道德的思考和法律的約束 本文分析了引起墮胎氾濫的社會 群體及個體原因, 並在承認胎兒生命意義的基礎上提出借助計劃生育政策改革, 管控流產廣告, 生命教育與性教育相結合, 以及充分發揮醫院社會工作者的作用四個方面, 糾正墮胎者與潛在墮胎者對於墮胎的態度及行為的對策 互聯網 + 時代患者隱私保護的倫理思考及對策 耿希 田立 關鑫 摘要本文分析 互聯網 + 時代患者隱私保護所面臨的新威脅, 對傳統的隱私保護技術 體制制度以及規範的有效性進行反思, 尋求新技術應用與患者隱私保護的結合點 作者認為, 對患者隱私的保護, 不應該成為新技術應用的障礙, 而是將二者有機地結合起來, 形成良好的互動 文章就在信息時代提高信息意識 管理 技術三個層面提出具體的保護建議

The Moral Narrative in a Time of Plague Cheng Guobin The emergence of deadly infectious diseases usually poses a critical challenge to medicine and medical practice. Many contemporary ethicists maintain that medical ethics today should be supplemented by the language of virtues because what is called professional ethics is not sufficient to respond to the challenge of medical crises in a time of epidemic diseases. By examining the moral narrative in the historical context of the deadly plague that occurred during the Qing Dynasty, the author argues that the traditional Chinese virtue ethics played an important role in mobilizing social resources and implementing control strategies to deal with the public health crisis. Nevertheless, the author also shows that virtue ethics are very often conditioned by a particular kind of medical knowledge, a given social organization, and the shared values of a particular community. That is to say, virtue ethics are closely related to the real-world life and its tradition. This must be taken into consideration when we attempt to reconstruct medical ethics today. Meanwhile, professional ethics are also needed to address the outbreak of infectious and communicable disease to deal with issues such as access to treatment, informed consent, mandatory or involuntary screening, and so forth. Dignity in Dying from a Confucian Perspective Li Jianhui and Li Yaming What does a death have dignity? In modern healthcare, the wide use of new technology has generated confusion around how to define and protect human dignity, especially in the case of death and dying. Those who advocate the legalization of assisted suicide often appeal to the right to die with dignity and the right to individual autonomy. The problem is that it is very difficult to justify one particular understanding of human dignity in the contemporary pluralistic world through a rational formulation without defining dignity. In this paper, the authors attempt to respond to the current debate on euthanasia and assisted suicide from a Confucian perspective. The paper first defines the Confucian concept of human dignity and shows how the concept could be used in the case of dignity in death and dying. The authors argue that in Confucianism, there are two kinds of dignity: One is intrinsic dignity, which is endowed by Heaven on everyone, and the other is extrinsic dignity, which arises from the cultivation of virtues. This extrinsic dignity is also called personal dignity. Unlike the individual-oriented human dignity model, Confucian ethics argue for a family-oriented model of human dignity. That is to say, the Confucian ideal of human dignity is not satisfied by a concept of human dignity that is centered on individual rights and freedom of choice; instead, it focuses on relations in a concrete community in which a person s human dignity is actualized through morals and virtues. In the case of euthanasia and assisted suicide, therefore, the decision should not be solely based on freedom of choice, but on what kinds of values and obligations the person has. In addition, the paper shows that the Confucian view of human dignity does not support the idea of prolonging life through technological means without restraints.

The Wisdom of the Zhuangzi and its Ethical Implications for Hospices Today Chen Cuiting Two major issues in hospice care are pain and death. For those who are facing death and dying, the issues are intensified. This paper discusses the issues relating to death and hospice care in a framework of the Daoist philosophy on life and death, as outlined in the Zhuangzi. The author attempts to show that the wisdom of Daoism can help us to deal with the finitude and vulnerability of human life when facing death. According to the Zhuangzi, the world of experience is constantly transforming and death is part of that transformation. Therefore, it is possible for the adaptive qualities of the perfectly well-adjusted person to remain balanced in the midst of this unavoidable stage of change and transformation (hua). This realization of the impermanence of life and the transient nature of worldly things, even human relations, leads to the Daoist attitude of non-attachment that enables one to realize the true nature of life and death. The paper concludes that a positive attitude toward life and death, as represented in the Zhuangzi, can help patients and their family members to deal with the pain of illness and death. The author also points out that embracing natural transformation is a way for the Daoist to attain the self-transcendence that ultimately dismantles the dichotomy between life and death. Ethical Awareness and Practice in Nursing Care: Interviews and Analysis Ge Xian, Lei Hongyan, and Liu Dongmei The purpose of this study is to investigate and analyze the ethical awareness and practice of clinical nurses in nursing care. By using specially designed questionnaires to interview 500 clinical nurses and 209 patients at three hospitals in Chengdu, Sichuan Province, the authors examine the current relationship in medical practice between medical professionals and patients. The study shows that the total score for the ethical knowledge of nurses is 16.38±3.91; for ethical practice it is 63.43±15.99; and the average score is 2.49±0.64. The score for patients satisfaction is 37.56±7. The study also shows that there are significant differences in ethical awareness among nurses with different educational levels and professional titles. Ethical practice is acknowledged as an essential part of good nursing, yet defining what comprises such practice is complex. The paper suggests that more ethical education that targets the situation in China should be provided that offers a holistic understanding of professional ethics for the nursing profession. Such ethical education is badly needed given the ethical tensions between medical professionals and patients in China today.

Widespread Induced Abortion in China: An Investigation of D City in H Province Cao Jun, Li Jinghua, and Dong Bo Abortion is legal in China. It is a government service available on request for women, yet it has recently generated ethical concerns. This paper investigates and analyzes the rationales given by women who have gone through induced abortion voluntarily or involuntarily, and reflects on the ethical and legal problems in China today. Although the case study is focused on D City in H province, the conclusion mirrors the general problem (i.e., general permissibility of abortion) in a society where the practice of abortion has been accepted by the public due to a government policy of family planning and population control. Sex-selective abortions also play a key role. In past decades, there has been little serious moral discussion on the issue of abortion. The paper suggests that apart from legal regulations the government should provide more education concerning sex, birth control and women s health. More importantly, moral education in light of respect for life should be strengthened. Ethical Considerations and Guidelines concerning the Protection of Patients Privacy in the Information Age Geng Xi, Tian Li, and Guan Xin Information technology refers to automated systems for storing, processing, and distributing information. In medical practice, this involves the use of computers and communication networks to collect and store medical information and data. Ethical guidelines for data protection and privacy have become critical issues in medical ethics in the age of the Internet and information technology. Both healthcare and IT professionals face questions of responsibility, accountability, and liability in handling private information and data. This paper discusses the tension between the problems in medical practice that may violate patients privacy and the effectiveness of data collection brought about by information systems. Although China has acknowledged the importance of privacy protection in past two decades, medical malpractice such as releasing patient s medical history without informed consent or even selling medical data for commercial purpose still exists. Apart from the potential harms caused by releasing private information, there are moral issues with regard to informational inequality and discrimination. The guidelines suggested by the authors have three facets: ethical education around privacy protection, effective regulation, and responsive management of IT institutions to evaluate the effects of contemporary information systems and the Internet on the protection of individual privacy.