The definition of medical ethics is directly related to the definition of bioethics. Are medical ethics and bioethics two independent disciplines? When you are about to write the Encyclopedia of Bioethics and the Encyclopedia of Medical Ethics started by Warren Empire 197 1, you can see that the names of medical ethics and bioethics are two different concepts. ,
Daniel Callahan's Encyclopedia of Bioethics, Medical Ethics and Bioethics, second edition, "Medical ethics is an ancient discipline, which only emphasizes the moral obligation of doctors and the relationship between doctors and patients. Although it is still important today, it is not enough to cover all issues. " Bioethics is a broader field, including important aspects in the field of life science. Medical ethics in medicine, biology, environment, population and social sciences, including bioethics and other topics, constitute bioethics and existing problems. "
Medical ethics in the subject of International Encyclopedia of Ethics is also listed as bioethics.
Different views: medical ethics experience ancient medical ethics and learn modern medical ethics (traditional medical ethics). Life can be seen from our medical ethics department and the development stage of ethics. Some scholars believe that today's medical ethics has developed to a new stage, namely, the stage of population and health ethics. It can be seen that our main bioethics is a stage covered by medical ethics. In J Stuart Horner's Encyclopedia of Applied Ethics, the definition is the same: medical ethics and bioethics are often confused, but the latter is one aspect of the former, but it has been dominant for the last 30 years.
Clear medical ethics
Thomas percival, an Englishman, published "Medical Ethics" on 1803, and published it at the first time. He did not define medical ethics from the front, but the materials can analyze the concept of medical ethics he has mastered. He said: "professional ethics" is a synthesis between human knowledge and extensive moral responsibility. "The general system of medical ethics is that the official behavior and communication in the medical field are guided by the principle of gentleness and integrity." This view has been widely accepted in the19th century. In the 1920s, chauncey Lick, an American professor of pharmacology, questioned this view. The improper use of the word "medical ethics" in Bosphore Street ..... refers to the interaction between occupation, management etiquette, etiquette and career members. But the real morality and etiquette, he thinks: etiquette is different and should be understood from a philosophical point of view. He thinks: "On the basis of real medical ethics theory, there is no essential difference between doctors and patients and between doctors and society. In 1970s, from the perspective of KD Clouser and Lick, the authority of medical ethics, his first edition of Encyclopedia of Bioethics: What is the general difference between medical ethics and daily morality? The same general moral rules, we use the definition of medical ethics: "Use general moral principles and morality to solve the health care practice and the development of medical science, medical care and the relationship between society and people, whether it is a branch of ethics (applied normative ethics) or a part of medicine."
In the past, medical ethics was overemphasized at home and abroad as a kind of medical ethics that was easily misunderstood by applying normative ethics. Medical ethics can only be understood as applying normative ethics and learning to solve specific problems with universal ethics and moral principles, which is not only incorrect, but also ignores the drug itself in order to maintain the health of patients. On the one hand, the function, nature and use of medical ethics are drugs to treat this disease. We can see that medicine itself contains an inherent morality-the interests of patients and the emergence of many moral problems, which is the result of the development of medical science and technology. On the other hand, the role of medical ethics is also obvious. Chen Shi's successful "surgical authenticity" is the management of the Prophet Confucianism, so we know the principle of medical science and say that "the combination of the two is the Confucian doctor in ancient China; The concept of medical ethics in medieval Europe is a Christian concept. The model of doctor-patient relationship in British and American medical ethics leads to the principle of autonomy in southern Europe. The relationship between doctors and patients based on mutual trust is still the dominant mode, and the role of medical ethics can be better understood. In a word, the interaction between medical technology and ethics is an important clue to the development of medical ethics. Research object and content of medical ethics
The main object of medical ethics research is that medical ethics is synonymous with learning medical ethics. The relationship between "Medical Ethics" and Comrade Qiu of "Medical Ethics" is not just a question of name, but there are two differences between them: the content of medical ethics is more than the general deontology, and it has no theoretical value, not proof. It is what we call ancient medical ethics, science, and actually there is no systematic applied ethics discipline, because it only studies the moral norms and guidelines that doctors should follow, and only studies the doctor-patient relationship. Medical ethics is a systematic discipline, which extends performance research from the core of the relationship between medical staff and doctors, medical treatment between people and society, and the relationship between medical treatment and society.
Comrade Du believes that the research of modern medical ethics mainly includes six aspects: the subject and object of medical ethics and their relationship, clinical medical ethics, ethical issues, the application of high and new technologies such as biotechnology, health policy, ethics, health ethics, medical ethics and basic theoretical research. This is a typical view that bioethics is the development stage of medical ethics.
In fact, in any case, in the "encyclopedia of applied ethics, the terminology of medical ethics, it is not a fixed long-term medical ethics and bioethics", its significance and principles, as well as the cultural factors of medical management, the funding and changes of medical care, the whole medical community,
Medical ethics of historical development
The Hippocratic school may be the first standardized behavior suggested by the medical profession and doctors, but this thought can be circulated for a long time, mainly because the Christian thought is in some aspects, not the idea of induced abortion and conforms to them? Whether the confidentiality of patients is the mainstream thought of ancient Greek medical circles. Many authors emphasize that the prognosis of this disease, the prognosis of Hippocrates, can play a safe role. To be on the safe side, the doctor knows what he can and can't do, thus protecting the doctor from treatment failure or refusing the treatment of the defendant. Traditional Christianity emphasizes the important role of honesty in overcoming diseases, and doctors should ignore their own dangers in order to save patients. Responsible for the poor, in fact, early Christians did the same. It can't be better than a new institution like hospital, which embodies the fraternity spirit of Judaism and Christianity. Although many of them are responsible for the accommodation and medical care of the sick, the elderly, the poor and the homeless, some good Christians are allowed to read books other than medicine and only see some of them. The Black Death of Hippocrates and Galen in the Middle Ages claimed countless lives. Doctors also have no good treatment. Many doctors escaped from the plague, but many priests still stayed in the city to pray for the spiritual comfort of the deceased, so that those who believe in God are also happy to be with the families of the deceased.
During the Renaissance, especially during the scientific revolution, mechanical science, physics and chemistry achieved great success and made a firmer step in medicine. Harvey's theory of effort dynamics finally replaced Galen's theory of blood movement. Under the guidance of18th century, the experimental medicine of anatomy and physiology based on the dominant mechanical view has made great progress in the rapid development of pathology. Before the coming of 19 century, it is impossible to make comprehensive progress in surgical technology, anesthesia and disinfection. In the late19th century, real progress was made in surgery. Recently, laboratory doctors have a moral philosophy of respecting science, and the noblest task of medicine is to prolong human life. Because of a series of new scientific diagnosis and treatment methods, doctors' sympathy for patients and realistic scientific protection provide treatment for patients, which is the most basic embodiment of medical humanism. /kloc-At the beginning of the 0/8th century, the standardized and moral doctors in Britain seldom mentioned Hippocrates, but paid attention to etiquette. Including clothes and behavior, there are four people who have made great contributions to modern Britain as British gentlemen: Thomas Chance, a doctor who published the Lecture Notes on Duties and Qualifications in john gregory 1772, thinks that doctors should not weaken the color of Christian charitable organizations, but should establish competitive occupations, because he firmly believes that the desire for wealth is crucial; Thomas Bedo emphasized that legal means should be used to get rid of Jianghu. Thomas percival's "Medical Ethics" was published in 1803, mainly to prevent and solve internal disputes in hospitals. The religious color has been greatly weakened. At the beginning of medical ethics, the greatest contribution of scientific and secular Thomas Bosphore Street was in 1847 "American Medical Association Ethics Code".
For the first time in the 20th century, people began to notice the increase of hospitalization expenses. Especially after the end of World War II, the X-ray image diagnosis after hospital medical treatment and the advent of 1972 computer have made great progress. The essence of land is considered to be tomography (CT) and nuclear magnetic resonance technology, which costs a lot of money and medical equipment. In the 20th century, medical services and medical treatment in scientific research increased significantly, but it may also lead to more moral problems. 1946 The Nuremberg Code and the World Medical Association stated in 1964 that "Helsinki (the latest edition in 2000) is an important document in medical research, involving people.
Before the 20th century, traditional medical ethics was mainly limited to the training of doctors. After the end of the Second World War, the practice of ethical code of conduct in clinical medicine extended the life span. Is it difficult to add new medical content to the ever-developing moral code? In the 1950s, Joseph Fletcher and Paul Ramsey (including theologians) in the United States wrote some articles, which made people begin to look for the social and moral impact of drugs and medical technology: firstly, traditional Chinese medicine, which was previously closed. These viewpoints are beneficial to the development of medical science, and people in the medical field begin to accept these external viewpoints; Third, expand the scope of its medical ethics and apply it to broader social ethics issues, such as the fairness of the distribution of social and health service facilities, and so on. Therefore, in the 1960s, medical ethics began to change, from the initial behavior to guide clinicians in social ethics and all concerns about health and disease, while the United States began to pay attention to patients' autonomy in the 1970s, which is an important change in medical ethics today.
The essence of medical ethics is the interests of patients, but it is consistent with the interests of patients and changes with the changes of the times and people's attitudes. Performance-based medical model is generally based on the past "cure" to "cure". In the 1950s, prolonging life was for the good of patients, but after World War II, prolonging life was not the only goal, and the quality of life was very important, which was a sign of respecting patients' wishes.
Bioethics (bioethics)
In the second edition of the Encyclopedia of Bioethics, the first sentence of this word is interpreted as: "There is a saying that there is nothing new in the sunshine of the Bible. However, since the fifties and sixties, with the rise of bioethics, this sentence is not correct. "Due to the emergence of new technologies and changing culture and concepts, new life and death, suffering, their right to exist, and the obligation to think for others and society, a brand-new field-bioethics represents a brand-new concept change, which not only opens up a new field (the intersection of ethics and life sciences), but also represents the influence of an academic thought and political factors on medical biotechnology and the environment. Bioethics in a narrow sense refers to new fields and great changes. Broadly speaking, it has been extended to law, policy, culture, history, discipline, mass media, philosophy, religion, literature and other social sciences. It is said that the dictionary entries of bioethics are in a broad sense, which is a study of the moral confusion faced by the bedside of dying patients and medical staff. The scope has been extended to the whole society, and citizens and legislators are striving to formulate fair health or environmental policies to choose the overall interests of the public and society.
Define moral life
The term bioethics was first used in 1970 at Willens Lepaute University, a biologist and cancer researcher in Wisconsin. Not long after, however, Andre Hellegers, a physiologist and production scientist in Washington, the Netherlands, cooperated with him and established the Kennedy Institute of Human Reproduction and Bioethics at Georgetown University on 197 1. His colleagues used different meanings. Florence Lepotti and this so-called "new discipline" combine biological knowledge with the knowledge of human value system. It is a bridge between science and humanities in the Middle East, helping human beings to survive and maintaining and promoting world civilization. Andre Hellgus and his colleagues applied medical and biomedical research ethics in a narrow sense. Warren Empire is at 197 1, ready to write. The name of "Encyclopedia of Bioethics" was originally two different concepts. The vast medical ethics in the west is a traditional formula with a narrow scope, which only emphasizes the moral obligation of doctors and the relationship between doctors and patients. It is no longer enough to cover all the problems. Broadly speaking, bioethics, such as medicine, biology, environmental science, population and social science, includes bioethics in the broad field of life science and ethical issues of traditional medicine.
To some extent, the entries in Raanan Geelong's bioethics dictionary are more comprehensive. Raanan Geelong's Encyclopedia of Applied Ethics writes: Ethical issues in the field of biological practice studied by bioethics (including medical treatment, nursing, including veterinarians, including other health care professionals, from the perspective of one word). In addition to the research of biological sciences, it also includes environmental ethics (including environmental pollution and the relationship between people and animals and nature in other regions), research on ethical issues in reproduction, heredity and population, ethics, and various social and political moral issues, such as unemployment, poverty, discrimination, crime, war and persecution, which have a negative impact on human health. In this discipline, a wide range of people are involved, besides doctors, nurses, life scientists and patients, there are also disciplines related to philosophy, moral theology and law in schools such as bioethics, economics, psychology, sociology, anthropology and history (tertiary disciplines).
Daniel? At the third international conference on Verkler, bioethicists and social responsibility put forward that the theme of bioethics has been changing and bioethics has gone through three stages. In the fourth stage of the first stage, if medical advertisements are allowed, it is forbidden to slander peers for acts marked by birth occupation codes. This stage is called the medical ethics stage and the second stage. Albert R.Jonsen said in his "Born for Bioethics": "Historians and their colleagues are in the stage of bioethics. At this stage, professional doctors in ancient medicine fundamentally changed their paternalistic style and told the truth. The public began to question the rights of patients in the academic alliance of bioethicists at this stage. Bioethicists need new ideas and methods. These new philosophical theories and methods are not moral individual behaviors, nor traditional ethical principles that define the profession of doctors, but social and political philosophy, especially the distribution of social justice. In the third stage, bioethicists study health care policies and health economics, and health officials in many countries and governments consult bioethics. The fourth stage of bioethics is called crowd health, which is different from the second stage, including professional code of conduct, medical staff and the public. As the third stage outside the scope of traditional doctor-patient relationship, it is in the whole biological and social sciences, humanities and management sciences, but it also has its own characteristics: the emergence and application of high-tech medicine is not the central issue, but only one, and it no longer pays attention to doctors' dilemma reasoning and who can get rare health resources. In American society, we can often see the increasing inequality in many developing countries. There are many signals telling us that compared with the majority of the population, the health care situation is deteriorating rather than improving. In order to accomplish this task, we must let those unfamiliar fields know, such as public health and international health care expenditure-utility analysis.
Historical background of bioethics
Bioethics first appeared in the United States with its unique historical background. Bioethics in a broad sense, from the number of people in 1900, from the development of medical science in the 20th century, the money invested in medical services, the services enjoyed, and the complexity and quantity of the medical service system, we can see the moral problems of a generation, science and technology, and we can see three lines: the scientific and technological development dominated by the change of the roles of hospitals and medical experts.
As early as the late19th century, the number of hospitals in the United States increased rapidly and eventually became the main source of medical services. The intervention of medical equipment and technology in diagnosis and treatment mainly focuses on the medical services provided by hospitals, which has become more effective and economical, and can meet the needs of people in the 1946 Hill-Burton Act. The federal government supports local hospitals, and the new national health insurance is also frequent.
1900 revolution laid the foundation, and medicine has become an inseparable part. In medical practice, the American Medical Association has reformed the education system to improve the level of medical services. Continue to support government medical science, especially medical education and patient care, research and introduction after World War II. In 1950s, the National Institutes of Health began to establish and support clinical research, trying to increase the number of patients and healthy volunteers, so subjects participated in it.
Due to the increase of medical science and technology knowledge, the scope of many doctors is getting narrower and narrower, and they are limited to establishing AA professional ophthalmology society 19 17. In the first half of the 20th century, more and more expert associations were established. Doctors' social status and economic status are gradually improved with other rose essences, and their attitudes and lifestyles towards many patients are also very clear.
Generally speaking, it began to appear in the 1960s. Hospital medical services advocate professional, dehumanized and organized medical services, while ignoring social, behavioral, environmental and humanized diseases, and placing too much emphasis on biological and physiological diseases. Therefore, patients complain that doctors have lost their overall care for patients and changed from familiar intimacy to "bedside strangers".
There may be such a misunderstanding in bioethics, which is simply understood as just emerging, because of biomedical high technology, which is a major factor, but in fact, bioethics is the result of the interaction of many factors. In addition to the ethics of the above medical factors, the emergence of cultural and social movements, the public medical problems involved have also played an unprecedented role. With the increase of complex medical technology and humanitarian use, the growth of urbanization and the subsequent uneven population distribution. With the improvement of living standard and education level, people's thinking is more complicated, and their awareness of self-protection is significantly improved. In the 1950s and 1960s, the government increased its investment in biomedical research to protect subjects and hired people who could afford medical insurance. In the 1930s, due to the introduction of the basic mechanism, the ability of people who were too focused on technology to buy insurance weakened, and most Americans still could not get proper medical care. In addition, the end of the consumer rights movement in the 1960s (protesting against the poor food in the 1960s) began to affect the medical system, and the patient rights movement in the 1970s was part of the larger civil rights. The women's movement also attracted the attention of female patients, but it also affected people's family planning and abortion issues, as well as family and population policies. The peace movement and the new growth ecological movement attracted people's attention to the environment and ecological movement at the same time. Because nuclear weapons threaten human health, the social responsibility of doctors is 197 1 year. These reflected medical functions ensure the overall health and integrity of the world population. These social and cultural trends and the development of biomedical science together constitute the bioethics movement that began in the late 1960s, and these social and political crises in the United States in the 1980s. In short, bioethics, as we know today, is rooted in individual rights of citizens, social justice and concern for environmental quality, which is a remarkable cultural identity of the American era.
Specific events, after the 1960s, renal dialysis and organ transplantation were widely used, but the problems encountered in the process of selecting dialysis objects; 1967 discusses the criteria of successful death after heart transplantation and Harvard brain death criteria. In medicine, abortion is very safe, contraceptives, prenatal diagnosis and ICU are widely used, and artificial respiration machines are widely used. However, the removal of ventilator in Quinlan case caused widespread concern and euthanasia. From the family tradition to the present, the concept of hospital death has changed greatly. After the application of biomedical research results in World War II, several cases occurred in the United States without informing patients of their consent, which led to moral condemnation. The publication of rachel carson's Silent Spring has set off a rise of environmental protection, democratic rights movement, individualism and feminist movement in the United States, and ... But this is a parallel cultural process, mainly to keep up with these changes, which is why bioethics can attract so much attention from the public and historical background.
There is no doubt that the United States is in a leading position in the field of bioethics. The most important sign is that it was founded in 1969, later renamed Hastings Report in 197 1, and was founded in197/Kennedy College. However, it is undeniable that Europe also did a lot of work in 65438. The Institute of Medical Ethics and the Institute of Medical Ethics have been established in Britain. He founded the Journal of Medical Ethics on 1975 and the Bulletin of Medical Ethics on 1985. Philosophical criticism of medical ethics has developed in Germany, the former Soviet Union and southern Europe. Medical ethics is a part of Catholic moral theology in traditional Catholic countries. Later, it gradually adapted to the development of new technology, and changing the concept of medical practice has nothing to do with science. Bioethics develops slowly. In Asia and Africa, it gradually developed from11990s to11980s. Some socialist countries have also established schools to promote socialist medical ethics.
It should be pointed out that every country's government has the obligation to formulate policies and relevant laws and regulations on human life and health, and the macro-control field of bioethics is not a problem, nor is it unique to China and the West, but a global problem, but at the same time, some types of bioethics problems in developed countries do not mean that the same problems will occur in developing countries.
at/>； Theoretical problems of bioethics
Three universal bioethics are the core issues of a discipline: What kind of person should I be to lead a moral life? Is this a morally correct decision? My behavior may affect the state and health of others. What are my responsibilities and obligations? As a member of society, what should I do for the public interest? The first question, is virtue worth it? Goals should emphasize people's behavior and achievements; The second problem is to realize that one person's behavior may affect others, and try to understand the relationship between us-we should do what we should do to others and expect others; Third, our social relations have gone further, and we can see the interdependence between people.
On the premise of basic morality and ethics, respect for autonomy, the interests of the vast majority of people and utilitarian social justice; Four principles, case study, virtue ethics; Descriptive ethics, feminist ethics, bioethics and regional culture
Bioethics research: the relationship between health service personnel and service personnel; The question of life and death; The interests of patients, the interests of others distribute justice; Conceptual problems (the meaning of the word); Ethical issues in medical practice-Nuremberg promotes bioethics, science and technology, social and environmental ethics. Faced with these problems, there are two important tasks to be clarified: is it a fact or a value? Should be able to carve a clear boundary to distinguish what is a medical problem and what kind of values? (Morality) (Doctors' good medical decisions do not represent good professional ethics); Another task is to develop a method to solve moral problems.
The diversity of bioethics and more and more bioethics problems provide guidance for the method. At present, there is a remarkable phenomenon in at least four areas. All of them are clinical bioethics, morality, management and policy, bioethics and cultural bioethics in theory, but they often intersect in practice and cannot be clearly distinguished. function
Bioethics
Comrade Qiu Renzong believes that when people prove that it is the correct decision of biomedicine, and some concepts and values in the framework are always the default values, the work of philosophers can help people critically evaluate the concepts and values of action about a specific process, which is the role of bioethics. Bioethics is a philosophy, which transcends specific social groups, occupations and religions and provides a different belief, that is, what is right, right and good. Ethics: from a philosophical and multidisciplinary perspective, analyze ethical issues in clinical practice, ethical thinking, and problems in medicine and life sciences. As a whole, doctors and other staff members realize greater responsibility in the medical field. Their bodies can see that due to social factors, such as unhealthy diet, smoking, lack of exercise, adverse effects on health, environmental pollution and other environmental threats, overpopulation, political differences, unemployment, poverty, crime and others.
Whether bioethics is a religion or an ideology, rather than another specific question of moral consultation, provides the only answer (within a limited scope). In most cases, the conclusion is that experiments are temporary, not absolute rights. It is not mandatory, but moral characteristics cannot appear in the community, so that community members can have a better concept of solving the democratic process and reach an agreement through consultation and dialogue.
In a word, bioethics is a new field, which is just the beginning. Need a more accurate definition, mining research methods. Daniel? Verkler Theme The Third National Bioethics Conference-Bioethicists and Social Responsibility The report on bioethics should be understood as a discipline: it is to accommodate scholars with different views and provide a place for future bioethics. Geelong: Although it is difficult to predict the future bioethics, it is clear that bioethicists will continue to participate in the stage on an equal footing.