医学伦理学(Medical Ethics) 曹永福 prof. M.D. 医学院医学伦理学系 Department of medical ethics , SDU School of medicine 地址：教学八楼8203室 电话：88382077 电邮：cyongfu@sdu.edu.cn

Textbooks： People’s Medical Publishing House co. LTD

Textbooks Higher Education Press

English textbooks

Some academic journals

The journal of medicine and philosophy

伦理学：王海明

Chapter 1 Introduction Section 1 Medical ethics & medicine Section 2 Morality & medical morality Section 3 Why to learn medical ethics Section 4 How to learn medical ethics

Case-1 2007年11月21日，怀孕9个月的李某某因呼吸困难，在其男友肖某某的陪同下赴北京某医院检查，医生检查发现孕妇及胎儿均生命垂危，建议行剖宫产手术，但肖某某多次拒绝签字。 在抢救了3小时后，医生宣布孕妇抢救无效死亡。

Case-2 2008年1月11日，浙江德清人民医院收治产妇周某某，大出血，生命垂危，需要切除子宫，但其丈夫拒绝签字同意手术。 该家医院由两名主治医生联合签字手术，产妇顺利产下一名男婴，母子平安。

Discussion The practice of which hospital do you agree with?

Chapter 1 Introduction Section 1 Medical ethics & medicine Section 2 Morality & medical morality Section 3 Why to learn medical ethics Section 4 How to learn medical ethics

Section 1 Medical ethics & medicine The character of medical ethics Category and meaning of ethics Medical ethics has been the integral part of the medicine The concept of medical ethics The category in the history The modern meaning

The category of ethics 规范伦理学 元伦理学 美德伦理学 描述伦理学 Normative ethics Meta-ethics 美德伦理学 Virtue ethics 描述伦理学 Descriptive ethics

Normative ethics To construct the morality system (norm, standard) To achieve the purpose of improve society and the mankind itself Moral principles Justice, equality, humanity、freedom happiness Moral rules Honesty, cherish life, self-esteem, modesty, wisdom, restraint, braveness, the doctrine of the mean

Meta-ethics About the meaning of the ethics concepts and the justification of moral judgment Category: value, good & evil, ought, right；fact & is The justification of meta-ethics: is→ought

Virtue ethics To achieve the good human morality To cultivate the virtue Moral evaluation Conscience and reputation Moral cultivation Moral education & self-education

Descriptive ethics Some humanities and social subject are related to morality Sociology, psychology, anthropology, folklore and so on Moral sociology, moral psychology, moral anthropology, moral folklore and so on

The modern meaning of ethics The subject of studying human morality The method and process to determine morality, the achievement of morality Meta-ethics: the method to determine the code of ethics Descriptive and normative ethics: the process to determine the code of ethics Virtue ethics: to achieve the code of ethics

Section 1 Medical ethics & medicine The character of medical ethics Category and meaning of ethics Medical ethics has been the integral part of the medicine The concept of medical ethics The category in the history The modern meaning

Humanistic medicine: the new extension of the medicine Bio-medicine & humanistic medicine Medical ethics is a branch of humanistic medicine Inter-disciplinary→the component of modern medicine A branch of Chinese medical association Exam course to obtain qualification of physicians

医学门类 1001 基础医学 1002 临床医学 1003 口腔医学 1004 公共卫生与预防医学 1005 中医学 1006 中西医结合 1007 药学 1008 中药学

《将人文溶入医学： 发展医学人文学科的一种模式》 在“医学”门类下设第九个一级学科——“人文医学” 在“人文医学”一级学科下设诸多二级学科 医学哲学；医学伦理学；医学心理学；医学法学；医学社会学；医患沟通 … 《中国高等医学教育》（1/2007）

Medical Ethics in SDU Ethics Medical ethics Qilu University: medicine is the art of benevolence （“医乃仁术”） Medical ethics Shandong medical university: professional ethics education SDU School of medicine: professional foundation course

齐鲁大学时期开设伦理学课程

齐鲁大学时期开设医师伦理学课程

Medical Ethics in SDU Ethics Medical ethics Qilu University:“医乃仁术” Shandong medical university: professional ethics education SDU School of medicine: professional foundation course

Section 1 Medical ethics & medicine The character of medical ethics Category and meaning of ethics Medical ethics is the integral part of the medicine The concept of medical ethics The category in the history The modern meaning

The category in the history 医德学 Medical morals 医学伦理学 Bio-medical ethics 近现代医学伦理学 Medical ethics 生命伦理学Bioethics

1. Medical morals the commandment and virtue of physicians Medical skill accompany medical ethics The history of western medicine and traditional Chinese medicine is the history of medical ethics The ancient medical books & practice of the physicians the commandment and virtue of physicians Physician- patient relationship Self-discipline

Thought of ancient Chinese medical ethics

Thought of ancient Chinese medical ethics 医德典故 “杏林春暖” “誉满杏林” “杏林” 医界的代名词

Thought of ancient Chinese medical ethics

Qilu University:“博施济众，广智求真”

Thought of ancient western medicine “The father of medicine” Hippocrates Corpus Textbooks, lectures, research, notes and philosophical essays on various subjects in medicine Hippocrates oath On arts

The category in the history 医德学 Medical morals 医学伦理学 Bio-medical ethics 近现代医学伦理学 Medical ethics 生命伦理学Bioethics

小品文：医师是什么？※ 格特修斯：医师的三副面孔：人-天使-魔鬼 伏尔泰：医生将他所知不多的药，倾入他所知更少的人。 泰勒： 医生就是开出处方，等病人死亡或者自然痊愈的人。 爱迪生：我们可以设定一个原理：当一个国家的医生越多，人口就越少。 ※ 李师郑编译：《世界医学史话》，台湾民生报出版局，1980年。

2.Mecical ethics The modern hospital and the association of physicians were born Physician-patient relationship & physician-physician relationship Self-discipline in profession Medical Ethics (Thomas Percival) The document and works (books) in medical ethics Declaration of Geneva（WMA） International Code of Medical Ethics(WMA)

The category in the history 医德学 Medical morals 医学伦理学 Bio-medical ethics 近现代医学伦理学 Medical ethics 生命伦理学Bioethics

Karen Ann Quinlan When she was 21, Quinlan became unconscious after arriving home from a party. she lapsed into a persistent vegetative state. After she was kept alive on a ventilator for several months without improvement, her parents requested the hospital to discontinue active care and allow her to die. The hospital refused. Although she was removed from mechanical ventilation during 1976, she lived on in PVS for almost a decade until her death from pneumonia in 1985. March 29, 1954 – June 11, 1985

3.Bioethics Many social, ethical and legal issues occurred with the development and clinical application of bio-medicine Revival of life & life support technology, euthanasia and hospice care, assisted reproductive technology, organ transplantation, human trial, animal experiment, human gene technology, healthcare system reform and policy … Social ethics intervention

http://course.sdu.edu.cn/280.html

课程中心“优秀课程网站”

Professional medical ethics What is medical ethics The subject of studying the identify and implement the good medical morality Professional virtue、ideal personality、cultivation Medical virtue WMA; Medical professionalism; CMDA… Professional medical ethics Ethical issues and their countermeasures caused by bio-medicine … Bio-medical ethics

Chapter 1 Introduction Section 1 Medical ethics & medicine Section 2 Morality & medical morality Section 3 Why to learn medical ethics Section 4 How to learn medical ethics

Section 2 Morality & medical morality The study object The morality and ethic in medicine Ⅰ. morality & ethic Ⅱ. medical morality

Meaning of morality and ethic 行为应该如何的规范(norm) 规范在人们身上形成的心理自我(personality) 行为事实如何的规律(human nature)

Behavior norms 社会制定或认可的关于人们具有社会效用的行为应该如何的非权力规范。 社会制定或认可 道德和伦理“具有社会效用” 道德和伦理是“应该而非必须的非权力”规范

Virtue 一个人的道德人格(Moral personality)。 一个人在长期的道德行为中所形成和表现出来的稳定的心理状态。 “规范”：人们外在的道德。 “品德”：人们内在的道德。

Human nature 人的“行为”所固有的具有利害人己的属性的规律。 “行为”：“伦理行为”，具有利害效用的行为。 “伦理行为事实如何”：人生而固有的各种伦理行为之本性——道德哲学家所说的“人性”(human nature)。

人性论 性善论（孟子） 性恶论（荀子） 性无善无恶论（告子） 性亦善亦恶论（世硕；董仲舒；杨雄） 你认为人性是善的还是恶的？

伦理行为的种类 1.无私利他：目的利他的4种行为 2.纯粹害他：目的害他的4种行为 3.纯粹害己：目的害己的4种行为 4.单纯利己：目的利己而手段利己和害己的2种行为 5.为己利他：目的利己而手段利他 6.损人利己：目的利己而手段损人

The category of morality (Ⅰ) According to the application domain Social Morality Religious Morality Natural Morality Individual Morality

The Ten Commandments I am the Lord, Your Cod; do not worship false gods. Do not take the name of God in vain. Keep holy the Sabbath Day. Honor your father and your mother. Do not kill. Do not commit adultery. Do not steal. Do not bear false witness against your neighbor. Do not covet your neighbor’s spouse. Do not covet your neighbor’s belongings.

The category of morality (Ⅱ) According to the structure of social life The morality in love, marriage and family The morality in public places Professionalism

The meaning of medical morality Norm & virtue in medicine 在医学领域中形成的人们行为应该如何的规范 规范在人们身上形成的心理自我——品德。

The category of medical morality Medical professional morality Medical research morality Healthcare management morality Patient morality

Chapter 1 Introduction Section 1 Medical ethics & medicine Section 2 Morality & medical morality Section 3 Why to learn medical ethics Section 4 How to learn medical ethics

Section3 why to learn medical ethics Benefit to train medical professional talent Benefit to scientifically develop the medicine Benefit to health of the healthcare system development

Benefit to train medical professional talent Medical professional talent should be have both virtue and ability Learning medical ethics is a good start of medical profession

General significance “德之不修，学之不讲，闻义不能徙，不善不能改，是吾忧也。” 《论语·述而》 “天下万事，莫不成于才，莫不统于德，无才固不足以成德：无德以统才，则才跋扈之才，实足以败，断无可成。”（吴鞠通：《医医病书》）

How to use the professional talent: the relation of virtue and ability “德才兼备” “有德无才” 虽然有做贡献而利人的良好动机，却未必会有做贡献而利人的良好效果，甚至可能好心办坏事。 “有才无德” 既可能做大贡献而利人，也可能造大灾难而害人。 “用人如贤”与“用人如器”

Special significance 医务人员的职业道德如何，直接影响到防病治病的效果，直接关系到人人的生死安危，家家的悲欢离合。 “以余论之，医乃生死所寄，责任匪轻……当以太上好生之德为心。”（明代名医龚廷贤） “人无恒，不可以作巫医。”（孔子）

A good start of medical profession The consciousness of medical ethics & humanities spirit The ethical thinking ability Medical ethics value & medical professionalism

Global Minimum Essential Requirements in Medical Education(Institute for International Medical Education, IIME)

Professional Values, Attitudes, Behavior and Ethics recognition of the essential elements of the medical profession, including moral and ethical principles and legal responsibilities underlying the profession; professional values which include excellence, altruism, responsibility, compassion, empathy, accountability, honesty and integrity, and a commitment to scientific methods

an ability to apply the principles of moral reasoning and decision-making to conflicts within and between ethical, legal and professional issues including those raised by economic constrains, commercialization of health care, and scientific advances; self-regulation and a recognition of the need for continuous self-improvement with an awareness of personal limitations including limitations of one's medical knowledge;

an understanding that each physician has an obligation to promote, protect, and enhance these elements for the benefit of patients, the profession and society at large; recognition that good medical practice depends on mutual understanding and relationship between the doctor, the patient and the family with respect for patient's welfare, cultural diversity, beliefs and autonomy;

respect for colleagues and other health care professionals and the ability to foster a positive collaborative relationship with them; recognition of the moral obligation to provide end-of-life care, including palliation of symptoms

recognition of ethical and medical issues in patient documentation, plagiarism, confidentiality and ownership of intellectual property; ability to effectively plan and efficiently manage one's own time and activities to cope with uncertainty, and the ability to adapt to change; personal responsibility for the care of individual patients.

Benefit to scientifically develop the medicine Value orientation and moral standard How to develop & ought to how to develop

Benefit to health of the healthcare system development 保证合乎伦理地开展诊疗行为 Two indispensable elements: medical morality and medical technology 为卫生改革和发展提供价值指导 Value Orientation and realization Mechanism

Secion4 How to learn medical ethics Historical method comparative method case analysis Ideal experiment Practice method

历史方法(Historical method) 用历史眼光去观察和分析医学道德。 揭示医学伦理概况(Almost frame) 概括医学伦理内容(Contents) 3．总结医学伦理特点(Characteristic) 4．指出医学伦理局限性(Limit)

比较方法(comparative method) 对不同医学伦理思想进行比较 探索 “同中之异”或“异中之同” 横比(horizontal comparison)、纵比(vertical comparison)、纵横交比(Cross comparison) 同比、异比、同异交比 横比 同一时期的不同医学伦理思想的平行比较

案例分析方法(case analysis) 提取典型的医学伦理案例，发现、分析其中伦理问题，提出解决医学伦理问题的方案。 讨论的结果可能莫衷一是，但这并不影响案例分析法的使用。

案例 -1 2007年11月21日，怀孕9个月的李某某因呼吸困难，在其男友肖某某的陪同下赴北京某医院检查，医生检查发现孕妇及胎儿均生命垂危，建议行剖宫产手术，但肖某某多次拒绝签字。 在抢救了3小时后，医生宣布孕妇抢救无效死亡。

案例 -2 2008年1月11日，浙江德清人民医院收治产妇周某某，大出血，生命垂危，需要切除子宫，但其丈夫拒绝签字同意手术。 该家医院由两名主治医生联合签字手术，产妇顺利产下一名男婴，母子平安。

理想实验(Ideal experiment) “假想实验”或“思想实验” 为了检验某种新的伦理理论、原则或者验证某种已经存在的伦理理论、原则。 哈曼的理想实验 “奴隶制度”和“惩罚无辜” 电车困境（trolley dilemma）

trolley dilemma Suppose you are the driver of a trolley. The trolley rounds a bend, and there come into view ahead five track workmen, who have been repairing the track. The track goes through a bit of a valley at that point, and the sides are steep, so you must stop the trolley if you are to avoid running the five men down. You step on the brakes, but alas they don't work. Now you suddenly see a spur of track leading off to the right. You can turn the trolley onto it, and thus save the five men on the straight track ahead. Unfortunately,...there is one track workman on that spur of track. He can no more get off the track in time than the five can, so you will kill him if you turn the trolley onto him.

电车困境（trolley dilemma） 牛津大学哲学教授菲利帕•富特（Philippa Foot） 一辆失控的飞驰而来的电车,如果不驶向左面的铁道压死1个人,就必定要驶向右面的铁道压死5个人。电车的司机应该驶向哪一条铁道? 扩充版本： 电车在轨道上，司机无法变更轨道，而搬道工可以，本来是冲向5个人的轨道，应否搬动轨道？

实践方法(Practice method) 结合医学科学发展和临床运用实践以及开展医学道德实践 。 将医学伦理理论学习与医学发展以及临床实践相结合。 将医学伦理付诸实践，开展医学道德实践。

Summary Four issue about medical ethics What is medical ethics? What does medical ethics research and study ? Why to learn medical ethics How to learn medical ethics