【作者】 毕肖红；

【导师】 刘俊荣；

【作者基本信息】 广州医学院 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 伦理困境的存在与现阶段法律法规具有密切关系,并通过权利与义务的冲突表现出来。本文通过典型案例,从权利与权利的冲突、权利与义务的冲突、义务与义务的冲突等方面归纳现历史阶段医疗活动中伦理与法律相冲突的基本情形。本文以现今医疗活动中存在的典型案例为依据设计调查问卷,通过问卷及访谈了解在伦理困境下社会公众、医务人员、卫生行政人员和司法人员等不同角色人员的选择,包括自身在伦理困境下的选择,对他人行为选择的评价以及对社会舆论的评价。并根据统计数据分析不同角色社会成员的选择及其选择背后的动机、目的和价值观。结论:①在道德与法律冲突的伦理困境下,医务人员不同的医疗行为选择体现了不同的价值判断;面对同一伦理困境,处于不同角色或不同团体的医务人员,其价值判断有所不同;统一价值判断的思想不能为解决伦理困境带来新的思维,尊重思想的多元化,把以人为本的思想融入法律法规的制定与实施当中,还原医务人员在困境中选择的主动权,有助于提高医务人员在伦理困境的主动性。②卫生行政人员的选择并非来源于价值判断,主要影响因素是主体利益;伦理困境中的选择及舆论评价,主要体现了同情共感的理解,而不是对与错的判断;对伦理困境解决的建议普遍倾向于法律诉求,但是纯粹伦理道德诉求和法律制裁都未能提供真正的出路;充分发挥医学伦理委员会的作用有利于解决因法律模糊而引起的争议。③社会舆论未能够代表大部分公众的立场,片面追求社会效应的舆论只会把民众与政府、民众与医院的矛盾扩大,民众需要运用思辨能力分析部分媒体所营造的社会舆论;同样,民众也需要运用思辨能力认识法律,并运用法律维护自身权利,遵守有意义的法律,不盲从法律;完善的社会管理是需要多种渠道听取各方民众声音,补充法律的缺陷;个人私德与社会公德的平衡有助于缓解伦理困境。本文通过文献检索以及对伦理困境下医疗行为选择及社会认同与评价的实证性研究,分别从国家制度层面、卫生行政机构层面、医院层面和社会公众层面分析了伦理困境的实质,这表现在:①从国家制度层面来看,伦理困境不仅反映了不同群体的利益之争,更深层次地反映了国家对社会公共事务实施的单向度管理;②从卫生行政层面来看,伦理困境反映了卫生行政人员因法律的权威导致责任感错位,从而无法根据事实价值进行选择;③从医院层面来看,伦理困境产生的实质是医院在社会公众要求的自由选择和法律法规、行政命令的约束中游走,无法寻求一个最佳的平衡点;④从社会公众层面来看,伦理困境并非源自人类本性中社会性和个体性的矛盾,它反映了部分法律法规不能有效地顺应民众的需求和意志。伦理困境的产生与现有法律法规的不足、法律完善机制的滞后、信息反馈渠道的不畅等密切相关;在消解伦理困境的过程中,需要坚持社会正义原则;在制度安排上建立有效的、可行的补救渠道;对因社会选择而受到损失的个人利益进行补偿;应用修复性司法理论解决因善意的违法行为而引致的惩罚问题。更多还原

【Abstract】 The existence of ethical dilemma has a close relationship with the current laws and regulations, and shown by the conflict of rights and obligations. According to typical cases, the base cases of ethical dilemma in medical practice activities can be concluded into three situations: the conflict between the rights and the rights, the conflict between rights and obligations, the conflict between obligations and obligations.In order to gather material about the election of different roles in the ethical dilemma, including the public, medical staffs, health administrators and judicial personnel, we make the questionnaires with typical cases. The questionnaire can be divided into three parts, the choice of their own, the evaluation of others and public’s opinion. And then analyze the motives, purposes and values behind the choice with the material. Conclusiont:①Between the dilemma of ethics and law, different medical behavioral choice reflects different value judgment. Even in the same dilemma, different person or team will have different value judgment. Use one value judgment can’t bring new thought to the dilemmas, respect diversification and apply the thought of people oriented to law, and revert the initiative to medical staffs, all of these can help medical staff have more initiative.②The choice of health administrators doesn’t come from value judgment, but from personal interest; the selection of the dilemma and the evaluation of public opinion, reflects sympathetic understanding, not the judgment about right or wrong; most of the health administrators will turn to the law for help when in the ethical dilemma, however, purely ethical demands or legal sanctions can’t help them find out the solution for the dilemma; when the controversial that cause by law vague, Medical Ethics Committee will pay an important part in the settlement.③Public opinion does not represent the majority; if public opinion just pursuit the social effect, it will expand the contradiction between the public and the hospital, and the contradiction between the people and government, people should distinguish truth from falsehood through serious consideration; similarly, we should distinguish good law from bad law, and make full use of the law to protect ourselves, and abide by the good law not by every law; listening to the voices from different people can help us improve the social management; if we can balance the interest between the personal and public, it can help us go out the ethical dilemmas.According to previous documentary study and investigation study, we respectively analyze the essence of ethical dilemma in different level, including government level, administrative level and personal level. Result:①On the government level, the ethical dilemma not only reflects the struggle among different interest group, but also reflect that the government carry on the one-dimensional management in public affairs;②On the administrative level, the ethical dilemma reflects that the authority of the law led to the irresponsibility of health administrators, as a result, health administrators can’t make a choice based on facts;③On the hospital level, the ethical dilemma arise for that they can’t balance the interest between the public and the law;④On the personal level, the ethical dilemmas doesn’t come from the contradiction between the public and the personal, unsteadily it reflects that the laws can’t meet people’s need and will. The rise of the ethical dilemmas has intimate relationship with the lack of laws; the law improves mechanism lag behind social development, and the poor information feedback channels. During the process of finding the way for the ethical dilemma, we should adhere to the principles of social justice; before the ethical dilemma happened, government should take some preventive or remedial measures; and compensate the loss of personal interests for the social choice; apply judicial repair theories to solve the punishment which caused by illegal acts but for good.更多还原