scholarly journals 病人自主性與家庭本位主義之間的張力

2002 ◽  
Vol 4 (2) ◽  
pp. 70-84
Author(s):  
Jin-cheng LEI ◽  
Zhi-qing XIE
Keyword(s):  
Informed Consent ◽  
Basic Unit ◽  
Individual Autonomy ◽  
Cultural Tradition ◽  
The West ◽  
Cultural Contexts ◽  
Patient’S Autonomy ◽  
The Family ◽  
The Difference ◽  
The Individual

LANGUAGE NOTE | Document text in Chinese; abstract also in English.在中國幾千年小農經濟和傳統文化背景下，個人利益、個人權利一直被置於家庭之下，個人自主性被包含在家庭自主性之內，表現為一種家庭本位主義。源自西方歷史、文化的知情同意移植到中國後，受傳統文化概念的影響，中國人對知情同意的認知、理解以及實踐方式均不同於西方人。這種不同集中表現在人們對家屬同意權的認可。以個人本位主義為背景的病人自主性與中國文化中的家庭本位主義之間存在張力。對知情同意在不同文化環境中不同踐行方式，應以文化寬容主義的態度對待之。不同文化背景下的倫理觀念，不僅存在差異性，而且也存在可通約性和相容性。由於種種原因，家庭同意並不能等同於病人本人的意願。隨著全球化進程的加速和人們相互交往的密切，類似知情同意這樣一些原本屬於個人的自然權利，將會愈來愈多地為各國人民接受。我們應當在某些條件具備時，盡可能地將家屬同意限制在合理的範圍，讓病人更好地表達自己的意願。Family has a long history. With China's small-scale peasant economy and traditional cultural background for centuries, family has been the most basic unit of polity, economy, and socio-cultural life. Interests and rights of the individual are always placed below those of family; individual autonomy is often included in family autonomy. All this can be called familism. There are deeper and determining economic reasons for familism. The economy of the family is controlled by the head of the family or clan so that the individual usually has no independent economic measures to support his or her autonomous rights.Informed consent originated in the Western culture. The theoretical premise of informed consent is respect for the patient's autonomy. The patient's autonomy is closely related with individualism in the West. After informed consent is spread from the West to China, due to the influence of traditional Chinese culture, the Chinese perception, understanding, and practice of are different from those of the West. The difference mainly lies in Chinese familism. To focus on the autonomy of the family reflects the influence of traditional familism upon informed consent. As a result, there exits a tension between the patient's autonomy based on individualism and familism in Chinese culture.Informed consent is not a culture issue, but it is closely related with cultural tradition. It is impossible to get away with cultural norms in the practice of informed consent. To different practicing methods of informed consent in different cultural contexts, the spirit of cultural tolerance is needed. In China, with the principle of cultural tolerance as a practical guidance, we should establish a set of procedure and ways of practicing informed consent with Chinese characteristics. Fundamentally, informed consent is to balance the unbalanced power between doctors and patients. According to the principle of cultural tolerance, the difference in the practice of informed consent at different cultural contexts should be tolerated so long as the basic purpose of informed consent is not violated. There exists a variety of cultural ideas among contemporary Chinese. The individual patient and his or her family are essential part of informed consent, with both having their rationality. Thus, we shouldn't reject absolutely some methods. From the angle of historical development, it is worthwhile noticing the transformation from family determination to individual autonomy. National and cultural differences are integrating in the age of globalization. Since laws, ethics, and customs in different countries and cultures are mutually exchanging, we should promote to make the practice of informed consent to become similar.DOWNLOAD HISTORY | This article has been downloaded 35 times in Digital Commons before migrating into this platform.

scholarly journals 知情同意的若干問題

2002 ◽  
Vol 4 (1) ◽  
pp. 131-147
Author(s):  
Xiaomei ZHAI
Keyword(s):  
Informed Consent ◽  
Clinical Medicine ◽  
Genetic Research ◽  
Individual Autonomy ◽  
Chinese Society ◽  
Cultural Traditions ◽  
The Family ◽  
Western Theory ◽  
Solid Foundation ◽  
The Individual

LANGUAGE NOTE | Document text in Chinese; abstract also in English.作為一種法律學說，知情同意在西方社會已經存在多年，並且得到長足的發展。這一學說來源於《紐倫堡法典》。知情同意不僅僅是“法律文件”，也不是醫患“共同決策"，它是具有豐當倫理內涵的一個概念，是一個人實際理解並且真正在沒有他人控制下有意地批准和同意專業人員做某事。中國具有其獨特的文化傳統背景和經濟發展水平，西方國家基於自主的和權利的理論、信念以及方法在中國基於義務的和強調集體的傳統文化中尚缺乏一定的根基。中國文化傳統上的倫理決策是基於義務而不是基於權�的。這種根深蒂岡的傳統所肯定的是社會或者整體的利益，容易忽視的是個人應享有的權利。在中國文化傳統中，家庭和社區具有很強的凝聚力，家庭或社區協助和支持下的知情同意往往建立在更加充分的理解、思考基礎之上。這種知情同意獲得的方式很有價值：更加精緻，更加體現了尊重人的倫理學原則。但是需要注意的是，這種協助不能完全超越自我決定性。另外，社區的“允許”並不等同於個人的“同意”，而且社區的允許也不應該取代個人的同意。另外，目前在中國，臨床藥理試驗，倫理審查委員會（IRBs）制度化，合理的補償與不正當的引誘的區別，基因研究中的知情同意問題以及利益衝突等很多現實問題都需要引起倫理學的關注，並進行大量的研究工作。In Western societies, the idea of informed consent as a legal account has long been there and developed significantly. This idea originated from the "uremberg Code". In fact, informed consent is neither a mere "legal document" nor a "common decision" made by the physician and the patient. It is a concept rich in moral content. It is about how an individual perceives and intentionally (without being controlled by others) agrees and allows professionals to carry out certain actions on him/her.China has a unique traditional cultural background and economic development level. Due to the emphasis on responsibility and collectiveness in Chinese cultural traditions, introducing the Western theory, beliefs, and practice based upon individual autonomy and rights to Chinese society does not have solid foundation. According to Chinese cultural traditions, people consider responsibility instead of rights during making ethical decisions. These deeply-rooted traditions assure the interests of the whole and tend to neglect the rights of the individual. Chinese families and communities have a very strong sense of cohesiveness. With the assistance and support of the family or community, the thinking and understanding of informed consent can be established on a more adequate and solid foundation. This kind of way to get informed consent is very valuable: it is more accurate and can also fulfills the ethical principle of respect. However, the assistance of the family or community should not override individual's autonomy in making decisions. Moreover, community "permission" is not equal to individual "consent". Indeed, it should not replace individual "consent".Contemporary China faces many practical problems, such as clinical medicine testing, establishing Institutional Review Broads (IRBs), differences between reasonable compensation and improper reward, conflict of interests in genetic research as well as the practice of informed consent. They demand ethical attention and a large amount of careful research.DOWNLOAD HISTORY | This article has been downloaded 13 times in Digital Commons before migrating into this platform.

scholarly journals DEVELOPMENT AND CAREER MANAGEMENT

2019 ◽  
Vol 31 (5) ◽  
pp. 1339-1344
Author(s):  
Baki Koleci
Keyword(s):  
Career Development ◽  
Social Relationships ◽  
Career Management ◽  
Personal Goals ◽  
Expert Opinions ◽  
The Family ◽  
The Subject ◽  
The Difference ◽  
The Individual

We, as individuals, continually through our lives, learn and acquire the knowledge, skill, and skill we expect to help us employ or apply appropriately in order to gain a living and secure our survival. Everyone wants to build a successful career with which he can be proud of his life. However, this is not always so easy and simple, it requires a lot of sacrifices, concessions, compromises with our partners, the family, close social relationships, and finally with ourselves. In this paper, the subject of the research is the determination of career development, career stages, career factors, then expert opinions, the difference between traditional and modern career views, goals pursued by individuals in the career, and so on, Career development can be seen as an experience of individuals (an internal career) and this is not related to an organization. Although the responsibility for career management is in the hands of individuals, individuals, however, organizations can play a key role in shaping and developing careers by providing help and providing support. Career development can not be pursued individually or separately from the personality as a whole, meaning it reflects on the context of life and the development of the person as a whole, not just personality as work. The main goal in career development is to realize the current and future needs and goals of the organization and individuals, which has to do more with developing employment opportunities and improving the skills needed for employment. Career success is reflected in the eyes of the individual and can be defined as a career pleasure through achieving personal goals related to the work, while at the same time enhancing the success and efficiency of the organization.

scholarly journals Ewolucja czy rewolucja? Przemiany rodziny na ziemiach polskich w pierwszej połowie XX wieku. Wybrane aspekty

2020 ◽  
Vol 147 (4) ◽  
pp. 823-837
Author(s):  
Katarzyna Sierakowska
Keyword(s):  
Twentieth Century ◽  
Social Environment ◽  
Family Life ◽  
Rate Of Change ◽  
Individual Autonomy ◽  
Parental Roles ◽  
The Family ◽  
The Individual

Evolution or revolution? Transformations of family in the Polish lands in the first half of the twentieth century: Selected aspects The text focuses on select issues related to the transformation of the family in the first half of the twentieth century, such as: changes regarding marital choices and relationships between spouses, changes in the scope of parental roles and the processes of individualization and individual autonomy in the family. It tries to answer the questions about the dynamics of these processes in different social milieus and to indicate factors that accelerated and delayed them. The analysis of the sources and literature concerning family lives does not allow for an unambiguous assessment of the rapidity and range of changes taking place in families. Nevertheless, it exposes the diversity of models existing in family life and shows that it depends on such elements as social environment, gender, idiosyncratic features of the individual, to the same extent as it does on the rate of change.

scholarly journals The Theory of Half-education (translation from German Maria Kultaieva)

2018 ◽  
Vol 20 (1) ◽  
pp. 128-152 ◽  
Author(s):  
Theodor W. Adorno
Keyword(s):  
German Idealism ◽  
Social Adaptation ◽  
Individual Autonomy ◽  
Cultural Contexts ◽  
The Social ◽  
Negative Dialectic ◽  
The Individual ◽  
Contemporary Education ◽  
Dialectic Of Enlightenment

The theory of  half- education was presented at first on the congress of German sociologists (1959). The tendencies regarded in this theory are really taking place in the contemporary education and have determining its crises, which becomes more evidence in the social and cultural contexts of the later capitalism. The theory of half-education is rethinking  and actualizing  of the conceptualizations of education and culture in the German idealism, Marxism and Freudianism, explicating the dialectic of Enlightenment through diagnostics of its degenerations and deformations in the options of the alien spirit, what has a very dangerous consequence of the liquidation of culture  that is converting into the mas one. Half-education  is parasitizing    on   the idea of education which has  intrinsic contradictions: its conditions are the individual autonomy and social freedom, but it is depending on society. Id demands both: the individual autonomy and social adaptation. These contradictions can be overcame  by the  application of  the negative dialectic, which joins complementary the critic of education and the critic of society opening new perspectives for them.

scholarly journals La conservazione del materiale biologico finalizzato alla ricerca scientifica: questioni giuridiche e riflessioni etiche sulle biobanche

2011 ◽  
Vol 60 (4) ◽  
Author(s):  
Elena Ferioli ◽  
Mario Picozzi
Keyword(s):  
Informed Consent ◽  
Ethical Issues ◽  
Individual Autonomy ◽  
Biomedical Data ◽  
Collective Interest ◽  
The Right To Privacy ◽  
Technical Requirements ◽  
The Individual ◽  
The Right ◽  
New Treatments

La richiesta di istituire biobanche oggi diventa sempre più impellente. Una biobanca è una struttura dove si raccolgono per un tempo lungo materiale biologico e dati di natura biomedica correlati al campione, che può provenire sia da pazienti che da cittadini. Da un lato si riconosce il ruolo che le biobanche possono avere sia nell’acquisire nuove conoscenze sia nel favorire nuovi trattamenti di diagnosi e cura, dall’altro è necessario riflettere sulle delicate e complesse questioni giuridiche ed etiche ad esse sottese. Il presente contributo, dopo aver fatto chiarezza sulla definizione e sui requisiti tecnici necessari per l’istituzione di una biobanca, si sofferma ad analizzare le principali questioni etico-giuridiche: a chi appartiene il tessuto e chi beneficia dei risultati ottenuti? Quale consenso informato è adeguato per protocolli sperimentali non prevedibili al momento del prelievo del tessuto? Come può essere garantita la riservatezza dei dati, anche in funzione dell’analisi genetica? Gli argomenti vengono analizzati a partire dalla letteratura internazionale, mostrando le diverse posizioni. In tema di proprietà del tessuto e di proprietà intellettuale dei risultati si evidenzia come sta emergendo una concezione solidaristica, in cui materiale e informazioni sono da considerarsi risorse a disposizione dell’intera collettività, che ne affida alla biobanca la gestione. Il modello di consenso informato che sembra prevalere è quello definito “ampliato”, di cui si evidenziano pregi e difetti, nell’ottica di un bilanciamento tra autonomia del soggetto, interesse della collettività ed esigenze della ricerca. La questione della riservatezza impone di riflettere sia sul diritto alla privacy sia sulla possibilità di utilizzo del dato per finalità di ricerca. Data la complessità delle questioni emerse, si ritiene che necessariamente la fiducia del paziente/cittadino verso la comunità scientifica giochi un ruolo fondamentale. Il Comitato di etica, a cui vanno assicurate competenze e risorse adeguate, diventa lo strumento di garanzia indispensabile per una gestione eticamente accettabile della biobanca. ---------- Today the request to create biobanks is more and more urgent. A biobank is a structure where biological specimens and related biomedical data, obtained from patients and/or citizens , are stored over time. On one hand, we acknowledge the role that biobanks may have in acquiring new knowledge and fostering new treatments for diagnosis and therapy, on the other we need to reflect upon the delicate and complex legal and ethical issues that biobanks rise. This paper, after defining the concept of biobank and the technical requirements needed to establish one, analyzes some major ethical and legal issues: Who owns the tissues and who can benefit from potential results? Which kind of informed consent is the most appropriate for experimental protocols not yet predictable at the time of tissue collection? How can data confidentiality be guaranteed also in relation to genetic analysis? The topics are analyzed with reference to the international literature, comparing different perspectives. Regarding the ownership of biological samples and the intellectual property rights of the potential research outputs based on the data, the recent literature introduces a new concept of solidarity which consider all samples and information at full disposal of the entire community and which indicates the biobank as the manager of the archive. The model of “broad” informed consent seems to prevail: we indicate its points of strength and weakness, considering a necessary balance among the individual autonomy, the collective interest and the research requirements. Finally, regarding the confidentiality of all data, we need to reflect upon the right to privacy along with the possibility to use the available data for research purpose. Considering the complexity of these issues, we believe that the patient’s trust towards the scientific community is the main matter. The Ethics Committee, to whom adequate resources and expertise must be granted, becomes the assurer entity for an ethically acceptable management of a biobank.

scholarly journals 儒家倫理對構建醫師專業精神的若干啟示

2008 ◽  
Vol 6 (1) ◽  
pp. 129-146
Author(s):  
Enchang LI ◽  
Yumei XU ◽  
Yue TENG
Keyword(s):  
Healthcare Professionals ◽  
Confucian Ethics ◽  
Individual Autonomy ◽  
Medical Professionalism ◽  
Cultural Tradition ◽  
Primary Concern ◽  
View Point ◽  
The West ◽  
Medical Issues ◽  
Digital Commons

LANGUAGE NOTE | Document text in Chinese; abstract also in English.《新世紀的醫師專業精神—醫師宣言》所規定的醫師專業精神的三條原則中，將患者利益放在首位原則和患者自主原則，由於諸多原因而存在著悖論。中國儒家的仁術、德教為先、修身為本、慎獨、推己及人、高度人倫的思想對解決以上悖論有啟發意義：遵循道德形成和醫學技術提高的規律，通過各種學習、強化方法，使醫者真正確立患者利益第一的專業精神和具有精湛的專業技能。從而使醫者成為患者利益的真正代表，能在各種情況下有效保護患者的利益。As a dominant cultural tradition in China, Confucianism has greatly inf luenced the Chinese medical ethics. From the view point of Confucian ethics, medicine is the“ art of benevolence” (renshu ). For a Confucian, Confucianism and medicine share the same principle. The concept of patients-first is deeply rooted in the Confucian ethical system in which the“ virtue of a doctor” (yide ) is a primary concern in medical professionalism. This paper f irst discusses the major three principles of professionalism presented by“ The Declaration of Medical Professionalism in the New Century,” and attempts to deal with the limitations of the Declaration by introducing Confucianism with respect to healthcare professionals and a doctor-patient relationship.The paper explains that the Confucian principle of care for others determines that Confucians take human relationship very seriously in their dealing with the health issue, since they understand that a person’s health is deeply affected by, and in turnaffects, other people. Therefore, the rule of individual autonomy as well as individual right emphasized in the West should not be taken as the only legitimate one in dealing with medical issues. More importantly, that the Confucian physician considers medical practice as benevolent action and thus it is more than medical professionalism.DOWNLOAD HISTORY | This article has been downloaded 89 times in Digital Commons before migrating into this platform.

scholarly journals 知情同意臨床實踐實證研究——第一人稱視角的考察

2017 ◽  
Vol 15 (2) ◽  
pp. 9-20
Author(s):  
Hua CHEN ◽  
Yonghui MA
Keyword(s):  
Informed Consent ◽  
Individual Autonomy ◽  
Medical Treatments ◽  
Legal Implications ◽  
Patient’S Autonomy ◽  
Digital Commons ◽  
Consent Document ◽  
Informed Consent Document ◽  
China Today ◽  
Medical Policy

LANGUAGE NOTE | Document text in Chinese; abstract also in English.知情同意作為一項權利，患者成為闡述其體驗的首要主體。實證調查表明，患者對於其權利認知還存在不足，多數偏好於患者與家庭共用模式；在實踐中，知情與同意在主體層面存在分離現象。對於病情的告知傾向於任選模式，但家庭是不可或缺的告知物件，對於診療、護理等相關資訊，傾向於患者模式；在同意方面，家屬成為獲取同意的主體。經濟因素成為患方“不同意”的首要原因。對於不同維度的調查表明，基於女性相對脆弱性特點，他們對於家庭的依賴性更強，其維權意識更強；在年齡層面，青少年對於權利的認知更理性，具有現代契約精神。在地域層面，縣級以上城市居民對於權利認知度更高；職業往往與教育程度相關，表明農民的個體依賴性更強；政府機關以及事業單位人員個體主體性更強。為此，需要加強患者權利教育，提升主體意識；對醫務人員加強職業道德教育，履行告知義務，強化醫患信任；深化醫療衛生體制改革，為知情同意的踐行提供空間與時間。An informed consent document is vital for all surgical procedures and medical treatments. Proper documentation and counseling of patients is important for informed consent. Opinion polls conducted in this essay show that the majority of people in China today have accepted informed consent as a legally binding medical policy, yet they do not fully understand the ethical and legal connotations involved, particularly the idea of the patient’s autonomy. As a result, the patient’s own experience as a first-person narrative is often ignored and his/her subjectivity is blurred when his/her family’s subjectivity intervenes. According to the essay, the problem appears when liberalism—which emphasizes individual autonomy and rights—does not square with the Confucian tradition that emphasizes family as a coherent unit. The essay also points out that there is a huge difference in patients’ perceptions of “individual rights,” due to their different levels of education. The author argues that informed consent could be better practiced if both doctors and patients were “well informed” and understood the moral and legal implications of informed consent.DOWNLOAD HISTORY | This article has been downloaded 97 times in Digital Commons before migrating into this platform.

scholarly journals 病人訪談: 一個知情同意的故事

2002 ◽  
Vol 4 (2) ◽  
pp. 119-124
Author(s):  
Shuqing WU
Keyword(s):  
Informed Consent ◽  
Medical Knowledge ◽  
Medical Professionals ◽  
Her Family ◽  
Digital Commons ◽  
The Family ◽  
The Will ◽  
The Individual ◽  
The Cost ◽  
Economic Capacity

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本故事提出了如下一些知情同意方面的問題：面對沒有文化、且毫無醫學知識的病人，如何履行知情同意？在病情緊急情況下應否免除知情同意或待病情穩定後再向病人或家屬補充說明？如果是後者，這種事後的同意有何意義？在醫院追逐利潤並與病人利益發生衝突的情況下，費用成為病人關注的重要問題，病人如何有效的表示自己的意見？在病人本人沒有經濟能力、又無醫療保險的條件下，一切依賴家屬，病人如何維護自己的權益？病人本人的意願有何意義？如何面對既不能否定家屬的同意又有可能出現家屬違背病人本人意願行事可能的困境？The story reported in this article raises some questions on informed consent. To patients with no education and no medical knowledge, how do medical professionals perform informed consent? In the situation of emergence, should medical professionals be excused from the obligation of informed consent? Or should the patient and his or her family be informed after the illness is cured? If this is so, what is the meaning of informed consent? With the conflict between the interests and the patient and the hospital, the cost is a very importance issue. How does the patient express his or her opinions effectively? Patients who have no economic capacity and no medical insurance depend on their families for medical care. How can their rights and interests are protected? What medical professionals should do if the decision of the family is against the will and interests of the individual patient?DOWNLOAD HISTORY | This article has been downloaded 38 times in Digital Commons before migrating into this platform.

scholarly journals Can a Soldier Say No to an Enhancing Intervention?

Philosophies ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. 13
Author(s):  
Sahar Latheef ◽  
Adam Henschke
Keyword(s):  
Informed Consent ◽  
Human Performance ◽  
Individual Autonomy ◽  
Significant Potential ◽  
Moral Decisions ◽  
Differential Vulnerability ◽  
Contextual Elements ◽  
The Individual ◽  
The Military

Technological advancements have provided militaries with the possibility to enhance human performance and to provide soldiers with better warfighting capabilities. Though these technologies hold significant potential, their use is not without cost to the individual. This paper explores the complexities associated with using human cognitive enhancements in the military, focusing on how the purpose and context of these technologies could potentially undermine a soldier’s ability to say no to these interventions. We focus on cognitive enhancements and their ability to also enhance a soldier’s autonomy (i.e., autonomy-enhancing technologies). Through this lens, we explore situations that could potentially compel a soldier to accept such technologies and how this acceptance could impact rights to individual autonomy and informed consent within the military. In this examination, we highlight the contextual elements of vulnerability—institutional and differential vulnerability. In addition, we focus on scenarios in which a soldier’s right to say no to such enhancements can be diminished given the special nature of their work and the significance of making better moral decisions. We propose that though in some situations, a soldier may be compelled to accept said enhancements; with their right to say no diminished, it is not a blanket rule, and safeguards ought to be in place to ensure that autonomy and informed consent are not overridden.

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