Ethics medical ethics

Medical ethics is one of the fastest developing and most controversial subjects in applied ethics. As we all know, cherishing and protecting life is a basic principle of traditional ethics. However, in the actual medical practice, this principle is often challenged by abortion, vegetative state and other problems. This has led to a series of debates on related topics in the field of medical ethics: is life worth ranking? Does a human embryo count as a person? If not, at what stage does the embryo develop into an adult? How to define death? Is it moral to take brain death as the standard to replace the traditional standard of cardiac arrest and take out healthy organs from a human body with a beating heart but brain death? How to realize the fair distribution of medical resources? In addition, the moral requirements of traditional medical ethics for medical staff are mainly "care" and "no harm", and the right of consent or refusal of patients in the process of diagnosis, treatment and pure research is not paid much attention here. Contemporary medical ethics requires doctors to think more about patients' participation in decision-making, and create conditions for patients to make their own decisions by informing them of the significance, opportunities, consequences and dangers of future treatment activities. Patients' right to know, privacy, respect and protection for AIDS patients, terminally ill patients' right to choose euthanasia, and how to deal with the possible conflict between doctors' obligation to save lives and patients' right to self-determination. It constitutes the basic topic of research and debate by contemporary medical ethicists.

Medical ethical events are not only the conflict between medical technology and sociology, but also the conflict between old and new medical technologies. For example, there are two important events in diabetes research:

The first incident is about "limiting grain" and "releasing grain". Traditional Chinese medicine has advocated liberalizing grain for thousands of years. However, western modern medicine constantly changes its guiding principles at this point. Nie Wentao said in his speech "Appropriate Technology Training in Primary Hospitals": During the period from the implementation of the "limited carbohydrate" dietary standard for diabetes (John Rollo standard) to the re-implementation of the "high carbohydrate" standard (such as Peking Union Medical College Hospital standard), countless patients lost their health further because of the wrong dietary treatment for diabetes. How should the medical profession face such a situation? The strong shock caused by this speech is precisely because he raised a profound scientific ethics question. Without standards, human nature may be lost; The mistakes implied in the standard itself may also be inhuman. Therefore, science is a social problem that transcends right and wrong itself.

The second thing is to strengthen blood sugar control. A study (ACCORD for short) was initiated by the National Heart, Lung and Blood Institute. One of the purposes of this experiment is to determine whether intensive blood sugar therapy can reduce the occurrence of cardiovascular diseases compared with conventional methods for patients with type 2 diabetes who already have cardiovascular diseases or have high risk of cardiovascular diseases. There were 1025 1 subjects from 77 clinics in the United States and Canada, with an average age of 62.2 years and an average glycosylated hemoglobin level of 8. 1%. The goal of intensive blood sugar control is to reach the normal glycosylated hemoglobin level of 6.0%. Due to the high mortality rate in the intensive treatment group, the study was terminated in February this year (average follow-up of 3.5 years). After careful analysis, the Accord Project Data Analysis and Monitoring Committee found that there were 257 deaths (14/ 1000? Years) was more than that in the conventional treatment group (203 cases,111000 people? The mortality of the former is significantly higher than that of the latter, and the relative risk increases by 22%. There is a significant difference between the two. Continuing this observation experiment may lead to more deaths of patients. Evidence-based medicine has an important principle, and medical ethics is more important than observation results. The patient is not a simple observation object, which is different from the general experimental animals. Patients should be fully respected and their rights and interests should be protected. In order to protect patients' rights and interests, Accord issued a statement on February 6, 2008, terminating the experiment of blood sugar control ahead of schedule, and transferring the intensive blood sugar control group to the routine blood sugar control group to continue the research on blood pressure and blood lipid control. At this time, the average observation time of the intensive blood sugar control treatment group was 3.5 years, and there was still 18 months before the end of the observation.

Thus, medical ethics is a complex issue, involving sociology, economics, medicine and other categories.