Error Reduction, Patient Safety and Institutional Ethics Committees

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. In this paper, the author endeavors to fill the gap. As noted in the Hastings Center's recent report, "Promoting Patient Safety," the occurrence of medical error involves complex web of multiple factors. Human misstep is certainly one such factor, but not the only one. This paper builds on the Hastings Center's report in arguing that institutional ethics committees ought to play an integral role in the transformation of a "culture of blame" to a "culture of safety" in healthcare delivery.     

制度伦理教育的合法性审视

制度伦理教育是指致力于使人认可、内化并践行契约伦理的教育.在我国,随着市场经济的发展,罗尔斯正义理论在教育界的影响日益深远等,它已经悄然兴起.合法性判断是对事物是否符合社会、时代发展的一个最基本的判断,所以对制度伦理教育进行合法性判断是非常必要的.道德教育合法性判断的依据包括道德伦理合法性判断的依据和道德教育方式方法合法性判断的依据.前者具体可分为民意、文化传统和超越三重依据;后者具体可分为尊重常识道德、教育者"言行一致"、旨在于使人向善、有效性四重依据.以这些依据作为评判的标准,不难发现制度伦理教育尽管有很多地方值得我们去借鉴,但它并不具有很强的合法性基础,它的兴起不能实现其已有的承诺.     

The Rise of Committees

Committees are of increasing importance in the process of EC policy-making, particularly in regulatory fields which touch upon politically sensitive issues. This article discusses the problems which have arisen due to the unforeseen emergence of committees within the institutional framework of the Community. It examines the main institutional conflicts in relation to committees and argues that parliamentary disdain for Comitology notwithstanding, the use of committees in the area of social regulation may be explained through a 'Member State-oriented' understanding of the institutional balance of powers. Committees may thus not only contribute to more effective decision-making, but may also secure a degree of subsidiarity. The increasing reliance on committees, however, might nonetheless be argued to detract from the general legitimacy of Community decision-making, especially since committees remain creatures of pragmatism. This article accordingly argues that the lack of transparency within committees, and the absence of general procedural rules upon the activities and composition of committees, should now be compensated for through the evolution of formal and generalisable procedural rules.     

Back to Basics: A Theory of the Emergence of Institutional Facts

In order to account for the mode of existence of social rules and norms, the author develops a theory of the emergence of institutional facts. Just as other kinds of institutional fact, rules and norms are meanings. Therefore, insight into the emergence of social rules and norms can be achieved by studying the recognition and the communication of meanings. Following accounts of meaning and factuality, institutional facts are characterized as unquestionable shared typifications. It is argued that, in becoming an institutional fact, a typification goes through two phases. First, it becomes a social habit. Second, this habit turns into an obligation by being objectified.     

鲁迅疾病叙事与中国现代生命伦理的发生

鲁迅文学中的疾病叙事不仅体现着鲁迅的医学背景、人格影响,而且灌注着鲁迅自己对生命的伦理观念。这些观念主要有三个方面的内容:一是主张安乐死,能医的就医,不能医的就帮助他死得没有痛苦;二是反对酷刑与虐杀,批判国民性中对科学的精神没有兴趣,而把聪明才智都挥洒在这种给被害人带来无穷而难忍的痛苦的虐杀与酷刑上;三是尊重残疾者但反对滥施同情,体现出肉体之小与精神之大的辩证认知。鲁迅的这种生命伦理观念既是鲁迅自身疾病纠缠的生命体验的升华,也是科学精神与生命哲学互织的结晶。鲁迅在其一生中对生命伦理现代化的思考与践行,体现出的正是他对《新青年》催生最后觉悟之觉悟即伦理觉悟的启蒙方略的主动呼应。     

The Standing Committees and the Ministries

The 23rd Congress of the CPSU posed the task of enhancing the role of the supreme Soviets and defined the principal directions to be followed in solving this task. The most important of them are the further improvement in the activity of the standing committees [postoiannye komissii], which contribute to the development of socialist democracy, the improvement in the work of the supreme Soviets and the agencies of state administration, and the activization of deputies. At the first session of the seventh Supreme Soviet [sed'mogo sozyva] of the USSR, the report by N. V. Podgorny, Chairman of the Presidium of the USSR Supreme Soviet, "On Organizing the Standing Committees of the Soviet of the Union and the Soviet of Nationalities," emphasized the major role of the standing committees in social and economic development and expressed confidence that their functioning would promote the fulfillment of the tasks facing the country. (1) The seventh supreme Soviets of the USSR and of the union republics carried out a number of practical measures to implement the instructions of the party to increase the role of the standing committees.     

The Standing Committees: Techniques of Monitoring

Note from the editors of Sovety deputatov trudiashchikhsia: Continuing the study of the functioning of Soviets, personnel of the USSR Academy of Sciences' Institute of State and Law looked into the operations of local organs of power in the Latvian SSR. Jointly with practical workers in the field, they prepared a number of scholarly recommendations, including proposals to improve the techniques of monitoring [kontrol'] by the standing committees of district and city Soviets.