The evolution of informed consent

Informed consent and the changes in what is expected over the 21st century provide an instructive case study of the mutual influence on one another of medical law and medical ethics. Over the years we have moved from a doctor-centred standard to a patient-centred standard and from a one-size-fits-all patient-centred standard to a more individual requirement that engages with the needs of a particular patient It is unreasonable to expect those changes to be reflected in anything less than an extended conversation in which the health care professional gives out some version of what a reasonable patient would expect to hear from an informed health care professional and then responds to the patient's questions as informatively and helpfully as he or she can. It is therefore convenient to refer to spontaneous and responsive disclosure as a very concrete implementation of the health care professional-patient partnership that is contemporary health care and at the heart of health care ethics.     

Would responsible medical lawyers lose their patients?

This essay presents an analytic approach to understanding patients' responsibilities. Prompted by arguments in Margaret Brazier's article 'Do No Harm--Do Patients Have Responsibilities Too?', the paper demonstrates how medical lawyers can attempt to answer the questions Brazier raises, particularly regarding the translation of ethical responsibilities into legal ones. It suggests that the expansive nature of medical law as a discipline renders increasingly unhelpful the paradigm 'autonomous patients' found in a narrowly understood medical ethics. The great variety of contexts in which analysis takes place--some more, and some less 'medical'--implies a need in each case to presume that there might be radical variation in the responsibilities (legal and ethical) of different patients. It is therefore argued that instead of a one-size-fits-all paradigm of 'patients', always possessive of the same rights and freedoms, medical lawyers must be prepared to conduct analysis around more particular, nuanced concepts of the patient, and ultimately in a frame of legal and political rather than moral theory.     

论改革开放以来中国社会价值观的变迁

改革开放以来,中国社会价值观的变迁是一种价值观范型的转换,即从以伦理道德及其理想人格为中心的价值观,向以人为本的价值观的转换。这一价值观范型的转换在总体上是一种历史的进步,但也存在着一些亟待解决的问题。加强和改进社会价值观的建设,促进以人为本的价值观的合理建构并使之成为真正具有权威性、范导力的社会主流价值观,是当代中国文化建设的重大课题。     

Emergency suicide care in France: the psychiatrist's liability as seen in case law

In France, in general emergency departments, psychiatric consultations are on the increase and suicidal behavior represents a frequent reason for consultation. Psychiatrists treat patients whose behavior may be impulsive and irrational, and whose critical judgment is impaired. In emergency units, the reception and initial assessment of the patient determines his or her future pathway through the healthcare system. By its very nature, emergency medicine deals with inherently unstable situations, which may lead to the risk of medical malpractice. The aim of this article is to provide a summary of the initial management of suicidal patients by general emergency units and to comment on the medical malpractice that may expose the practitioner to risk of liability. An analysis of case history has shown that in suicide cases, malpractice due to inadequate supervision is the most frequent ruling.     

公务员角色定位的困境分析及对策思考

对公务员角色的定位历来是公共行政学探讨的重要问题。传统的行政学及其继承者——新公共行政和新公共服务把公务员定位为"公共人";公共选择学派则将公务员定位为"经济人"。但各种研究范式的分离与竞争始终没有摆脱以技术理性为基础的"人性假设"和实证研究范式的限制。公务员角色在现实中发生错位,其背后所反映的是管理主义运动兴起过程中公共行政陷入的身份危机。社会建构主义重视社会群体互动和协商的结果,把公务员作为一个群体来看待,而不是将其作为抽象的个体加以定位。因此,通过自由式民主和协商民主的手段,形成一种自我认同、相互信任的组织文化,或许是走出公务员角色定位困境的新路径。     

Good and Evil in Indian Buddhism: The five Sins of Immediate Retribution

Indian Buddhist sources speak of five sins of immediate retribution: murder of mother, father, an arhat, drawing the blood of a buddha, and creating a schism in the monastic community. This category provides the paradigm for sinfulness in Buddhism. Yet even these sins can and will, be expiated in the long run, demonstrating the overwhelmingly positive nature of Buddhist ethics     

A note on the non-maximality of the optimal fines when the apprehension probability depends on the offense rate

This paper reconsiders the problem of optimal law enforcement when the apprehension probability depends on the offense rate as well as policing expenditures. A natural consequence of such an apprehension probability is the possible multiplicity of the equilibrium due to strategic complementarity, and the actual offense rate is realized by the self-fulfilling nature of the offense rate. If people believe that lowering the fine will lead to a lower offense rate, each individual will be less inclined to commit an illegal activity due to their expectation of a higher apprehension probability. Thus, the maximal fine is not socially optimal in this case.     

The need to know versus the right to know: privacy of patient medical data in an information-based society

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."(1) "Safeguards to privacy in individual health care information are imperative to preserve the health care delivery relationship and the integrity of the patient record."(2) As early as the fourth and fifth centuries B.C., Hippocrates contemplated the importance of medical information to the care and treatment of patients. His oath suggests that privacy of a patient's medical information creates the foundation upon which a patient reposes trust in his or her physician. While defining the earliest version of the physician-patient privilege, the oath does not envision the extent of modern day access to healthcare information. A patient's relationship with the modern healthcare delivery system often includes a team of physicians, nurses, and other clinical support personnel. This relationship extends beyond direct caregivers and may include healthcare administrators, payor organizations, and persons unfamiliar with a patient's identity, such as researchers and public health officials. Accessing a patient's medical information links these participants to the patient's healthcare delivery relationship. The Hippocratic Oath does not contemplate such broad access, nor does it contemplate the emerging privacy crisis resulting from the application of computer technology to medical record storage and retrieval. The combination of broad access, individual privacy rights, and computer technology requires a rethinking of measures designed to protect the realities of the modern medical information society.     

认罪认罚案件量刑建议“分类精准”模式之提倡

量刑建议权是公诉权的应有之义,对于认罪认罚案件而言,检察机关提出精准量刑建议是量刑协商的根本要求,不仅不会侵犯审判权而且有利于审判权更加合理地行使,为实现审判中心主义创造条件,具有正当性基础。精准量刑建议包括确定量刑建议和"最小化幅度"量刑建议,按照认罪认罚案件的不同类型,遵循比例原则和诉讼经济原则之间的制约与被制约关系,并根据量刑建议精准化程度与程序简化力度之间成正比、与案件重大程度成反比的关系,构建出"分类精准"模式,分为速裁程序及有期徒刑三年以下简易程序案件的确定量刑建议、有期徒刑三年以上五年以下简易程序案件的确定量刑建议为主"最小化幅度"量刑建议为辅等五种类型。检察机关分类测算精准量刑建议时,在量刑基准上应坚持责任优先主义,根据行为的不法与罪责确定责任刑,并采取"点的理论"确定起点刑和基准刑,把认罪认罚作为独立的预防刑情节予以考量。通过建立与"分类精准"相适应的量刑指南、量刑协商、量刑建议说理、量刑调整等机制,提高量刑建议精准化水准。     

警察心理咨询的定位研究

目前关于警察心理咨询的必要性、重要性研究较多,但是关于警察心理咨询应该如何定位、如何评价、如何开展等问题的研究较少。由于警察心理问题的一般性与特殊性,心理咨询应当与传统的思政工作有机结合;在警察队伍中吸收或培养专门人才从事该项工作,同时密切与当地的心理学专家合作,取得支持;警察心理咨询应当很好的完成一般心理问题、轻度心理障碍的辅导与治疗,能够诊断与判别严重心理疾病,及时将之转介,同时给予管理部门关于当事民警精神状况的适当建议,以及针对普遍或有可能普遍出现的心理问题,建议管理部门作出预防措施。常规的警察心理保健也成为心理咨询部门的延伸工作。     

检察权谦抑性的法理基础

刑事诉讼中的检察权行使,要尽可能地保持克制、妥协、宽容,这就是检察权的谦抑性.检察权的谦抑性是受刑事诉讼法学、刑法学、犯罪社会学和刑事政策学等学科理论和实践发展的深刻影响而形成的.检察权行使的谦抑性最终要由具体的检察官来体现和贯彻,因此,一方面要从立法上人手;另一方面,要通过培养心怀谦抑的检察官入手,从而使刑事法的谦抑理念与检察官内在的谦抑品性相协调.     

基于信任的自动化决策:算法解释权的原理反思与制度重构

基于个人信息的算法自动化决策越来越普遍,我国《个人信息保护法》和相关国内外法律都引入算法解释权加以应对。但由于算法具有黑箱性、不确定性与复杂性,算法解释权是否应理解为一般性权利还是限定性权利,要求系统性解释还是个案性解释、事前解释还是事后解释、人工解释还是机器解释,都存在解释争议与适用困境。在原理层面,这一争议与困境源于个人算法控制论。应以沟通信任原则重构算法解释权,将算法解释权的性质视为一种程序性权利,而非实体性权利。算法解释权制度也应进行重构,建议根据自动化决策所处的行业领域、市场化程度、个案影响、企业能力而对其内容、程度、时间和方式作不同要求。     

The Dutch experience

Euthanasia has been legally sanctioned in the Netherlands by a series of court decisions going back to the 1970s. The author discusses the cultural and historical factors that may have contributed to this development. In the past decade, studies sanctioned by the Dutch government reveal that guidelines established for the regulation of euthanasia--a voluntary, well-considered, persistent request, intolerable suffering that cannot be relieved, consultation with a colleague, and reporting of cases--are consistently violated. Of greatest concern is the number of patients who are put to death without their consent--there are more involuntary than voluntary cases. Euthanasia intended originally for the exceptional case has become an accepted way of dealing with the physical and mental distress of serious or terminal illness. In the process palliative care has become one of the casualties while hospice care lags behind that of other countries. Case examples are given.     

THE EMERGING FORENSIC ROLE FOR WORK PRODUCT REVIEW AND CASE ANALYSIS IN CHILD ACCESS AND PARENTING PLAN DISPUTES

An emerging forensic service is that of conducting a work product review of a court‐appointed child custody evaluator's evaluation and report. If the reviewer determines there are serious deficiencies in the work product, then the reviewer will provide consultation to the retaining attorney and expert testimony. The reviewer usually is in a hybrid role of consulting/advising the retaining attorney, testifying, and educating the court. Ethical issues in providing forensic services and rebuttal testimony as a reviewer are discussed. Both reviewers and evaluators have a duty to be objective and balanced in their analyses of data and issues. Both types of experts should strive to be helpful to the court and try to serve the best interests of children. Ethical nuances involving review work are discussed. Evaluator and reviewer share the same dataset. Evaluators need to take care to keep a high quality case record with legible interview notes. Reviewers provide a monitoring function for the court or a function of forensic quality control so the court will not be misled by expert testimony of evaluators that is based on flawed data collection and/or analysis. A list of questions is presented for reviewers to use in scrutinizing the quality of the custody evaluation. A list of questions is presented for examining the quality of the reviewer's own work product. The importance of a case analysis and use of conceptual frameworks by evaluators and reviewers is discussed.     

Connecting consumer choice to the healthcare system

American healthcare needs to be reformed into competing, efficient, comprehensive care systems. To get there from here, we need a health insurance market in which each person or household has a wide, responsible, informed, individual multiple choice of health care financing and delivery plans. The point of this is competing delivery systems, not just competing carriers. To compete, some carriers will create or contract with selective delivery systems or doctors selected for their quality and cost-effectiveness. Others will already be teamed up with large multispecialty group practices. On the other hand, high deductible plans will not help us get to a reformed delivery system.     

美国性骚扰法律制度及其借鉴意义

性骚扰是不受欢迎的带有性色彩的言行,是一种非法的性歧视。依美国判例,性骚扰不必源于性的目的,其内容不必是直接的表示;同时,性骚扰行为者在主观上应当是有过错的,受害者在主观上须为不欢迎骚扰行为。构成可诉的性骚扰行为其损害后果须达到严重的程度。依美国最新判例,同性之间也可以构成性骚扰;雇主对员工中的上级职员的性骚扰行为承担民事责任。美国的性骚扰法律制度对我国的立法具有一定的借鉴意义,如公法上的规定并不排除私法的适用,性骚扰的含义应当包含性别歧视,雇主责任应当在立法上得以确立,立法者应当在道德规范和法律规范中寻找平衡点。     

The Ethical Triage Dilemma: Who Should Receive Medical Care First; Is This the Right Question?

In 2020, with the outbreak of the COVID-19 pandemic, academics and scientists began to question the triage criteria for allocating insufficient healthcare resources, trying to ethically justify the answer to the question, Who should receive medical care first? In this article, I will argue that even if we apply triage criteria, we won't be able to avoid the violation of human dignity or of the right to life and to health care. I will then suggest that, maybe, the real ethical triage dilemma lies not in the question, Who should receive medical care first? but in the question, How are we to decide who should receive medical care first?     

文化分裂及对当代认知研究范型的反思

人文文化与科学文化从一开始就在不断地融合与分裂中此长彼落 ,且都对认知心理学研究产生了影响 ,科学主义带给认知心理学以繁荣又使之走向困境、人文主义的批判有其合理性又失之偏颇。两种文化的认同比对立更具建设性。认知研究应在三个层面上展开 ,即哲学的考察、结构与过程的考察、生态学的考察。未来一个时期认知心理学中的信息加工研究范型仍以主流形式存在 ,但生态学范型会越来越占据重要地位 ,该领域研究可能出现一种现象学的回归。     

Teaching police ethics: analysis of an increasingly complex teaching context

ABSTRACT

The importance of ethics in policing and, therefore, in police education and training, is widely acknowledged. Nonetheless, disagreement often exists about the ways in which police ethics subjects should be taught and who should teach them. In this paper, three areas of debate will be critiqued, with the aim of arriving at principled responses to the underlying issues. The first issue will be whether police ethics subjects should include any ethical theory and, if so, to what extent. Related to this, but also a distinct issue in itself, is the question of whether standalone police ethics subjects should be valued over dispersing ethics learning throughout a police curriculum (e.g. as a ‘golden thread‘ running through every subject). Finally, the question of who should teach police ethics subjects will be considered. Here, the issues largely revolve around the relevant significance of philosophical expertise, knowledge and critical analysis as compared to policing expertise. Importantly, the principled responses developed in the paper will not only be theoretically sound. They will also take account of the real-world conditions in which many police ethics subjects are delivered, particularly situations where agreements in place require police ethics subjects to be taught by both police officers and academics.     

Teaching medical ethics and law

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.