International and domestic medical morality system

1. International and domestic medical morality system 第一节 医学道德规范 第二节 医德基本原则 第三节 医学人道主义

2. 第一节 医学道德规范 Medical Ethics Since it was founded in 1947, a central objective of the WMA has been to establish and promote the highest possible standards of ethical behavior and care by physicians. In pursuit of this goal, the WMA has adopted global policy statements on a range of ethical issues related to medical professionalism, patient care, research on human subjects and public health. WMA Council and its standing committees regularly review and update existing policies and continually develop new policy on emerging ethical issues

3. 一、医学道德规范 • （一）医学道德规范涵义 • （二）医学道德规范的类型

4. 医学道德规范涵义 • 社会制定或认可的关于医学界具有社会效用的行为应该如何的非权力规范。 • 制定主体 • 具有利害之效用 • 非权力性

5. 普遍和特殊(General & special) • 共同医学道德和特定医学道德(common & special) • 在整个人类社会和医学领域中，医学界应该遵循的医学道德规范。 • 在不同的社会和不同的医学领域中，医学界应该遵循的医学道德规范。 • 医学道德原则和医学道德规则(principle & rule) • 某一医学领域中根本的道德规范，是该领域中决定和产生其它道德规范的道德规范。 • 某一医学领域中非根本的道德规范，是该领域中被决定和被产生其它道德规范的道德规范。

6. 绝对和相对absolute & raletive • 绝对医学道德规范 • 产生、决定、支配其他一切医学道德规范的标准，是一切医学道德规范所由以推出的道德标准，即医学道德目的。 • 相对医学道德规范 • 绝对医学道德规范之外的全部医学道德规范，是在某一条件下应该遵守，而在另一条件下可以不遵守的医学道德规范。

7. 优良和恶劣good & bad • 优良医学道德规范 • 在一定的医学和社会背景下，具有客观必然性的医学道德规范。 • 恶劣医学道德规范 • 在一定的医学和社会背景下，具有主观随意性的医学道德规范。

8. 国际、内外主要医学道德规范

9. （一）我国主要的医学道德规范 • 1.《医务人员医德规范及其实施办法》中提出了七条医学道德规范 • 1988年12月15日国家卫生部颁布 • 2.医学生誓词(oath) • 国家教委高等教育司1991年106号文件附件四 • 3.卫生行业风尚 • 江泽民《在全国卫生工作会议上的讲话》1996就12月9日

10. 医学道德规范 • （1）救死扶伤，实行社会主义的人道主义，时刻为病人着想，千方百计为病人解除病痛。 • （2）尊重病人的人格与权利，对待病人，不分民族、性别、职业、地位、财产状况，都应一视同仁。 • （3）文明礼貌服务。举止端庄，语言文明，态度和蔼，同情、关心和体贴病人。 • （4）廉洁奉公。自觉遵纪守法，不以医谋私。 • （5）为病人保守医密，实行保护性医疗，不泄露病人隐私与秘密。 • （6）互学互尊，团结协作。正确处理同行间的关系。 • （7）严谨求实，奋发进去，钻研医术，精益求精。不断更新知识，提高技术水平。

11. 医学道德规范 • 针对医患 • 救死扶伤，人道待患 • 尊重病人，一视同仁 • 文明礼貌，关心体贴 • 谨言慎行，保守医密 • 针对医医 • 互学互尊，团结协作 • 针对自我 • 廉洁奉公，遵纪守法 • 严谨求实，奋发进取

12. 医学生誓词(oath) • 健康所系，性命相托。 • 当我步入神圣医学学府的时刻，谨庄严宣誓： • 我志愿献身医学，热爱祖国，忠于人民，恪守医德，尊师守纪，刻苦钻研，孜孜不倦，精益求精，全面发展。 • 我决心竭尽全力，除人类之病痛，助健康之完美，维护医术的圣洁和荣誉，救死扶伤，不辞艰辛，执着追求，为祖国的医药卫生事业的发展和人类的身心健康奋斗终生。

13. 卫生行业风尚 • 发扬救死扶伤、终于职守，爱岗敬业、满腔热情，开拓进去、精益求精，乐于奉献、文明行医的行业风尚。

14. 国际主要医学道德规范 • 1.Delcaration of Geneva • 2.International Code of Medical Ethics • 3. Medical professionalism in the new millennium: a physicians' charter

15. 世界医学协会（World Medical Association, WMA） • 由各国医学协会自由加入组成的非政府间国际组织，代表全体医务工作者的机构，成立于1947年9月，目前已有100个成员，一个非政治性组织。 • 旨在确保医务人员的独立性，为医务人员的医疗行为制定最高伦理标准，各成员有一个共同的理想——对患者负责。

16. http://www.wma.net/en/10home/index.html

17. 最新成员（2013.10.14）

18. 世界医学协会的目标 • 致力于在医学教育、医学科学、医学技术和医学伦理等诸方面为人类人道主义成就最高的国际标准，为全世界的人们之健康而奋斗！ • The purpose of the WMA is to serve humanity by endeavoring to achieve the highest international standards in Medical Education, Medical Science, Medical Art and Medical Ethics, and Health Care for all people in the world.

19. Policy Resources

20. Ethics Course • Objectives • After working through this course you should be able to: • understanding the role of ethics in medicine • recognize ethical issues when they arise in your practice • deal with these issues in a systematic manner • Medical Ethics Manual

21. Contents • Chapter one • Introduces the course with a description of medical ethics and a discussion of its importance for the practice of medicine. • Chapter two • Deals with the difference between medical ethics and other ethics and with how individuals make ethical decisions.

22. Chapter three • Focuses on the patient-physician relationship, including beginning-of-life and end-of-life issues. • Chapter four • Deals with the relationships between physicians and society.

23. Chapter five is concerned with the how physicians relate to other physicians, to medical students, and to other health care providers. • Chapter six introduces the basic ethical requirements for medical research involving human subjects. • Chapter seven concludes the course with some reflections on the privileges and responsibilities of physicians and the future of medical ethics.

24. Declaration of Geneva • Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 • amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968and the 35th World Medical Assembly, Venice, Italy, October 1983and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 • editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006

25. AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION: • I SOLEMNLY PLEDGE to consecrate my life to the service of humanity; • I WILL GIVE to my teachers the respect and gratitude that is their due; • I WILL PRACTISE my profession with conscience and dignity; • THE HEALTH OF MY PATIENT will be my first consideration;

26. I WILL RESPECT the secrets that are confided in me, even after the patient has died; • I WILL MAINTAIN by all the means in my power, the honour and the noble traditions of the medical profession; • MY COLLEAGUES will be my sisters and brothers;

27. I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; • I WILL MAINTAIN the utmost respect for human life; • I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat; • I MAKE THESE PROMISES solemnly, freely and upon my honour.

28. WMA International Code of Medical Ethics • Adopted by the 3rd General Assembly of the World Medical Association, London, England, October 1949 • amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968and the 35th World Medical Assembly, Venice, Italy, October 1983and the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006

29. Duties of Physicians in General • A PHYSICIAN SHALL • always exercise his/her independent professional judgment and maintain the highest standards of professional conduct. • respect a competent patient's right to accept or refuse treatment. • not allow his/her judgment to be influenced by personal profit or unfair discrimination.

30. be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity. • deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.

31. not receive any financial benefits or other incentives solely for referring patients or prescribing specific products. • respect the rights and preferences of patients, colleagues, and other health professionals. • recognize his/her important role in educating the public but should use due caution in divulging discoveries or new techniques or treatment through non-professional channels.

32. certify only that which he/she has personally verified. • strive to use health care resources in the best way to benefit patients and their community. • seek appropriate care and attention if he/she suffers from mental or physical illness. • respect the local and national codes of ethics.

33. Duties of Physicians to Patients • always bear in mind the obligation to respect human life. • act in the patient's best interest when providing medical care. • owe his/her patients complete loyalty and all the scientific resources available to him/her. Whenever an examination or treatment is beyond the physician's capacity, he/she should consult with or refer to another physician who has the necessary ability.

34. respect a patient's right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be only removed by a breach of confidentiality. • give emergency care as a humanitarian duty unless he/she is assured that others are willing and able to give such care.

35. in situations when he/she is acting for a third party, ensure that the patient has full knowledge of that situation. • not enter into a sexual relationship with his/her current patient or into any other abusive or exploitative relationship.

36. Duties of Physicians to Colleagues • behave towards colleagues as he/she would have them behave towards him/her. • NOT undermine the patient-physician relationship of colleagues in order to attract patients. • when medically necessary, communicate with colleagues who are involved in the care of the same patient. This communication should respect patient confidentiality and be confined to necessary information.

37. 新世纪的医师职业精神——医师宣言 • 新世纪医师职业精神——医师宣言，系由美国内科学委员会、美国医师学院和欧洲内科医学联盟共同发起和倡议。首次发表于2002年《美国内科医学年刊》和《柳叶刀杂志》。 • 目前为止，包括美国、英国、法国、德国、加拿大等国在内，已有30多个国家和地区的130个国际医学组织认可和签署该宣言，并被翻译成12种语言，在30多家医学杂志发表。

38. Medical professionalism in the new millennium: a physician charter • Fundamental Principles • Principle of primacy of patient welfare. • Principle of patient autonomy. • Principle of social justice. • A Set of Professional Responsibilities • Commitment to professional competence.

39. Commitment to honesty with patients. • Commitment to patient confidentiality. • Commitment to maintaining appropriate relations with patients. • Commitment to improving quality of care. • Commitment to improving access to care.

40. Commitment to a just distribution of finite resources. • Commitment to scientific knowledge. • Commitment to maintaining trust by managing conflicts of interest. • Commitment to professional responsibilities.

41. 基本原则 • 将患者利益放在首位的原则；患者自主的原则；社会公平原则。 • 职业责任 • 提高业务能力；对患者诚实；为患者保密；和患者保持适当关系；提高医疗质量；促进享有医疗； 对有限的资源进行公平分配；对科学知识负有责任；通过解决利益冲突而维护信任；对职责负有责任。

42. 《中国医师宣言》 • 中国医师协会道德建设委员会2011年6月发布。 • 健康是人全面发展的基础。作为健康的守护者，医师应遵循病人利益至上的基本原则，弘扬人道主义的职业精神，恪守预防为主和救死扶伤的社会责任。我们深知，医学知识和技术的局限性与人类生命的有限性是我们所面临的永久难题。我们应以人为本、敬畏生命、善待病人，自觉维护医学职业的真诚、高尚与荣耀，努力担当社会赋予的增进人类健康的崇高职责。

43. 为此，我们承诺： • 1、平等仁爱。2、患者至上。3、真诚守信。4、精进审慎。5、廉洁公正。6、终生学习。 • 守护健康、促进和谐，是中国医师担负的神圣使命。我们不仅收获职业的成功，还将收获职业的幸福。我们坚信，我们的承诺将铸就医学职业的崇高与至善，确保人类的尊严与安康。

44. 第二节 医德基本原则

45. 一、医德基本原则的形成 • 39年《纪念白求恩》：毫不利己、专门利人的精神、对工作极端负责和对同志对人民极端的热忱，对技术精益求精。 • 41年，为中国医大第14期毕业生题词：“救死扶伤，实行革命人道主义”，成为全国医务工作者的座右铭。

46. 第一次全国医德学术讨论会 • 1981年6月在上海举行，会议向全国医药院校倡议开设医学伦理学课程； • 确立“救死扶伤，防病治病，实行社会主义人道主义，全心全意为人民服务”的医德基本原则。 • 关于“救死扶伤” 是否仍然需要? • 关于“医学人道主义” 是否存在? • 关于“为人民健康服务”

47. 医德基本原则 • 救死扶伤、防病治病，实行社会主义医学人道主义，全心全意为人民健康服务。 • 1．医德价值目标 • 2．医德手段 • 3．医德要求

48. 医德价值目标 • 医务人员实施医德手段所要达到的有益结果，规定着医务人员的服务方向和服务宗旨，即为什么人服务？服务什么？ • “为人民健康服务” • 对“人民”的正确理解 • 对“健康”的正确理解 • 对“为人民健康服务”的正确理解

49. 医德手段 • 医务人员为实现医德价值目标所采取的方式和方法。 • “救死扶伤” • “防病治病” • 必须掌握医学专业知识和临床技能，必须学会与患者进行有效地沟通。

50. 医德要求 • 确定社会主义根本性的医德要求。 • 确定的基本的道德要求 • “实行社会主义医学人道主义” • 最高的道德要求： • “全心全意”