Introduction and Commentary of Measurement for Moral Injury of Foreign Army / 中国医学伦理学

In recent years, foreign army researches showed that moral injury emerged in the war had gradually become a new traumatic act to the veterans. How to effectively evaluate and prevent moral injury has drawn exten-sive attention of scholars. This paper introduced and commented the measurement of the foreign army moral injury. At present, foreign measurement scales of moral injury mainly had three kinds of MIES, MIES ( improved ver-sion) , and MIQ-M. Moral injury is the new horizon of ethical research in our country, and it is of great applica-tion prospect to carry out the research on measurement of moral injury.

Moralidade e risco na interface médico-paciente na perícia médica da Previdência Social / Morality and risk in doctor-patient interface at medical expertise of Social Security

Uma dupla vulnerabilidade, doença e incapacidade para o trabalho: essa é a condição que deverá ser verificada pelos médicos peritos da Previdência Social entre os que solicitam o benefício auxílio-doença. Em uma sociedade organizada em torno da produção e consumo de bens, a ausência de rendimentos quase sempre significa o rebaixamento social e a privação. No contexto previdenciário, o ato médico ocorre sem que a conduta esteja voltada para o restabelecimento da saúde, tratamento ou prevenção do adoecimento, mas a ausência do compromisso assistencial seria suficiente para prescindirmos do exame moral dessa interface? Este artigo desenvolve o argumento de que a atividade médico-pericial de controle sobre a entrada e/ou permanência em auxílio-doença envolve um tipo específico de risco que decorre da singularidade da tarefa de controle. Nesta o compromisso com o paciente, ou pessoa em sofrimento, típico da medicina, é deslocado em decorrência da necessidade de controle do acesso ao benefício. Entre a beneficência para com o demandante e o interesse coletivo de preservar recursos pela observância estrita do regramento previdenciário, há um espaço discricionário preenchido pela atividade médica, o espaço de arriscar-se, de tensionamento e, por vezes, de disfunções. A especialização em reconhecer a incapacidade laborativa é moralmente conflitiva. A reflexão ativa e o julgamento consciencioso não eliminam o risco moral, mas tornam mais evidentes as condições de sua emergência e a necessidade de considerá-lo seriamente ao lidar com essas práticas de controle sobre a população...

Double vulnerability, disease and work disability: this condition must be verified by medical experts in the Brazilian Social Security system among those applying for sick leave benefits. In a society organized around the production and consumption of goods, lack of income often means downward social class mobility and social deprivation. In the context of Social Security, medical activity is not focused on health restoration, treatment or prevention of disease. However, would be the lack of focus on health care assistance an argument strong enough to ignore the moral exam of this patient-physician interface? Thus, this paper argues that the expert medical activity over the entry or stay on sick leave benefits involves a specific type of risk arising from the singularity of the control task. This commitment to the patient, typical of medicine, is shifted due the need to control access to benefit. Between beneficence towards the plaintiff and the collective interest of preserving resources for strict observance of pension rules, there is a discretionary space filled by medical activity, the space venture, tensioning and sometimes of malfunctions. Medical expertise in recognizing incapacity to work is morally conflictive. The active reflection and fair judgment do not eliminate the moral conflict, but the conditions of its emergence become more obvious as well as the need to consider moral conflicts seriously when dealing with these control practices over the population...

Ethical case deliberation involving the end of life decision.

ABSTRACT: End of life decisions involving the patients who are in unbearable, intense suffering are often not easy to make especially when there are moral dilemmas or conflicts. The patient, physician and care givers may have to come together to decide on a reasonable course of action. However, in arriving at a moral course of action a moral conflict may arise between all concerned parties. In resolving such a conflict there is a need to adopt a method. Here, a brief set of questions has been used as a method that can help to structure a case deliberation following a set of carefully separated steps. This paper adopts the Nijmegen method of case deliberation to analyse a case that involves a moral conflict. In addition to the method adopted the paper gives a careful consideration to the cultural underpinnings of the case. The choice of this method does not indicate that it is the best of all existing method but that the whole exercise is an attempt to point out how a moral conflict may arise in a case and how such conflict can be resolved by using a structured method.

Moral Conflicts in Current Healthcare Reform and Countermeasures / 中国医学伦理学

This essay probes into the reality,causes and solutions to the moral conflicts in the healthcare reform in current China,aiming to provide reference from an ethical perspective for correctly understanding and solving the problems in current healthcare reform.