Practice and thinking on improving the ability of hospital ethical review: Take the Affiliated Taizhou People′s Hospital of Nanjing Medical University as an example / 中华医学科研管理杂志

Objective:To explore the ways and methods to improve the ability of hospital ethical review and ensure the quality and efficiency of ethical review.Methods:By consulting the literature and combining the practical experience of the construction of the ethics committee and the ethical review work in the hospital, analyze the present situation of ethical review in our country, and deeply analyze the main problems existing in the work of ethical review in hospitals.Results:The quality and efficiency of ethical review can be effectively improved by implementing centralized management, optimizing work processes, establishing emergency response systems, opening green channels, optimizing the composition of committee members, strengthening ethical training and assessment, establishing emergency response systems, opening green channels, strengthening pre-review communication, establishing emergency response systems, opening green channels, strengthening formal review, increasing publicity, and improving ethical awareness.Conclusions:Clarifing the division of responsibilities and strengthen multi-department interaction can effectively improve the efficiency of ethics review. Optimizing the structure of ethics committee, strengthen the training and assessment of members, can effectively enhance the ability of ethics committee review. Unifing the list of documents, optimizing the work flow and the way of examination can effectively shorten the period of ethical examination. It is suggested that continuous ethical training and assessment should be carried out, that an information-based platform system should be used to achieve dynamic supervision, and that a certification system and assessment mechanism for ethics committees should be established at the national level, to promote the improvement of the ability of ethical review.

Exploration and construction of an evaluation indicator framework for clinical research benefits in China / 中国医学伦理学

ObjectiveThe aim is to construct an evaluation framework for clinical research benefits， and provide a reference for the formulate of evaluation standards for clinical research benefits. MethodsThe Delphi method was used to carry out expert consultation， and the mean， score of importance， coefficient of variation and coordination， etc. of evaluation indicators were summarized and calculated， to screen evaluation indicators for clinical research benefits. ResultsTwenty-three experts in this field were selected for correspondence， and their enthusiasm was 100% in both rounds， the authority coefficients were≥0.90， and Kendall’s coefficients of concordance were<0.25 （P<0.001）. By referring to the mean and coefficient of variation of the indicators， as well as combining them with expert suggestions， an evaluation framework for clinical research benefits was ultimately formed with 2 primary indicators， 5 secondary indicators， and 8 tertiary indicators. ConclusionThe evaluation framework for clinical research benefits constructed in this paper can comprehensively evaluate the research benefits， as well as provide a basis for reasonably determining the research risk-benefit ratio and developing quantitative evaluation tools for clinical research benefits.

Ethical conflict between reproductive rights and offspring rights of patients with genetic disease： an ethical analysis of an ectodermal dysplasia case asking for assisted reproductive technology to assist in pregnancy / 中国医学伦理学

With the continuous progress of human assisted reproductive technology （ART）， more genetic diseases have been discovered and the use of innovative technologies is intended to reduce genetic risks， and the reproductive rights of infertile couples have been protected and satisfied to a greater extent. However， in some special genetic cases， offspring rights need to be fully considered. This paper conducted an ethical analysis of an “ectodermal dysplasia” case asking for the implementation of human ART to assist in pregnancy， revealing the ethical dilemmas in the implementation of ART for patients with genetic diseases， which were caused by the contradiction between the protection of the patient’s reproductive rights and the offspring rights， as well as the contradiction between the implementation of ART and the blocking of genetic risk. According to the literature review， it is proposed that in the diagnosis， treatment， and ethical judgment process of genetic cases， informed consent should be fully fulfilled. Based on the ethical foundation of care， narrative medicine methods should be used to form doctor-patient joint decision-making， avoiding paternalism. Meanwhile， sufficient information support should be provided and the ethical supervision mechanism should be improved to effectively solve the ethical dilemmas.

Multiple modes of doctors⁃patients shared decision⁃marking from the ethical perspective / 中国医学伦理学

The shared decision marking between doctors and patients is a moral requirement，which stems from the basic rights of medical staff to accept patients or their families，such as autonomy，informed consent and choice.In order to achieve the shared decision marking between doctors and patients，medical staff and patients play different roles.The task of medical staff is to introduce professional knowledge and specific experience，provide patients with multiple recommendations for diagnosis and treatment choices，and the task of patients is to choose treatment plans recognized in the shared decision marking based on their understanding of medical and ethical knowledge such as treatment goals，health values，and basic rights.From the ethical perspective，based on the shared decision marking between doctors and patients，this study deeply analyzes its ethical significance.Centering on the basic requirements of ethics，this study explores various practical models such as the doctor-patient joint participation model，the doctor-patient-family joint participation model，the doctor-nurse-patient joint participation model，the high-risk case conversation model of medical intervention，and the multidisciplinary team collaboration model from multiple perspectives and depths，to further promote the implementation of the shared decision marking between doctors and patients and to provide some reference basis.

Ancient traditional Chinese medicine’s concept of righteousness and benefit and its contemporary value from the perspective of Mozi’s concept of righteousness and benefit / 中国医学伦理学

The purpose of medical practice and attitude towards the remuneration of the ancient traditional Chinese medicine （TCM） practitioners have a high degree of commonality with Mozi’s concept of righteousness and benefit. Under the regulation of Mozi’s “ideology of valuing righteousness and advocating benefit”， ancient TCM practitioners formed the purpose of the medical practice of benefiting patients with skills and prioritizing righteousness， as well as the attitude towards the remuneration of balancing righteousness and benefit and gaining benefits from righteousness. Learning from the past to the present， the essence of TCM’s concept of righteousness and benefit was used to cultivate the pursuit of righteousness in medical practice among medical staff through infection education. Ideological and political education courses and media promotion were used to urge medical staff to keep the bottom line of medical practice of regulating benefit with righteousness. With the help of incentive mechanisms， various paths were constructed such as salary distribution that balanced righteousness and benefit incentive mechanisms， as well as organically integrated them into contemporary medical ethics education on the concept of righteousness and benefit， with a view to establishing a view of medical concept of righteousness and benefit that is in line with the current economic and social development， and to assist in building a harmonious doctor-patient relationship， promoting the medical health development， and building a human health community.

Ethical Problems and Countermeasures in Rehabilitation Intervention for Patients with lymphedema after Breast Cancer Operation / 中国医学伦理学

In order to explore the medical and social problems related to postoperative lymphedema in breast cancer patients, improve the compliance of rehabilitation treatment and help patients return to society. The self-designed questionnaire was used to investigate 76 patients who met the criteria of lymphedema after breast cancer and refused or failed to adhere to rehabilitation threapy. According to the relevant measurement scale theory and method, the computer-aided software was used to analyze the data to find out the problem and analyze the cause. The prominent problems of poor compliance in patients with breast cancer after operation were successively: subjective factors, objective factors, family social and ethical factors, multidisciplinary factors, hospital management and policy issues. For the above ethical problems, we should adopt positive coping strategies to increase the compliance of patients and improve their quality of life.

Exploring the Integration of Wuliande’s Spirit into Medical Education in the Context of "Curriculum Civics" in the New Era / 中国医学伦理学

The construction of "Curriculum Civics" in medical schools needs to go in the same direction as "Civics Curriculum" and "Liberal Studies Education" , and explore the realization path of shaping noble souls through positive ideological and political leadership and mutual collision of hearts and minds.The integration of Wuliande’s spirit into medical education is an all-round exploration from the perspectives of value connotation, contemporary meaning and path exploration, which has important contemporary significance and application value, and is also a practical requirement for inheriting and innovating Wuliande’s spirit and constructing a "Great Thought and Politics" work system under the pattern of "Great Health" in the new era. Based on the above background, this paper explored and interpreted how to fully follow the law of talent growth and the law of education to cultivate new-age medical and health talents who are red and professional, benevolent, health guardian and public health fighter from the perspective of collaborative education of medical ethics education and ideological and political education.

The Practice Path of Integrating the Red Doctor’s Spirit into the Cultivation Environment of Humanistic Spirit in Medical Colleges / 中国医学伦理学

The integration of red doctor’s spirit into the cultivation environment construction of medical humanistic spirit is an important way to promote the cultivation of medical humanistic spirit in the new era. By excavating the educational resources of red doctor’s spirit, create the cultural environment atmosphere of educating people; integrating the spirit, culture and history of red doctor’s to enhance students’ Party spirit and concept; practicing the spiritual and cultural connotation of red medicine, carry out rich humanistic quality activities and other practical paths, and cultivate the professional spirit of medical students to remain true to our original aspiration and keep our mission firmly in mind, and strive for the development of medical and health undertakings and the people’s physical and mental health for life.

The Path Analysis of Integrating Sun Simiao’s Medical Ethics Thought into the Humanistic Spirit of Medical Students / 中国医学伦理学

Medicine is the subject of studying human and its inherent humanistic attribute endows medicine with the temperature it deserves. However, with the continuous improvement of medical testing technology and treatment technology, medical workers pay more attention to diseases and ignore humanistic care, which has become an important factor in the aggravation of patients’ burden and the tension relationship between doctors and patients. There are many virtues in Chinese traditional culture. Sun Simiao’s medical ethics thought of "great doctor with professionalism and sincerity" embodies the core value of the humanistic spirit of Chinese traditional medicine. In his medical ethics thought, the moral and ethics of "great doctor with professionalism and sincerity", the medical practice attitude of "being cautious and diligent", the values of "benevolence for the world" and the professional conduct of "honesty and truth" still have strong practical significance at present. It is the good material to cultivate the humanistic spirit of medical students. This is of great value to integrate Sun Simiao’s medical ethics thought into cultivate medical students with both "professionalism" and "sincerity", practice the original intention of medical and health undertakings, and carry forward cultural self-confidence.

Research on the Path of Integrating the Life View of "Human Life is Most Important" in Traditional Chinese Medicine into Medical Ethics Education for Medical Students / 中国医学伦理学

The life view of "human life is the most important" in Traditional Chinese Medicine (TCM) originates from the people-oriented theory of Chinese traditional culture, the benevolence thought of Confucianism, the rebirth thought of Taoism and the compassion thought of Buddhism. Taking the life view of "human life is the most important" as the starting point, it has formed medical ethics thoughts such as the social responsibility of saving the world, the medical practice purpose of treating all patients equally, the meticulous working attitude, the diligent and tireless learning attitude, and the exploration spirit of widely exploring the medical roots, which still has important educational significance. Therefore, the life view of "human life is the most important" should be integrated into the medical ethics education of medical students, and the medical ethics literacy of medical students should be improved through the following ways: strengthen the vocational ideal education of saving the dying and healing the wounded, and enhance the sense of social responsibility of medical students; consolidate the theme of life first classroom education and improve the professional identity of medical students; enrich and innovate the practice forms of protecting life, pay attention to the practicality of medical ethics education.

Medical Ethics of Ancient Traditional Chinese Medicine and Its Contemporary Value from the Perspective of Pre-Qin Confucian Benevolence / 中国医学伦理学

Ancient traditional Chinese medical ethics thought is a value system with Pre-Qin Confucian benevolence thought as the core. Under the cultivation and regulations of Pre-Qin Confucian benevolence, such as "benevolent love", "taking life as morality" and "self-denial and ritual", ancient Chinese medicine gradually formed the medical ethics ideal of "helping the world and saving people", the medical ethics goal of "life is the most important" and emotion towards patient of "considering others in one’s own place". Learn from the past, cultivate the professional emotion of "saving people and helping the world" of medical staff through example education; using recessive education to guide both doctors and patients to respect their lives, thus creating a social atmosphere of mutual respect between doctors and patients, and advocating doctor-patient communication that apply oneself to others with the help of carrier education; the essence of ancient traditional Chinese medical ethics thought is integrated into the construction of contemporary medical ethics, so as to overcome the problem of medical ethics anomie that life is technicalized and medical services are materialized in today’s medical development, make contemporary medical ethics thought meet the needs of today’s medical development, make medical development return to benevolence and promote the healthy development of medicine.

Study on the Teaching Path of Medical Ethics in Medical Colleges and Universities in Ethnic Areas by Integrating the Consciousness of the Chinese National Community / 中国医学伦理学

From an ethical point of view, the ethical characteristics of the consciousness of the Chinese national community contain an ethical starting point based on "love"; ethical path with "people first" as the core; ethical vision for the purpose of "prosperity". The consciousness of the Chinese national community greatly conforms to the teaching objectives and teaching content of medical ethics. Therefore, medical ethics teaching from the perspective of the Chinese national community should implement the fundamental task of helping students develop good morals and enhance the moral quality of "love"; take the "community of doctor-patient destiny" as the starting point of education and build the concept of "people first"; strengthen the country’s sense of responsibility of "prosperity and strength" and establish the mission of "rooting and maintaining health at the grassroots level", build a strong consciousness of the Chinese national community.

Thinking and Research on Aesthetic Education in Medical Ethics Course from the Perspective of Aesthetic Education / 中国医学伦理学

As an important carrier of cultivating people with virtue, curriculum aesthetic education combines aesthetic education with professional courses and general courses, and brings it into the whole process of professional talent cultivation. As the core course of medical humanistic education, Medical Ethics not only has natural affinity with aesthetic education, but also has the functions of emotional aesthetic education, rational aesthetic education and human aesthetic education. Through the analysis of aesthetic education points in Medical Ethics, this paper put forward the implementation path to realize the function of the curriculum aesthetic education: exert aesthetic influence on medical students with the help of aesthetic media, guide medical students’ aesthetic attitude, and then make medical students learn to feel, appreciate beauty through practice and sharing ideas, before or after class, online or offline, so as to contribute to the cultivation of high-quality medical talents with lofty aesthetic pursuit and noble-personality cultivation.

Contributions and new achievements of medical ethics to ethical governance of science and technology / 中国医学伦理学

The release of Guidelines to Strengthen the Governance over Ethics in Science and Technology marked that China's ethical governance system of science and technology has entered a new stage.The research and practice on ethics in science and technology in China are carried out along two approaches.One approach is to derive the rules of specific science and practice from the principles of general ethics.The other is to gradually form ethical governance principles and consensus for a specific type of phenomenon or problem in the process of science and technology,starting from scientific research problems and scientific and technological events and cases.Medical ethics research has also formed the tradition of medical ethics and modern bioethics in this way.In the practice of ethical governance,medical ethics is at the forefront of scientific and technological ethics,forming a"pilot area"for the research and development of scientific and technological ethics,an"explorer"for the institutionalization of ethical review,and a"demonstration area"for scientific and technological ethical governance.The release of ethical governance opinions is not the end of research on medical ethics governance,and medical ethics needs to have new achievements.Firstly,rethinking the theoretical basis and methodology of medical ethics and adhering to the guidance of Marxist theory.Secondly,a rethinking of the two research paths and how they can balance development and support each other.Thirdly,rethinking the relationship between ethics and the rule of law,and continuously improving the level of legalization of ethical governance.

A review of clinical application and ethical research on medical genetic testing / 中国医学伦理学

The ethical issue of medical genetic testing is one of the highly concerned and controversial issues in the field of life sciences.With the rapid development of genomics research,the possibility of using genetic testing for disease risk assessment in clinical events has been increased,especially in precision medical genetic testing and preventive testing.By reviewing the current status and common ethical issues of the clinical application of genetic testing,and sorting out the corresponding ethical principles,this paper proposed the ethical principles of equal respect,informed consent,privacy protection,and non-harm,aiming to help medical staff to regulate diagnosis and treatment behavior,enhance their awareness of the ethical aspects of genetic testing,as well as promote the better development of genomics research.

Exploration of deferred informed consent in clinical research / 中国医学伦理学

Informed consent is an important ethical symbol in clinical research,and researchers have the responsibility to fully inform participants of the research information before conducting clinical research.However,it is difficult to obtain complete informed consent form participants or their guardians within a narrow treatment time period in clinical research conducted in emergency situations.Currently,in addition to traditional general informed consent,there are also reality-accepted informed consent,including exemption of informed consent,broad informed consent,and deferred informed consent.By introducing the origin and development process of deferred informed consent in clinical research,this paper sorted out the current application status of deferred informed consent,proposed the prerequisites for applying deferred informed consent in emergency situations,and explored the issues that need to be noted during the application process of deferred informed consent.It is hoped to provide an ethical defense and ethical procedure for the application of deferred informed consent in clinical research in emergency situations.

The ethical review and reflection on in-utero pediatrics / 中国医学伦理学

In-utero pediatrics is a fetal general medicine for perinatal medicine redevelopment,with the main purpose of preventing and treating fetal diseases,which studies the early prevention,screening,diagnosis,and treatment of diseases from gametes,fertilized eggs,and embryos sequential to children,adolescents,adolescence,and even the entire life cycle.Medical ethics provides strong support for the normative development of this discipline.This paper summarized the formation and development of in-utero pediatrics,analyzed the vulnerability of service subjects within in-utero pediatrics,and sorted out their ethical issues in the prevention and control of birth defects,fetal intrauterine diagnosis and treatment,as well as multidisciplinary collaborative diagnosis and treatment.It was proposed that in-utero pediatrics should follow the medical principle of maternal and fetal interests first,the principle of respect,and the principle of no harm.Finally,suggestions for ethical review of clinical and research projects on in-utero pediatrics were proposed,including strengthening the advisory service role of the ethics committee in clinical practice,timely launching the guidelines of ethical review for clinical research,and enhancing the ethical awareness of medical staff.

The practice path of integrating the red doctor's culture in improving medical ethics of medical students in the new era / 中国医学伦理学

Red doctor’s culture is an important part of China’s advanced revolutionary culture that was born in the great practice of people’s health services，and a valuable resource for medical students’ medical ethics education in the new era. At present， the values of medical students are affected by multiple influences， and education of medical ethics lacks systematization and is marginalized. Red doctor’s culture enriches the connotation of socialist medical ethics construction and is an important starting point of medical ethics education，integrating into medical ethics education will help cultivate youth of China in the new era and strengthen medical humanistic education.The red doctor’s culture can be integrated into the medical ethics education of medical students in the new era from the following aspects： leverage the primary role of channels， optimize the campus cultural environment， effectively utilize practical training as carrier， strengthen ideological guidance and situational education， and establish a robust online narrative platform. In the context of “Healthy China”， medical schools should collaborate to cultivate well-rounded successors into the medical profession.

Qiu Fazu’s view of medical ethics and its value of the times / 中国医学伦理学

This paper expounds the medical ethic qualities of Qiu Fazu ‘s putting the patients’ interests above all else， including the attitude of treating patients with excellent medical skills and benevolent love， the working style of being highly responsible and careful， the never-ending academic spirit of being rigorous and realistic， the medical concept of strict enthusiasm and sincere care， and the moral quality of indifference to fame and wealth and no partiality. It is indicated that family education environment， excellent traditional Chinese culture， moral models leading are the formation logic of Qiu Fazu’s medical ethics. Qiu Fazu’s views on medical ethics are of great value to the education of medical ethics in the new era. To improve the level and effectiveness of medical ethics education， it is necessary to strengthen the excellent traditional Chinese culture education， strengthen international exchanges and cooperation， lead the advanced moral examples， and cultivate social practice ability.

Investigation and analysis of the current situation of case reporting ethical review and patient informed consent reports in comprehensive journals of clinical medicine in China / 中国医学伦理学

ObjectiveTo investigate and analyze case reporting ethical review and patient informed consent reports published in the comprehensive journals of clinical medicine in China in 2022. MethodsAccording to the data from the 2022 Edition of the Chinese Science and Technology Journal of the Citation Reports （Extended Version），the case reports published in comprehensive journals of clinical medicine in 2022 were selected as the research objects.The information on ethics and patient informed consent was extracted from the case reports that met the selection criteria，and Microsoft Excel 2021 and SPSS 21.0 were used to sort out and analyze the data. ResultsA total of 587 case reporting articles were published in the 42 included journals in 2022，of which 36 （6.13%） reported on science and technology ethics and/or informed consent.Case reports reporting on science and technology ethics and/or informed consent mostly came from the key magazine of China technology （88.89% Vs.65.88%），and the proportion of manuscripts involving science and technology ethics on the official website of the journal was relatively high （86.11% Vs.63.88%），and the difference was statistically significant （P<0.01）. ConclusionThe proportion of case reports of science and technology ethics and/or informed consent in journals of comprehensive discipline classification of clinical medicine was relatively low.Currently，most international journals are required to obtain the informed consent of patients or legal guardians before publishing case reports.Compared with this，there are still certain gaps in China，which need to be paid great attention to.