【作者】 彭红；

【导师】 李永国；

【作者基本信息】 中南大学 ， 生命伦理学， 2008， 博士

【摘要】 在人类发展的历史过程中,疾病和死亡时刻威胁着人类的生命与健康,有部分人逐渐从一般的社会生产中分离出来,利用自己所掌握的医疗技术和所拥有的医疗手段专门从事医疗活动,形成了特定的医学职业,并逐渐形成了医、患交往的医患关系。自从有医学活动,人们就没有停止过对医患关系的思考,而且对医患关系的研究是生命伦理学的核心问题之一。医患关系从最初的意义讲是一种人伦关系,随着社会经济发展,医患之间的关系发生了变化,医患关系从单一向综合,从单元素向多元素,从低层次向高层次发展。随着现代科学技术与医学科学技术的发展,现代医患关系出现了物化、多元化、复杂化和博弈性趋势,改变传统医患关系以义务论为基础的线性的伦理道德关系;也不是近代医患关系以功利论为核心的法律关系,笔者认为当代医患关系是建立在道德、法律、经济基础之上的带有博弈特征的信托关系。博弈实质上是关系的冲突与均衡,进入二十世纪七十年代以来,全球范围内医患冲突不断发生,医患关系紧张,医患冲突成为当代社会的重大问题。目前,我国医患之间的冲突,实质上是社会群体在经济状况、文化价值、心理状态、道德水平、法律法规等多方面的矛盾与冲突,是现实社会问题在医疗卫生领域的反映,不是某一主体或某一方面的原因所能涵盖的,有政策层面的制度、法律缺陷,道德、文化等社会的硬件与软件不合格、有医院管理的原因,也有医生和患者的原因等等。而医患沟通障碍是引起医患冲突最直接最广泛的原因。本课题力求理论与实践相结合,讨论当前医患关系的热点问题。由于医患关系是生命伦理学研究的中心议题和核心内容,其涉及的面非常广,笔者试图从微观层面,以一个独特视角把握医患关系的难点——医患沟通问题,并将医患沟通作为医患冲突调适的突破口。通过实际的案例分析论证,多学科多视角分析医患沟通的障碍。针对医患沟通障碍(噪音)的三大原因提出相应的对策:针对医患之间对“疾病”现象不同的认识,提出对话——在沟通中寻找理解之路,通过对话,医患之间达到“视域融合”和“效果历史”;针对信息不对称下利益冲突导致的医患信任危机,提出合作——重建医患信托关系,在病人权利的托付中实现“内在价值的信任”;针对技术至上导致医学人文精神的“迷失”,提出教育——重塑医学人文精神,在医学教育与实践活动中培养医学人文精神,制订了国内首张《医学生医患沟通行为量表》,在本校实习医生中进行医患沟通能力的测量,并开展了医学生医患沟通能力的教育实践活动。试图通过对话、合作和教育等途径找到一条调适医患冲突之路。更多还原

【Abstract】 In the course of human development, disease and death thread the people all along. Some of the members began to specialize out from the general social production stream and to make use of their skills and means for specialized medical practice. Hence, there formed the medical profession and gradually developed the relations between the doctors and patients. Ever since then people never terminate the consideration of this relation and priority it as one of the core topics in their research field of life ethics. From the initial explanation, the relation means the human relations with social ethics. As the development of society and its economy, the relations between the doctors and patients have also developed and changed from the one liner dimensional toward the comprehensive, from single factor to multi diathesis, from elementary to advance levels. As the advancements of modern sciences and technologies as well as these in medicine field, the present relations between the doctor and patient exhibit the trends of materialization, multiplicity, complication and sense of game. These change away from the traditional liner ethic and moral relations on the obligation of the relations and no longer appear as the legal relations based on the utilitarianism in the later and modern period; the present relations between the doctors and patients are trusts and credits ones that established on the basis of morality, law and economy with the feature of game.The game eventually is the conflict and equilibrium of the relations. Since the 70^th of the 20^th century, the conflicts between the doctors and patients arose ceaselessly in the areas of the globe, the tension of the doctors and patients and the conflicts have become the major social trouble of the countries. Nowadays, the conflicts between doctors and patients in China actually represent the contradictions and conflicts of social groups in economic status, cultural values, the states of mind, levels of ethics and among the laws and regulations. They are the reflection of social problems in the field of medicine, and cannot be covered by merely one body or the factors of one side. They can be the defects of the government policies and laws, can be traced toward the disqualification of the hardware and software in the moral or cultural construction of the society, and can be the results of the ill-administration of the hospitals and the causes of both the doctors and patients. While the most direct and widespread cause for these is the lack or ill communications between the doctors and patients.The present study tries its best to integrate the theoretical and practical studies; it discusses and confronts the hot issue of the relations between the doctors and patients. Because the issue of relations is the core content and topic in the study of life ethics, it covers a wide field in discipline of researching. The present dissertation will start from studying the micro angle of communications between doctors and patients, a particular view of the aporia of the relations. The communication of both sides is regard as the breakthrough for the harmonization of the conflicts. By means of case analysis and argumentation, the obstacles of communication are dissected from varies disciplines and angles of view. The respective tactics and countermeasures are provided for the three causes of the obstacle （noise） in communications: As for the different understanding of "disease" from both sides, dialogue, annotation of context can be the way of appreciation. With the dialogue, the both can reach the "integration of field of vision" and "effect in history". As for the inequality in information and thus the credit and trust crisis between patients and doctors in interests, the cooperation is proposed so as to rebuild the trust and credit relations between the both sides, to fulfill the "inner value of trust" by means of entrusting the privileges and rights of the patients on doctors. As for the "Lose" of medical humanity in the sense of technology be at top position, the study insists that the education should be emphasized. The reconstruction of medical humanity should be carried in the medical education. The medical students should be trained with medical humanity in the class and clinic practice process.更多还原