北京大學和芝加哥大學醫學倫理學教育和實踐機制比較研究

Medical Ethics Education and Practice: A Comparative Study of Peking University and the University of Chicago

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

本文通過中國和美國的醫學生對同一個案例的不同看法，提出了醫學倫理學教育的本質問題，即如何實現醫學生的道德？作者根據芝加哥大學臨床倫理中心和北京大學醫學倫理學教研室工作的實際情況繪出了兩個單位的工作示意圖，基於此，作者嘗試對北京大學和芝加哥大學醫學倫理學教育和實踐械制進行比較研究。總的來說，無論是從學生入學時的年齡和學生對學醫目的的明確上，還是從醫學倫理學的教學方法上，以及學校在醫學倫理學的教育體制等方面，二者都存在很大的差別。我國的醫學倫學教學雖然已經比較普及地進行案例教學。但案例教學若想深入下去還是比較困難的，若不成功，非常容易使學生得出學習醫學倫理學之後沒有什麼長進的感覺，表面上看是因為學科本身的對案例分析沒有明確答案的原因，但本質上是教師在引導學生思考的方式、角度和啟發性存在問題，沒能真正提高學生分析和解決問題的能力。所以，本文提出了我國的醫學倫理學教育是個系統工程，需要在案例分析方法、教師的素質本身的提高、帶教老師的倫理學培訓、教師與醫生聯合進行課題申請和研究、醫院成立醫院倫理委員會和IRB兩個與倫理學有關的職能部門等方面必須加強，也開展定期的發生在醫院內的案例討論，這樣既可以使醫學倫理學教學和科研人員能通過正常渠道進入醫療實踐中，充分實現醫學倫理學的實踐性，並反映到醫學倫理學的教學中，也能在醫學生的培養、醫學生成為醫生之後的繼續教育等方面取得突破性進展。

Based on the fact that medical students at Peking University and at the University of Chicago have different moral responses to a case of medical ethics, this essay raises a question regarding the education of medical ethics: how can medical students realize their medical morality? It firstly offers a general introduction to the distinct working systems of the Center of Clinical Ethics at the University of Chicago and the Teaching and Research Office of Medical Ethics at Peking University Health Science Center. Then it compares the essential differences of the two institutions in their working systems. Generally speaking, there exist differences between the two institutions in the age of students at medical school, their objectives of choosing to study medicine; methods of medical ethics teaching, and education systems. In particular, even though case study as an important educational method is used commonly in current China, it is difficult to deepen the content and strategy of the teaching. Sometimes students think they have not learned anything from the teaching of medical ethics. Simply speaking, it is because there are no fixed, black-or-white answers to many cases used in the course. More essential reason, however, lies in the quality of medical ethics teachers themselves. They often cannot do a good job on the way of teaching and fail to lead students to think carefully. As a result, they cannot assist students to improve their ability to analyze and resolve ethical issues. The essay concludes that education of medical ethics is a systematic moral engineering. It should be paid attention not only to the effective methods of teaching (such as case analysis) and the promotion of the quality of medical ethics teachers, but also to the combination between medical ethics teachers and physicians in clinical practice, and the establishment of hospital ethics committees and IRBs. The essay recommends that Chinese medical ethics teachers, hospital managers and university administrators should appreciate the importance of medical ethics education and help medical ethics teachers and researchers go into practice through certain routine channels, strengthen the training of the humanities on the side of medical ethics teachers, and at the same time make good progress in the continuous ethical education of physicians.

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