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1、基于生育文化与生命伦理的ART临床管理问题研究 基于生育文化与生命伦理的ART临床管理问题研究 A Study of ART Clinical Management in the Perspectives of Fertility Culture and Bioethics【中文摘要】 由于受到生物、环境、心理等诸多因素的影响,人类的不孕症发病率逐年呈上升趋势。不孕症不仅是严重影响个体和家庭正常生育的问题,继而会对生育关涉的所有方面产生影响,比如生育技术、生育文化、生育伦理、生育法律乃至社会和谐和安定等。从汉语语境下的中国生育文化角度来看,生殖障碍问题及其技术上的解决将会在个人、家庭、宗族乃至
2、社会层面产生深远的影响。当代科学和技术特别是当代生命科学和技术的发展使得人类辅助生殖技术(ART)在生物和社会各个层面都逐渐走向成熟,这一技术进展为具有社会意义的生育问题的解决提供了新的选项,但同时在生命、社会、道德、法律等多维度提出了一系列的复杂问题。本文试图从生育文化和生命伦理的视域,同时尝试以博弈论的工具框架对ART临床管理问题在社会、伦理层面展开分析和讨论。相对于理论和宏观层面的整体探讨,这种运用相关人文要素关注微观层面的临床管理的研究,对ART的有效和合理实施同样具有重要的理论和实践价值。本文旨在中国传统生育文化的场域下,并结合若干具体案例展开生命伦理学分析,并采用博弈模型的构建的方
3、法,对ART临床管理问题开展多角度、多侧面的探讨。本文首先对ART及其临床管理问题做了概括性阐述。在ART概念界定的基础上介绍该技术的临床分类、操作原则与规程,并且对该技术在现代生命科学技术中的地位进行了系统分析。文章揭示了ART临床管理的概念、管理体系和构成要素,并通过对ART临床管理面临问题的分析,提出了一系列ART临床管理的深层问题。本文尝试引入博弈论及其经典模型作为研究的主要方法。在介绍该理论方法的基础上,深入阐明了博弈方法运用于临床人文管理的可能和意义,并对博弈方法应用于ART的临床人文管理研究的价值进行了较为深入的探讨。本文还试图建构博弈模型运用于ART临床的人文管理研究,该方面的
4、研究方式是,根据论题的逻辑顺序,分别着眼于ART市场中的医疗行为和患者需求,建立ART人文管理博弈模型、生育问题与不育问题的博弈模型,并进行了较为详细的分析和阐述。同时还对在就医过程中发生的由医疗市场中的信息不对称所导致的患者逆向选择现象进行了研究和探讨,并对ART市场中医疗机构的道德风险问题予以关注,在阐明道德风险的概念的基础上,对ART市场中道德风险的几种主要表现形式开展了分析。文章从一般社会文化,特别是生育文化的角度对ART临床管理的探讨,是对该技术领域临床人文管理的具体尝试和实验性研究。作者认为缺少文化层面所建立的生育观念的管理是没有理论和合理观念的无原则管理。从人类生育文化的层面和视
5、角审视生殖和人类辅助生殖的问题,是建立正确的ART临床管理基本观念的基础。文章认为生育制度所具有的独特社会意义,对于完成家庭结构的建立和整个社会制度的完善都能够起到重要作用。ART给社会“绝续”问题提供了具体而有重要价值的生物和社会选项,作为自然生育的有效补充方式,对生命科学技术和社会发展都具有重要意义。本章还在一般性论述的基础上,探讨了生育文化场域对ART临床管理的规制效应问题。本文还着眼于ART的实践层面,探讨了生命伦理在ART临床管理中的渗透与作用。在对生命伦理和生殖伦理等概念廓清的基础上,文章运用案例分析的方法对医疗机构在开展ART的过程中存在的多方面问题做了详细的探讨和阐述。对个案的
6、探讨分别从逆向选择与道德风险等两种医院管理困境展开。此外,相应于由于ART导致的道德风险的三方面表现,文章还对这三种情况分别开展了案例讨论和分析,并将医疗市场存在的另一种变异类型即代孕市场等问题作为典型现象进行了较为重点的研究和分析。文章在结论部分,围绕ART所展开的宏观社会伦理情境与微观管理实践之间存在的张力与相互影响做出了总结性论述。并就该问题的深入研究本文提出了进一步的思考和设想。【英文摘要】 Recent years have witnessed a constant uprising of the incidence of infertility, under the influen
7、ces of biological, environmental, and social psychological factors. The problem of infertility not only poses threat to individual and family functions of child-bearing, but gives rise to all-dimensional impacts, namely, upon fertility technology, culture, ethics, laws, as well as harmony of society
8、. From the perspective of fertility culture in Chinese context, Reproductive Barriers pose deep and negative threats upon individuals, families, ethical clans, even up to social dimensions. In recent years the development of medical technology gradually brings the maturity of ART (Assisted Reproduct
9、ive Technology), which provides a new alternative to remove Reproductive Barriers. Furthermore, a series of complicated issues from relative dimensions should also be taken into examination. Beside the introduction of fertility culture and bio-ethics, Game Theories are adopted as well, to carry out
10、the discussion concerning the social and ethical influences of ART. In addition to a Macro-examination, the Micro-research of hospital management would contribute no less in revealing theoretical and practical values of ART. This research adopts the perspective of aculture fieldof traditional fertil
11、ity culture, combined with concrete case-studies and models of Game Theory, to conduct multi-angled and all-directional research of the clinical practice of ART.The research begins with a summarized review of ART and its relative clinical managements, followed by a concrete introduction of clinical
12、classifications, operational principles and clinical regulations of ART, as well as a systemic analysis of the significance of ART among modern bio-scientific technologies. After revealing the concept, management system and elements of ART clinical management, this article raises a series of questio
13、ns concerning ART clinical management.The article introduces the method of Game Theory, with typical models, as the main method of Micro-research. Following the introduction of the Game theory as such, the possibility and significance to combine Game Theory in the research of ART clinical management
14、 are discussed extensively.New models of Game Theory are established to cover the issues of humanity managements of ART. The method takes specific approaches according to a logical question-sequence, to establish, describe and analyze several models on ART humanity management and comparative cases o
15、f fertility and infertility, respectively reflecting the logics of hospital activities and patient demands. Furthermore, the article studies and discusses the information asymmetry within the process of medical treatment, which gives rise to adverse selection of medical agents by uninformed patients
16、. This article also emphasizes on the discussion on moral hazard of hospitals and doctors in the medical market of ART. After elaboration of the concept of moral hazard, this chapter further devotes to the discovery of several types of moral hazard.The article shifts to cultural dimension of fertility culture, to launch the study of ART clinical management in the light of social culture, which contributes a probing and operational research of the application of huma
