Research status and inspiration on decision-making dilemmas on family members of intensive care unit patients / 中国医学伦理学

Due to the particularity of the Intensive Care Unit(ICU)environment,the visiting time of family members is strictly limited,resulting in family members being unable to communicate with patients in time to understand their wishes and preferences.Moreover,the sudden onset of the diseases and clinical uncertainty can easily lead to ambivalence among family members in decision-making,leading to decision-making dilemmas.This paper reviewed the concepts,assessment tools,causes,effects,and coping strategies of decision-making dilemmas for family members of ICU patients,with a view to providing a theoretical basis for future intervention in decision-making dilemmas for family members of ICU patients,improving their quality of agency decision-making,shortening patient hospitalization time,improving the health outcomes of patients,and ultimately increasing the satisfaction of medical and nursing.

Research progress on moral resilience of medical staff / 中国医学伦理学

To review the concept development,characteristics,measurement tools,influencing factors,effects,and cultivation of moral resilience among medical staff at home and abroad.The characteristics of moral resilience of medical staff include personal integrity,adaptability,self-regulation,self-management,and moral efficacy of medical personnel,as well as the relational integrity of the medical team.The influencing factors of medical staff's moral resilience include the support system of the medical team,personal qualities of medical staff,and their understanding of events.Moral resilience can promote the physical and mental health of medical staff,effectively cope with moral injury,reduce occupational fatigue and turnover intention of medical staff,as well as alleviate the moral dilemmas of medical staff.Cultivate moral resilience to enhance the ability of medical staff to resist moral dilemmas.

Exploring the mechanism of moral injury from the perspective of personality development theory / 中国医学伦理学

Personality development theory starts from the physiological needs of individuals,proposes the"two-part personality structure"with"subconscious"and"consciousness"as the subject,and then deduces the"three-part personality structure"with"id,ego,and superego"as the subject.Based on this framework,an instinctive personality dynamics schema was constructed to explore the causes of self-imbalance.Taking these as a foothold,the paper deduced the formation of moral injury from the personality dynamic schema,found the moral anxiety from the self-contradiction of ego,id,and superego,as well as deduced the representation form of moral injury based on Freud's"anxiety".Furthermore,the differences in individual personality development are introduced into the study of moral injury to distinguish between anxiety and guilt in the symptoms of moral injury,in order to better understand moral trauma.

Moral resilience cultivation strategies from the perspective of traditional culture / 中国医学伦理学

Moral resilience is the ability to positively respond to moral dilemmas,consisting of firm beliefs,tenacious willpower,harmonious relationships,and a peaceful mind.The Chinese nation is a resilient nation,its excellent traditional Chinese culture is vast and profound,containing extremely rich ideas about moral resilience.For example,"being erudite and determined,eager to ask and thinking closely,and benevolence lies in it"and"if one aspires to pursue benevolence,they will not do evil things".The ancients believed that human resilience could correct moral motives and enable people to overcome difficulties and forge ahead in adversity.The intellectual wisdom of the ancients can provide advice and consultation for cultivating moral resilience today.Therefore,need drawing on traditional culture to strengthen moral resilience.

Progress and prospects of moral injury research in China:a qualitative research based on NVivo12 / 中国医学伦理学

Objective:Papers related to moral injury on platforms such as CNKI,Wanfang,and VIP were retrieved and analyzed to understand the current status of moral injury research in China,provide a reference for future related content research,as well as lay the foundation for subsequent in-depth research on moral injury.Methods:Quantitative and qualitative analyses were conducted on literature related to moral injury from 2012 to 2023.Using the NVivo12 analysis tool,based on the content analysis method,the current status of research on moral injury in China was reviewed from the three dimensions of moral trauma,including research topics,research objects,and research perspectives.Results:The research themes of moral injury in China were mainly summarized in five aspects:concept,mechanism,measurement and assessment,symptoms and manifestations,as well as prevention and treatment.The research subjects were mainly high-risk occupational groups such as war-related personnel,medical staff,and teachers.The research was mainly conducted from the perspectives of ethics,medicine,cultural studies,and psychology.Conclusion:In the future,research on moral injury in China needs to deepen its theoretical system and promote empirical research.Expand research horizons,as well as enrich the research in the field of interdisciplinary and cross-disciplinary.Raise the level of attention,and pay attention to the physical and mental well-being of special employment groups.

Influence of nursing students empathy on moral courage： the path of moral sensitivity / 四川精神卫生

BackgroundNurses' moral courage is a special type of altruistic behavior， which is considered to be a key factor to improve patient safety. Empathy level can positively predict altruistic behavior， and moral sensitivity exerts an obvious mediation role in the positive prediction. At present， there is no relevant research to explore the path role of moral sensitivity in the relationship between empathy and moral courage. ObjectiveTo verify the mediation role of moral sensitivity in the relationship between empathy and moral courage among nursing students， so as to provide references for increasing the moral courage among nursing students. MethodsFrom June 1 to June 30， 2022， a total of 602 nursing students were recruited via convenience sampling from a tertiary grade A hospital in Mianyang， and participants were assessed using Interpersonal Reactivity Index-Chinese （IRI-C）， Moral Sensitivity Questionnaire-Revised Chinese Version （MSQ-R-CV） and Nurses' Moral Courage Scale （NMCS）. Pearson correlation analysis was used to assess the correlation among above scales. The Process macro plug-in for SPSS was used to test the mediation effect of moral sensitivity on the relationship between empathy and moral courage. ResultsA total of 602 valid questionnaires were collected， with an effective recovery rate of 96.78%. IRI-C score of nursing students was positively correlated with MSQ-R-CV score and NMCS score （r=0.269， 0.146， P<0.01）. MSQ-R-CV score was positively correlated with NMCS score （r=0.722， P<0.01）. The mediation effect model was established with IRI-C score as independent variable， MSQ-R-CV score as intermediary variable， and NMCS score as dependent variable. Analysis showed that the direct effect of empathy on moral courage among nursing students was not significant （direct effect value of -0.052， 95% CI： -0.178~0.008）， while analysis yielded a significant indirect effect of empathy on moral courage via moral sensitivity （indirect effect value of 0.189， 95% CI： 0.209~0.407）. ConclusionThe moral sensitivity of nursing students plays a significant mediation role in the relationship between empathy and moral courage. ［Funded by 2022 Higher Education Teaching Research and Reform Project of Southwest Medical University （number， JG2022239）］

Ethical Issues and Resolutions in Human-animal Chimera Research / 中国医学伦理学

Human-animal chimera technology is increasingly applied to large animals. It is highly possible to cultivate human organs in pigs for transplantation in the future. Chimeric animals contain more and more human materials and are present in their brains and reproductive systems, which may humanize them and give them a higher moral status and even dignity. It raises an important ethical question: should such chimeric animals be created? If so, how they should be treated. It is not convincing to refute the research of human-animal chimera with the arguments of destroying natural order, unnatural and moral chaos. But the non-identity view holds that scientific research makes the lives of chimeric animals more valuable and that they are not actually harmed because their only other options do not exist. The answers to these ethical questions can resolve the ethical risks arising from the research of human-animal chimera.

Reflection on the Elderly Discrimination in the Allocation of Scarce Medical Resources from the Age Restriction Phenomenon in ICU of a Certain Country / 中国医学伦理学

In March 2020, the outflow of age limited videos from ICU in Spain inspired us to rethink whether there is age discrimination in the allocation of scarce medical resources. This paper frist reflected on the problem of age discrimination caused by this phenomenon from four moral intuitions: the sacred view of life, the quality of life and values, public health ethics and Chinese culture, and then examined whether it is illegal from the legal level, finally pointed out the negative impact on the society, and put forward that taking age as the standard for the allocation of scarce medical resources is not suitable for China’s national conditions.

The Harm of Shame to Self and Its Way out from the Perspective of Bioethics / 中国医学伦理学

Psychological research results confirmed that the negative impact of shame on self often causes psychological diseases, and shame does not always related to ethical value. People with serious sense of shame will lead to negative evaluation and overall negation to themselves, and the sense of shame accompanied by great pain will cause great harm to individuals. To realize the sublimation of shame, the ethical orientation of its self cognitive schema and evaluation method must be changed, from the orientation of "transforming self and reaching perfection" to the position of "caring for self and accepting imperfect self" . To tap the positive value of shame, individuals must avoid hurting themselves and then care for themselves. "The principle of not harming life" and "do not denying people’s ethical subject status" are the bottom line of the ethical value of shame.

Research on the Moral Responsibility of Face Recognition and Medical Diagnosis / 中国医学伦理学

The application of face recognition technology is gradually expanding to the medical field. It has been initially used in the medical diagnosis of endocrine diseases and genetic syndrome. This technology is expected to be used for the screening of genetic syndrome and endocrine diseases, shortening the delay period of disease diagnosis and helping the staging of endocrine diseases. However, this technology also has some moral risks, such as the risk of personal information security disclosure, the challenge to the future of mankind and the division of moral responsibility. This paper reflected on the dilemma of moral responsibility in the application of face recognition and medical diagnosis, and explored the two basic problems of "who is the subject of moral responsibility" and "the specific division of moral responsibility of different moral subjects" in face recognition and medical diagnosis. Finally, some suggestions on the moral responsibility in face recognition and medical diagnosis are put forward. The first is to determine the role of face recognition and medical diagnosis as an auxiliary category, and doctors are still the main medical subject; the second is to build the responsibility ethics mechanism and laws and regulations, the establishment of the responsibility system of face recognition and medical diagnosis is inseparable from the joint action of law and ethics.

Practical Analysis on the Integration of Traditional Chinese Medicine Culture into Ideological Education in Colleges and Universities / 中国医学伦理学

Colleges and universities are not only an important base for cultivating young talents, but also the forefront of ideological education. Strengthening ideological education in colleges and universities is related to the long-term peace and stability of the party and the country. Traditional Chinese Medicine (TCM) is a great creation of the Chinese nation and a treasure of ancient Chinese science. In the face of COVID -19, the TCM delivered in a satisfactory answer, which once again blessed the life and health of the people. TCM culture condenses the experience and wisdom of the Chinese nation for nearly one thousand years, and has unique national characteristics and spiritual pursuit. It is a great creation of Chinese culture. In the context of the new era, integrating TCM culture into ideological education in colleges and universities and giving full play to the function of TCM culture as the "key" of Chinese civilization is not only the urgent call of moral education in colleges and universities, but also the realistic development requirement of contemporary China.

Research on the Path of Optimizing the "Ideological and Creative Integration" in Traditional Chinese Medicine Universities under the Perspective of the Great Anti-epidemic Spirit / 中国医学伦理学

The great anti-epidemic spirit is the brightest spiritual symbol of the anti-epidemic struggle and the inheritance and development of the spirit of patriotism, collectivism and socialism. Under the context of normalized epidemic prevention and control, it is necessary to give full play to the leading role of the great anti-epidemic spirit and explore the new mode of innovation and entrepreneurship education of "ideological and creative integration" in Traditional Chinese Medicine(TCM) universities. Summarized the educational value of anti-epidemic spirit, boost TCM universities to realize cultural education and promote TCM cultural inheritance and innovation; analyzed the difficulties existing in the process of "ideological and creative integration" in TCM universities, and provide accurate direction for optimizing the path of "ideological and creative integration" in TCM universities. To explore the multiple paths of "ideological and creative integration" in TCM universities requires multi-party cooperation, joint management, accelerating the optimization of "ideological and creative integration", and establishing a hierarchical "ideological and creative integration" system, so as to provide new ideas for us to implement the educational goal of "establishing moral integrity in cultivation" under the background of normalized epidemic prevention and control.

Reflections on Moral Governance Path of Public Health Emergencies / 中国医学伦理学

Moral governance is an important social practice activity to improve social norms, cultivate citizens’ moral character, and cultivate citizens’ legal literacy. The changes of the social environment under public health emergencies have brought new changes and challenges to the work of moral governance. Under the background of normalization epidemic prevention and control, it is necessary to accurately understand and deeply grasp the risks of social and environmental changes caused by public health emergencies, fully combine the needs of public health emergency management, and be targeted in the content and requirements of moral governance. At the same time, it is significant to actively transform governance ideas, and improve the effectiveness of moral governance through multi-dimensional path innovation such as value and orientation, resources and methods, technology and carrier, strategies and means.

Ethical Issues in the Application of IVF from the Perspective of Females Undergoing IVF / 中国医学伦理学

Infertile women experience complex biological and social experiences in the process of receiving IVF. From the perspective of females undergoing IVF, it is helpful to analyze the ethical and social problems that IVF may face more intuitively and concretely. In this study, 213 women who were undergoing IVF were randomly selected to carry out a questionnaire survey. The results showed that the choice of IVF for infertile women was driven by multiple pressures from family and society, not entirely on their own; They are not aware of the technology, but have a positive attitude, and are eager to be fully informed in the treatment process. In addition, the treatment brings great economic pressure to women who were undergoing IVF and has no significant impact on the relationship between husband and wife. Only by paying attention to the above problems and solving them can we benefit more infertile women and help them realize their reproductive wishes.

Analysis on Collective Moral Injury / 中国医学伦理学

The previous moral injury theory implied the premise of taking individual as the research object, while there were few studies on collective moral injury. Collective moral injury is defined as a series of consequences of violating widely accepted moral beliefs rather than simply adding up symptoms of injured individuals within a group. From the America "Floyd Case", this paper analyzed the functional elements and generating mechanism of collective moral injury, that was, the diversification of trauma sources events could appear alone or interweave, collective moral resilience showed the characteristics of social integrity and time accumulation, the interaction between collective trauma sources and collective moral resilience determined whether collective moral injury occurs. As the We-Media become popular, collective feature of moral injury is more evident, which presents two new features that the Internet platform becomes a hub for trauma events and the information Internet recorded consolidates collective moral resilience. To deal with collective moral injury, it was needed to respond to social concerns and guidance moral public opinion, respect the original endogenous order and inherit the traditional culture, satisfy reasonable moral needs and enlighten moral sense of people as well.

Moral Schema Based on the Integration of the Mechanism of Moral Injury / 中国医学伦理学

Moral injury is a kind of trauma symptom caused by the impact of external immoral events on the internal moral value system of individuals or groups. Its origin lies in the deviation between individual’s internal moral schema and external moral situation. As a collection of moral consciousness units with value orientation in the regular activities of individuals in the moral environment, moral schema is composed of periphery and core. Moral schema realizes the domination of moral ego by supervising individual’s speech and behavior, exercising moderate control over individuals based on moral practice, and examining individual behavior with self-guilt as the tool of judgment. Moral schema is selective about what happened and acts as a filter for trauma events. Based on this, individuals can interpret or be subverted by moral events, thus playing a preventive role in moral injury.

Analysis of Moral Emotion from the Perspective of Moral Injury Research / 中国医学伦理学

Moral emotion is a kind of psychological activity that generated when dealing with realistic moral relationship or analyzing human behaviors, expressed as emotional emotions of love and hatred. From the perspective of moral injury research, on the one hand, moral emotion expresses as emotional collapse, which reflects the huge gap between reality and moral cognition, and deviates from values; on the other hand, it shows the typical symptoms of moral injury, such as shame, guilt, anger, apathy and so on. Based on this, the therapy of moral injury should start from solving the ethical conflict of moral injury, and carry out the healing process of "ethical and moral cognitive education, enlightening the thinking of core value issues, encouraging and guiding independent moral practice" in stages according to the different levels of individual moral emotion. As a result, moral emotion can be rational enough to promote healing moral injury.

Research Progress on Moral Injury of Foreign Medical Staff under the Background of COVID -19 Pandemic / 中国医学伦理学

This paper reviewed the research on moral injury among foreign medical staff in the background of the COVID -19 pandemic. It was found that foreign medical staff bore multiple moral pressures and impacts in the face of the epidemic, including the collision between medical practice and utilitarian policy, the inability to meet personal needs, the rapid transformation of medical mode, and a variety of comprehensive factors. Therefore, the moral injury of foreign medical staff is particularly prominent. In order to avoid and reduce the occurrence of moral injury, it is necessary to strengthen the cultivation of moral resilience, provide psychological and social support, and carry out personalized treatment for medical staff.

Moral Dilemma and Research on Coping Style of Frontline Nurses During the Outbreak of COVID -19 / 中国医学伦理学

【Objective:】 To understand the moral dilemma, coping style of frontline nurses and their correlation during the COVID -19. 【Methods:】 From March to April, 2021, 651 nurses working in designated hospitals for COVID -19 were selected by convenient sampling, and the Chinese version of Moral Distress Scale-Revised (MDS-R) and Chinese version of Coping Style Questionnaire (CSQ) were used for investigation. 【Results:】 Frontline nurses’ MDS-R score was 91.0, "value conflicts" was the moral dilemma with the highest frequency and intensity, more than half (51.0%) of the respondents had considered leaving their position because of moral dilemma. "Problem solving" and "seeking for help" were the major coping strategies adopted by the nurses. Nurses who directly provide medical services for COVID -19 patients, dissatisfied with hospital-related training and adopted negative coping strategies had higher moral dilemmas than other nurses. 【Conclusion:】 The moral dilemma of frontline nurses is at a high level during the period of epidemic prevention and control. Nursing managers should pay attention to guiding and helping nurses to establish positive coping styles and improve their ability to respond to major public health emergencies.

The Experience of Nurses’ Moral Dilemma in Intensive Care Unit: A Qualitative Study / 中国医学伦理学

【Objective:】 To understand the true experience and feelings of nurses in the intensive care unit on the clinical experience of moral dilemmas, and to provide strategies for reducing the impact of moral dilemmas. 【Methods:】 Thirteen nurses in the intensive care unit were interviewed face to face by descriptive nature research method. The traditional content analysis method were used to compute the data, and the coding, categorization and topic extraction were carried out cyclically until the data were saturated and the interview was stopped. 【Results:】 The moral dilemma experience of nurses in the intensive care unit had the following three themes: negative psychological experience, negative behavior experience, and life and death cognitive experience. 【Conclusion:】 Nurses in the intensive care unit will have complex negative experiences after experiencing moral dilemmas. This negative experience threatens nurses’ mental health. Nursing managers should pay attention to the impact of moral dilemmas on nurses and formulate effective measures, thereby ensure nursing safety and maintain the healthy development of the nursing team.