Sabin J E
Teaching Center, Harvard Community Health Plan, Boston, MA, USA.
Behav Sci Law. 1994 Autumn;12(4):317-30. doi: 10.1002/bsl.2370120403.
Although the medical profession's codes of ethics have rightly been criticized for having claimed authority to decide questions of medical ethics for society, codes continue to provide crucial guidance to the individual clinician in matters of ethics. Examination of the code of the American Psychiatric Association (APA) shows that while it emphasizes the psychiatrist's fiduciary responsibility to individual patients, it ignores the crucial dimension of stewardship responsibilities to society. As a result, the ethical pronouncements of the APA have thus far been of little use to clinicians with regard to the major issues posed by managed care. In contrast, the code of the National Association of Social Workers considers the ethics of social institutions as well as those of individual practitioners, and advises clinicians on how to manage the inevitable and legitimate tensions between fiduciary and stewardship commitments. Until the APA extends the scope of its ethical vision, it will not be able to help clinicians struggle constructively with the question of how it is possible to "care about patients" and "care about money."
尽管医学界的道德准则因声称有权为社会决定医学伦理问题而受到合理批评，但这些准则在伦理问题上仍继续为个体临床医生提供关键指导。对美国精神病学协会（APA）准则的审视表明，虽然它强调精神科医生对个体患者的信托责任，但却忽视了对社会的管理责任这一关键维度。因此，就管理式医疗带来的主要问题而言，APA的伦理声明到目前为止对临床医生几乎没有用处。相比之下，美国社会工作者协会的准则既考虑社会机构的伦理，也考虑个体从业者的伦理，并就临床医生如何处理信托责任和管理责任之间不可避免且合理的紧张关系提供建议。除非APA扩大其伦理视野的范围，否则它将无法帮助临床医生建设性地应对如何既“关心患者”又“关心金钱”这一问题。
