Dougherty C J
Creighton University, Omaha, NE, USA.
Health Prog. 1997 Mar-Apr;78(2):20-2.
To genuinely improve U.S. healthcare, we must base it on seven moral values familiar to Americans: Preserving individual dignity. Patients have a right to information about their medical condition and a right to participate in decisions about treatment. Society should make a basic package of healthcare available to all who need it. Caring for patients' welfare. As providers are obliged to have compassion for patients' suffering, they should also put patients' interests above their own and avoid conflicts of interest. Protecting the least well-off. Many who are poor, less educated, or members of racial or ethnic minorities bear disproportionate burdens of morbidity and mortality. They should receive care that compensates for those disadvantages. Seeking the common good. Our society has a strong disposition toward excessive individualism. We need greater emphasis on public health and preventive measures, as well as more opportunities for the public to help shape the healthcare system. Containing the healthcare costs. Waste is offensive both economically and morally. We can contain costs only by grappling explicitly with the need for healthcare rationing, which should be applied according to ethical criteria. Retaining a sense of responsibility. Society can help renew a sense of responsibility b anchoring it in the concept of subsidiarity, according to which the best government is the least government necessary to perform its appropriate tasks. Establishing high standards of quality. Providers should pursue excellence as measured by improved medical outcomes, uniform use of appropriate procedures, and increased consumer satisfaction. Quality-of-life judgments can be useful in making healthcare decisions, especially for persons who are dying.
要真正改善美国的医疗保健体系,我们必须以美国人熟悉的七种道德价值观为基础:维护个人尊严。患者有权了解自己的病情,有权参与治疗决策。社会应为所有有需要的人提供基本的医疗保健服务。关心患者福祉。由于医疗服务提供者有义务同情患者的痛苦,他们也应将患者的利益置于自身利益之上,并避免利益冲突。保护最弱势群体。许多穷人、受教育程度较低者或少数种族或族裔成员承受着不成比例的发病和死亡负担。他们应获得能够弥补这些不利因素的医疗服务。追求共同利益。我们的社会强烈倾向于过度个人主义。我们需要更加重视公共卫生和预防措施,以及为公众提供更多机会来塑造医疗保健体系。控制医疗成本。浪费在经济和道德上都是令人厌恶的。我们只有通过明确应对医疗资源分配的必要性才能控制成本,而这种分配应依据道德标准进行。保持责任感。社会可以通过将责任感建立在辅助性原则的概念上来帮助恢复这种责任感,根据这一原则,最好的政府是履行其适当任务所需的最少政府。建立高质量标准。医疗服务提供者应追求卓越,这可以通过改善医疗结果、统一使用适当程序以及提高消费者满意度来衡量。生活质量判断在做出医疗保健决策时可能会很有用,尤其是对于临终患者。