Kottow M H
University of Chile, Santiago, Chile.
Med Health Care Philos. 1999;2(3):225-9. doi: 10.1023/a:1009956012201.
Medical ethics could be better understood if some basic theoretical aspects of practices in health care are analysed. By discussing the underlying ethical principles that govern medical practice, the student should also become familiar with the notion that medical ethics is much more than the external application of socially accepted moral standards. Professions in general and medicine in particular have internal values that command their moral virtuosity at the same time as their technical excellence. Three examples where clinical practice can be clearly shown to require an ethical analysis are given: medical praxiology illustrates the motives, means and aims of physicians and patients; clinical decision-making as a practical syllogism that reaches prescriptive conclusions based on medical knowledge and the patient's wishes/intentions. Finally, diagnostics as an ethical bayesian approach is discussed, where the patient informedly decides the benefits and risks of further testing.
如果对医疗保健实践的一些基本理论方面进行分析，就能更好地理解医学伦理学。通过讨论指导医疗实践的潜在伦理原则，学生还应熟悉这样一种观念，即医学伦理学远不止是社会认可的道德标准的外部应用。一般职业尤其是医学，都有内在价值，这些价值在要求技术精湛的同时，也要求具备道德水准。文中给出了三个能清楚表明临床实践需要进行伦理分析的例子：医学实践学阐明了医生和患者的动机、手段和目的；临床决策作为一种实践三段论，基于医学知识和患者的意愿/意图得出规范性结论。最后讨论了作为一种伦理贝叶斯方法的诊断，即患者在充分知情的情况下决定进一步检查的益处和风险。
