Dwyer James
University of Pittsburgh, 3708 Fifth Avenue, Suite 300, Pittsburgh, PA 15213, USA.
Bioethics. 2003 Oct;17(5-6):432-46. doi: 10.1111/1467-8519.00359.
We live in a world with enormous disparities in health. The life expectancy in Japan is 80 years; in Malawi, 40 years. The under-five mortality in Norway is 4/1000; in Sierra Leone, 316/1000. The situation is actually worse than these figures suggest because average rates tend to mask inequalities within a country. Several presidents of the IAB have urged bioethicists to attend to global disparities and to broaden the scope of bioethics. For the last six years I have tried to do just that. In this paper, I report and reflect on my attempts to teach bioethics in ways that address global health and justice. I then discuss ways to address key ethical issues in global health: the problem of inequalities; the nature of the duty to assist; the importance of the duty not to harm; the difference between a cosmopolitan and a political view of justice. I also discuss how teaching about global health may help to shift the emphasis in bioethics--from sensational cases to everyday matters, from autonomy and justice, and from access to healthcare to the social determinants of health. At the end of my paper, I reflect on questions that I have not resolved: how to delineate the scope of bioethics, whether my approach over-politicises bioethics, and how to understand the responsibilities of bioethicists.
我们生活在一个健康状况存在巨大差异的世界。日本的预期寿命为80岁；而马拉维为40岁。挪威五岁以下儿童的死亡率为千分之四；在塞拉利昂则为千分之316。实际情况比这些数字所显示的更糟，因为平均比率往往掩盖了一个国家内部的不平等。国际生物伦理学会的几位会长敦促生物伦理学家关注全球差异，并扩大生物伦理学的范围。在过去六年里，我一直试图这样做。在本文中，我报告并反思了我以解决全球健康与正义问题的方式教授生物伦理学的尝试。然后，我讨论了应对全球健康中关键伦理问题的方法：不平等问题；援助义务的性质；不伤害义务的重要性；全球正义观与政治正义观之间的差异。我还讨论了关于全球健康的教学如何有助于转变生物伦理学的重点——从轰动性案例转向日常事务，从自主性和正义，以及从获得医疗保健转向健康的社会决定因素。在本文结尾，我思考了一些尚未解决的问题：如何界定生物伦理学的范围，我的方法是否使生物伦理学过度政治化，以及如何理解生物伦理学家的责任。
