Fiester Autumn
Department of Medical Ethics, University of Pennsylvania, USA.
Am J Bioeth. 2004 Winter;4(1):W12-6. doi: 10.1162/152651604773067505.
Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs.
医疗事故保险费率在美国医疗领域引发了一场危机。费率不断上涨，而报销费用却未能跟上步伐。作为回应，受这场危机冲击最严重的州的医生感到不得不采取政治行动，而目前首选的行动似乎是医生罢工。虽然医疗事故保险危机被认为很严重，但这是否能为医生罢工这种极端行动正名呢？医生应该采取这种集体行动吗？当采取这种行动时，对患者和医疗行业又会有哪些代价呢？我将提出三个相关论点来反对医生罢工，这些论点构成了对这种行动的初步禁止：其一，罢工旨在对患者造成伤害；其二，罢工是对医患关系的一种冒犯；其三，罢工有可能降低公众对医疗行业的尊重。与任何初步义务一样，存在一些可能推翻道德禁令的正当条件，但我将论证，当前的医疗事故危机并未达到这样的正当条件的程度。虽然医疗事故危机要求并证明美国医生采取政治回应是合理的，但罢工和怠工并非控制保险成本这一合理目标的道德正当手段。
