Narrigan Deborah
Graduate Program in Midwifery, Philadelphia University, USA.
J Midwifery Womens Health. 2004 May-Jun;49(3):243-9. doi: 10.1016/j.jmwh.2003.12.012.
When clients and health care providers differ in their understanding of what is right or wrong, an ethical dilemma may arise. Such dilemmas occur in everyday clinical practice. Health care providers have the professional responsibility to analyze these dilemmas. A clinical case study of an ethical dilemma that occurred in a cross-cultural context is examined. The language of the client and provider differed, and no interpreter service was available. Given these conditions, the provider's ethical dilemma was whether, and if so how, to give safe, satisfying care that respected the needs of a client with limited English proficiency. Measuring the morality of the provider's decisions and actions using Rawls' ethical theory of social justice finds deficits. A 10-step Bioethical Decision-Making Model by Thompson is used to demonstrate one method for analyzing the moral dimension of a clinical scenario focusing on the decisions and actions taken by a midwife. Scrutinizing ethically challenging clinical encounters will result in better understanding of the moral dimensions of practice.
当客户和医疗服务提供者对正确或错误的理解存在差异时，可能会出现伦理困境。此类困境在日常临床实践中时有发生。医疗服务提供者有专业责任分析这些困境。本文将审视一个发生在跨文化背景下的伦理困境的临床案例研究。客户和提供者使用的语言不同，且没有口译服务。在这些情况下，提供者面临的伦理困境是，是否以及如果是这样该如何，提供安全、令人满意的护理，同时尊重英语水平有限的客户的需求。运用罗尔斯的社会正义伦理理论来衡量提供者决策和行为的道德性存在缺陷。汤普森提出的一个10步生物伦理决策模型被用来展示一种分析临床情景道德维度的方法，该情景聚焦于一名助产士所采取的决策和行动。仔细审查具有伦理挑战性的临床遭遇将有助于更好地理解实践的道德维度。
