Faunce Thomas
School of Medicine, Faculty of Law, Australian National University, Australia.
Monash Bioeth Rev. 2004 Oct;23(4):41-55. doi: 10.1007/BF03351419.
Healthcare whistle blowing, despite the benefits it has brought to healthcare systems in many developed countries, remains generally regarded as a pariah activity by many of the most influential healthcare professionals and regulatory institutions. Few if any medical schools or law department health law and bioethics classes, teach whistle blowing in a formal sense. Yet without exception, public inquiries initiated by healthcare whistle blowers have validated their central allegations and demonstrated that the whistle blowers themselves were sincere in their desire to implement the fundamental virtues and principles of medical ethics, bioethics and public health law. In many jurisdictions, the law, this time remarkably in advance of professional opinion, has offered legislative protection for reasonable allegations of whistleblowers made in good faith and in the public interest concerning a substantial and imminent threat to public safety. One reason for this paradoxical position, explored here, is that healthcare whistle blowing lacks a firm virtue-based theoretical bioethical and jurisprudential foundation. The hypothesis discussed is that the lack of this bioethical and jurisprudential substrate has contributed to a situation where healthcare whistle blowing suffers in terms of institutional support due to its lack of academic legitimacy. This article commences the process of redressing this imbalance by attempting to lay the theoretical foundations for healthcare whistle blowing. As a case study, this article concludes by discussing the Personal and Professional Development course at the ANU Medical School where healthcare whistle blowing is a formal part of a virtue-based curriculum that emphasises the foundational importance of conscience. Illustrative elements of that program are discussed.
医疗行业举报行为,尽管在许多发达国家已给医疗体系带来诸多益处,但在众多最具影响力的医疗专业人士和监管机构眼中,总体上仍被视为一种遭人嫌弃的行为。几乎没有医学院或法学院的健康法与生物伦理学课程会正式讲授举报行为。然而,毫无例外,由医疗行业举报人发起的公开调查都证实了他们的核心指控,并表明举报人自身真心希望践行医学伦理、生物伦理学及公共卫生法的基本美德和原则。在许多司法管辖区,法律这次显著领先于专业意见,为举报人出于善意且符合公共利益,就对公共安全构成重大且紧迫威胁所提出的合理指控提供了立法保护。本文探讨这一矛盾立场的一个原因是,医疗行业举报行为缺乏坚实的基于美德的理论生物伦理学和法理学基础。所讨论的假设是,这种生物伦理学和法理学基础的缺失导致了一种情况,即医疗行业举报行为因缺乏学术合法性而在机构支持方面受到影响。本文试图为医疗行业举报行为奠定理论基础,从而开启纠正这种失衡状况的进程。作为一个案例研究,本文最后讨论了澳大利亚国立大学医学院的个人与职业发展课程,在该课程中,医疗行业举报行为是基于美德的课程体系的正式组成部分,该体系强调良心的基础性重要意义。文中还讨论了该课程的一些示例内容。