Ehrich Kathryn, Williams Clare, Scott Rosamund, Sandall Jane, Farsides Bobbie
King's College London, UK.
Soc Sci Med. 2006 Sep;63(5):1213-24. doi: 10.1016/j.socscimed.2006.03.005. Epub 2006 May 3.
Through the lens of the 'welfare of the child' assessment, this paper explores how staff working in the area of in vitro fertilisation and preimplantation genetic diagnosis (IVF/PGD) balance reflexive relations of legitimacy and accountability between the public and private spheres, and between medicine, the citizen and the state. The wider research of which this analysis is a part uses multiple methods to study two National Health Service Assisted Conception Units in England. Research methods used included observation clinics and interviews with staff from a range of disciplines. We illustrate how the staff reveal tensions between their views that the welfare of the child assessment can be seen as intrusive and discriminatory, and on the other hand that medical intervention in reproduction should be socially and professionally accountable. These tensions can be understood sociologically in terms of a gradual movement from socially based solutions to fertility problems and disabilities, towards a biomedical, and arguably genetically oriented worldview of such problems. Rather than being viewed as discrete, these two orientations should be seen as indicating an emergent direction of travel along a continuum, with elements of both being present in the accounts. We argue that consideration of the welfare of the child involves staff in ethical boundary-work across the two orientations and between the accountabilities and responsibilities of healthcare professionals, individuals and the state.
通过“儿童福利”评估的视角，本文探讨了在体外受精和植入前基因诊断（IVF/PGD）领域工作的人员如何平衡公共领域与私人领域之间，以及医学、公民与国家之间合法性与问责制的反思性关系。本分析作为其中一部分的更广泛研究，运用多种方法对英格兰的两个国民医疗服务体系辅助生殖单位进行了研究。所采用的研究方法包括观察诊所情况以及与来自一系列学科的工作人员进行访谈。我们阐述了工作人员如何揭示他们观点之间的紧张关系，即一方面认为儿童福利评估可能具有侵扰性和歧视性，另一方面又认为生殖医学干预在社会和专业层面应负有责任。从社会学角度来看，这些紧张关系可以理解为从基于社会的解决生育问题和残疾问题的方式，逐渐转向对此类问题的生物医学，甚至可以说是基因导向的世界观。这两种取向不应被视为相互独立，而应被看作是沿着一个连续统一体的新兴发展方向，在相关描述中两者的元素都有体现。我们认为，对儿童福利的考量使工作人员在跨越这两种取向以及医疗保健专业人员、个人和国家的问责与责任之间进行道德界限划分工作。
