Swick Herbert M, Bryan Charles S, Longo Lawrence D
Institute of Medicine and Humanities, University of Montana and St. Patrick Hospital and Health Sciences Center, Missoula, 59802, USA.
Perspect Biol Med. 2006 Spring;49(2):263-75. doi: 10.1353/pbm.2006.0026.
The numerous challenges now facing the profession of medicine have led to an intense focus on professionalism by individual physicians and by their professional and academic organizations. In 2002, a distinguished group of leaders in internal medicine created the Physician Charter, which calls on physicians to reaffirm medical professionalism through commitment to three principles and 10 responsibilities. The Charter reflects a duty-based ethic that is chiefly concerned with physician competence. This article offers a critical analysis of the Physician Charter from the perspective of the traditional values of medicine as articulated in medical oaths and championed by leaders of past generations, exemplified by William Osler. The authors argue that medical professionalism should reflect the values of a virtue-based ethic that stresses compassion and beneficence, rather than the values of a duty-based ethic. The challenges that now confront the practice of medicine can be addressed successfully only to the extent that physicians promote virtue-ethics, act collectively in the public interest, and render service that clearly transcends their own self-interests.
医学专业如今面临的诸多挑战，使得个体医生及其专业和学术组织都高度关注职业精神。2002年，一群杰出的内科领域领导者制定了《医师宪章》，呼吁医生通过承诺三项原则和十项责任来重申医学职业精神。该宪章反映了一种主要关注医生能力的基于义务的伦理观。本文从医学誓言所阐述的、并由历代领导者（以威廉·奥斯勒为例）所倡导的医学传统价值观的角度，对《医师宪章》进行批判性分析。作者认为，医学职业精神应反映基于美德的伦理观的价值观，这种价值观强调同情和行善，而非基于义务的伦理观的价值观。只有当医生弘扬美德伦理、为了公众利益集体行动并提供明显超越自身利益的服务时，医学实践目前面临的挑战才能得到成功解决。
