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医生和分子生物学家伦理推理的实证研究——生物医学伦理四大原则的重要性

Empirical investigation of the ethical reasoning of physicians and molecular biologists - the importance of the four principles of biomedical ethics.

作者信息

Ebbesen Mette, Pedersen Birthe D

机构信息

Centre for Bioethics and Nanoethics, University of Aarhus, Aarhus C, Denmark.

出版信息

Philos Ethics Humanit Med. 2007 Oct 25;2:23. doi: 10.1186/1747-5341-2-23.

Abstract

BACKGROUND

This study presents an empirical investigation of the ethical reasoning and ethical issues at stake in the daily work of physicians and molecular biologists in Denmark. The aim of this study was to test empirically whether there is a difference in ethical considerations and principles between Danish physicians and Danish molecular biologists, and whether the bioethical principles of the American bioethicists Tom L. Beauchamp and James F. Childress are applicable to these groups.

METHOD

This study is based on 12 semi-structured interviews with three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company.

RESULTS

In this sample, the authors found that oncology physicians and molecular biologists employed in a private biopharmaceutical company have the specific principle of beneficence in mind in their daily work. Both groups are motivated to help sick patients. According to the study, molecular biologists explicitly consider nonmaleficence in relation to the environment, the researchers' own health, and animal models; and only implicitly in relation to patients or human subjects. In contrast, considerations of nonmaleficence by oncology physicians relate to patients or human subjects. Physicians and molecular biologists both consider the principle of respect for autonomy as a negative obligation in the sense that informed consent of patients should be respected. However, in contrast to molecular biologists, physicians experience the principle of respect for autonomy as a positive obligation as the physician, in dialogue with the patient, offers a medical prognosis based upon the patients wishes and ideas, mutual understanding, and respect. Finally, this study discloses utilitarian characteristics in the overall conception of justice as conceived by oncology physicians and molecular biologists from the private biopharmaceutical company. Molecular biologists employed at a public university are, in this study, concerned with allocation, however, they do not propose a specific theory of justice.

CONCLUSION

This study demonstrates that each of the four bioethical principles of the American bioethicists Tom L. Beauchamp & James F. Childress - respect for autonomy, beneficence, nonmaleficence and justice - are reflected in the daily work of physicians and molecular biologists in Denmark. Consequently, these principles are applicable in the Danish biomedical setting.

摘要

背景

本研究对丹麦医生和分子生物学家日常工作中涉及的伦理推理和伦理问题进行了实证调查。本研究的目的是通过实证检验丹麦医生和丹麦分子生物学家在伦理考量和原则上是否存在差异,以及美国生物伦理学家汤姆·L·博尚和詹姆斯·F·奇尔德雷斯的生物伦理原则是否适用于这些群体。

方法

本研究基于对三组受访者进行的12次半结构化访谈:一组是在公立医院诊所工作的肿瘤内科医生,两组是从事基础研究的分子生物学家,一组受雇于公立大学,另一组在一家私营生物制药公司。

结果

在这个样本中,作者发现肿瘤内科医生和受雇于私营生物制药公司的分子生物学家在日常工作中都牢记着“有益”这一特定原则。两组人员都有帮助患病患者的动机。根据该研究,分子生物学家明确考虑对环境、研究人员自身健康和动物模型的“不伤害”;而对患者或人类受试者的“不伤害”只是隐含考虑。相比之下,肿瘤内科医生对“不伤害”的考量则与患者或人类受试者相关。医生和分子生物学家都将尊重自主性原则视为一种消极义务,即应尊重患者的知情同意。然而,与分子生物学家不同的是,医生将尊重自主性原则视为一种积极义务,因为医生在与患者对话时,会根据患者的意愿和想法、相互理解与尊重提供医疗预后。最后,本研究揭示了肿瘤内科医生和来自私营生物制药公司的分子生物学家在正义的总体概念中所具有的功利主义特征。在本研究中,受雇于公立大学的分子生物学家关注资源分配,然而,他们并未提出具体的正义理论。

结论

本研究表明,美国生物伦理学家汤姆·L·博尚和詹姆斯·F·奇尔德雷斯的四项生物伦理原则——尊重自主性、有益、不伤害和正义——都体现在丹麦医生和分子生物学家的日常工作中。因此,这些原则适用于丹麦的生物医学环境。

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