Civaner Murat, Arda Berna
Uludag University School of Medicine, Department of Medical Ethics, Bursa, Turkey.
BMC Infect Dis. 2008 Mar 6;8:29. doi: 10.1186/1471-2334-8-29.
AIDS, SARS, and the recent epidemics of the avian-flu have all served to remind us the debate over the limits of the moral duty to care. It is important to first consider the question of whether or not the "duty to treat" might be subject to contextual constraints. The purpose of this study was to investigate the opinions and beliefs held by both physicians and dentists regarding the occupational risks of infectious diseases, and to analyze the argument that the notion of "presumed consent" on the part of professionals may be grounds for supporting the duty to treat.
For this cross-sectional survey, the study population was selected from among physicians and dentists in Ankara. All of the 373 participants were given a self-administered questionnaire.
In total, 79.6% of the participants said that they either had some degree of knowledge about the risks when they chose their profession or that they learned of the risks later during their education and training. Of the participants, 5.2% said that they would not have chosen this profession if they had been informed of the risks. It was found that 57% of the participants believed that there is a standard level of risk, and 52% of the participants stated that certain diseases would exceed the level of acceptable risk unless specific protective measures were implemented.
If we use the presumed consent argument to establish the duty of the HCW to provide care, we are confronted with problems ranging over the difficulty of choosing a profession autonomously, the constant level of uncertainty present in the medical profession, the near-impossibility of being able to evaluate retrospectively whether every individual was informed, and the seemingly inescapable problem that this practice would legitimize, and perhaps even foster, discrimination against patients with certain diseases. Our findings suggest that another problem can be added to the list: one-fifth of the participants in this study either lacked adequate knowledge of the occupational risks when they chose the medical profession or were not sufficiently informed of these risks during their faculty education and training. Furthermore, in terms of the moral duty to provide care, it seems that most HCWs are more concerned about the availability of protective measures than about whether they had been informed of a particular risk beforehand. For all these reasons, the presumed consent argument is not persuasive enough, and cannot be used to justify the duty to provide care. It is therefore more useful to emphasize justifications other than presumed consent when defining the duty of HCWs to provide care, such as the social contract between society and the medical profession and the fact that HCWs have a greater ability to provide medical aid.
艾滋病、非典以及近期的禽流感疫情都提醒我们关注关于护理道德责任界限的争论。首先考虑“治疗责任”是否可能受到情境限制这一问题很重要。本研究的目的是调查医生和牙医对传染病职业风险的看法和信念，并分析专业人员“推定同意”的概念可能成为支持治疗责任依据的观点。
对于这项横断面调查，研究人群从安卡拉的医生和牙医中选取。373名参与者均收到一份自填式问卷。
总计79.6%的参与者表示，他们在选择职业时对风险有一定程度的了解，或者在后续的教育和培训中了解到了这些风险。5.2%的参与者表示，如果他们事先被告知风险，就不会选择这个职业。发现57%的参与者认为存在标准风险水平，52%的参与者表示，除非采取特定的防护措施，某些疾病的风险将超过可接受水平。
如果我们用推定同意的观点来确立医护人员提供护理的责任，我们会面临一系列问题，包括自主选择职业的困难、医疗行业中持续存在的不确定性、几乎不可能回顾性地评估每个人是否得到了充分告知，以及这种做法可能会使对某些疾病患者的歧视合法化甚至助长这种歧视这一看似无法避免的问题。我们的研究结果表明，还可以在这个问题清单中增加另一个问题：本研究中五分之一的参与者在选择医学职业时要么对职业风险缺乏足够的了解，要么在学院教育和培训期间没有充分了解这些风险。此外，就提供护理的道德责任而言，似乎大多数医护人员更关心防护措施的可用性，而不是他们事先是否被告知特定风险。出于所有这些原因，推定同意的观点说服力不足，不能用来为提供护理的责任辩护。因此，在界定医护人员提供护理的责任时，强调推定同意以外的理由会更有用，比如社会与医疗行业之间的社会契约，以及医护人员有更强的能力提供医疗救助这一事实。
