Tauber Alfred I
Center for Philosophy and History of Science, 745 Commonwealth Avenue, Boston University, Boston, MA 02215, USA.
Perspect Biol Med. 2008 Summer;51(3):450-63. doi: 10.1353/pbm.0.0034.
The demands and needs of an individual patient require diverse value judgments to interpret and apply clinical data. Indeed, objective assessment takes on particular meaning in the context of the social and existential status of the patient, and thereby a complex calculus of values determines therapeutic goals. I have previously formulated how this moral thread of care becomes woven into the epistemological project as a "moral epistemology." Having argued its ethical justification elsewhere, I offer another perspective here: clinical choices employ diverse values directed at an array of goals, some of which are derived from a universal clinical science and others from the particular physiological, psychological, and social needs of the patient. Integrating these diverse elements that determine clinical care requires a complex synthesis of facts and judgments from several domains. This constructivist process relies on clinical facts, as well as on personal judgments and subjective assessments in an ongoing negotiation between patient and doctor. A philosophy of medicine must account for the conceptual basis of this process by identifying and addressing the judgments that govern the complex synthesis of these various elements.
个体患者的需求和要求需要多种价值判断来解读和应用临床数据。事实上，在患者的社会和生存状况背景下，客观评估具有特殊意义，因此，一个复杂的价值演算决定了治疗目标。我之前已经阐述了这种护理的道德脉络是如何作为一种“道德认识论”融入到认识论项目中的。我在其他地方论证了其伦理依据，在此提供另一种视角：临床选择运用针对一系列目标的多种价值观，其中一些目标源自普遍的临床科学，另一些则源自患者特定的生理、心理和社会需求。整合这些决定临床护理的不同要素需要对来自多个领域的事实和判断进行复杂的综合。这个建构主义过程既依赖临床事实，也依赖患者与医生之间持续协商中的个人判断和主观评估。医学哲学必须通过识别和处理支配这些不同要素复杂综合的判断来解释这一过程的概念基础。
