Antommaria Armand H Matheny
Divisions of Pediatric Inpatient Medicine and of Medical Ethics and Humanities, University of Utah School of Medicine, 100 N Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
Theor Med Bioeth. 2008;29(3):201-12. doi: 10.1007/s11017-008-9077-x.
The analysis of a dispute can focus on either interests, rights, or power. Commentators often frame the conflict over conscience in clinical practice as a dispute between a patient's right to legally available medical treatment and a clinician's right to refuse to provide interventions the clinician finds morally objectionable. Multiple sources of unresolvable moral disagreement make resolution in these terms unlikely. One should instead focus on the parties' interests and the different ways in which the health care delivery system can accommodate them. In the specific case of pharmacists refusing to dispense emergency contraception, alternative systems such as advanced prescription, pharmacist provision, and over-the-counter sales may better reconcile the client's interest in preventing unintended pregnancy and the pharmacist's interest in not contravening his or her conscience. Within such an analysis, the ethicist's role becomes identifying and clarifying the parties' morally relevant interests.
对一场争端的分析可以聚焦于利益、权利或权力。评论员们常常将临床实践中围绕良知的冲突,界定为患者获得合法可用医疗服务的权利与临床医生拒绝提供其认为在道德上令人反感的干预措施的权利之间的争端。多种无法解决的道德分歧来源使得按这些条件解决争端不太可能。相反,人们应该关注各方的利益以及医疗保健提供系统能够容纳这些利益的不同方式。在药剂师拒绝配发紧急避孕药这一具体案例中,诸如提前处方、药剂师提供以及非处方销售等替代系统,或许能更好地调和客户预防意外怀孕的利益与药剂师不违背其良知的利益。在这样一种分析中,伦理学家的角色就变成了识别和厘清各方在道德上相关的利益。