Frader Joel, Bosk Charles L
General Academic Pediatrics, Children's Memorial Hospital, 2300 Children's Plaza #16, Chicago, IL 60614, USA.
Am J Med Genet C Semin Med Genet. 2009 Feb 15;151C(1):62-7. doi: 10.1002/ajmg.c.30200.
Conscientious objection (CO) to genetic testing raises serious questions about what it means to be a health-care professional (HCP). Most of the discussion about CO has focused on the logic of moral arguments for and against aspects of CO and has ignored the social context in which CO occurs. Invoking CO to deny services to patients violates both the professional's duty to respect the patient's autonomy and also the community standards that determine legitimate treatment options. The HCP exercising the right of CO may make it impossible for the patient to exercise constitutionally guaranteed rights to self-determination around reproduction. This creates a decision-making imbalance between the HCP and the patient that amounts to an abuse of professional power. To prevent such abuses, professionals who wish to refrain from participating have an obligation to warn prospective patients of their objections prior to establishing a professional-patient relationship or, if a relationship already exists, to arrange for alternative care expeditiously.
对基因检测的良心拒绝(CO)引发了关于成为医疗保健专业人员(HCP)意味着什么的严重问题。关于良心拒绝的大部分讨论都集中在支持和反对良心拒绝各方面的道德论证逻辑上,而忽略了良心拒所在的社会背景。援引良心拒绝来拒绝为患者提供服务,既违反了专业人员尊重患者自主权的职责,也违反了确定合法治疗选择的社区标准。行使良心拒绝权利的医疗保健专业人员可能会使患者无法行使宪法保障的围绕生殖的自决权。这在医疗保健专业人员和患者之间造成了决策失衡,相当于滥用专业权力。为防止此类滥用行为,希望避免参与的专业人员有义务在建立医患关系之前,将其异议告知潜在患者,或者,如果医患关系已经存在,则应迅速安排替代护理。