Barilan Y M
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Med Ethics. 2009 Mar;35(3):153-8. doi: 10.1136/jme.2008.025411.
The article examines the new discourse on medical professionalism and responsibility through the prism of conflicts among moral values, especially with regard to truth-telling. The discussion is anchored in the renaissance of English-language writing on medical ethics in the 18(th) century, which paralleled the rise of humanitarianism and the advent of the word "responsibility". Following an analysis of the meanings of the value of responsibility in general and in medical practice in particular, it is argued that, similarly to the Aristotelian notion of equity, responsibility of care is a second-order value, which corrects virtues, laws and norms in exceptional circumstances. Virtues and practices of the second order, such as responsibility and deliberation, bear especially on professional doctoring, which includes a commitment to give priority to the good of the patient over one's own good. It is argued that, in situations of conflict, and particularly conflicts between personal moral identity and the good of patients, the fundamental professional commitment is to critical and rational deliberation and to the cultivation of psycho-moral flexibility. This leads indirectly to moral growth and strengthening of professional character.
本文通过道德价值观冲突的视角，尤其是关于讲真话的问题，审视了医学专业精神与责任的新论述。该讨论基于18世纪英语医学伦理学著作的复兴，这与人道主义的兴起以及“责任”一词的出现相平行。在分析了责任价值在一般情况下尤其是医学实践中的含义之后，文章认为，与亚里士多德的公平概念类似，护理责任是一种二阶价值，它在特殊情况下纠正美德、法律和规范。诸如责任和审慎等二阶美德与实践尤其适用于专业行医，其中包括致力于将患者的利益置于自身利益之上。文章认为，在冲突情况下，尤其是个人道德认同与患者利益之间的冲突中，基本的专业承诺是进行批判性和理性的思考，并培养心理道德灵活性。这间接导致道德成长和职业品格的强化。
