Forrow L, Arnold R M, Frader J
Department of Medicine, Beth Israel Hospital, Boston, MA.
J Med Philos. 1991 Feb;16(1):93-112. doi: 10.1093/jmp/16.1.93.
Formal training in clinical ethics must become a central part of residency curricula to prepare practitioners to manage the ethical dimensions of patient care. Residency educators must ground their teaching in an understanding of the conceptual, biomedical, and psychosocial aspects of the important ethical issues that arise in that field of practice. Four aspects of professional competence in clinical ethics provide a useful framework for curricular planning. The physician should learn to: (1) recognize ethical issues as they arise in clinical care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about these issues in ways that lead to ethically justifiable courses of action; (3) apply those practical skills needed to implement an ethically justifiably course of action; and (4) judge when the management of a clinical situation requires consultation with individuals or institutional bodies with additional expertise or authority. We argue that these practical goals can be accomplished with a relatively modest emphasis on the theoretical aspects of medical ethics.
临床伦理方面的正规培训必须成为住院医师培训课程的核心组成部分，以便让从业者做好准备，应对患者护理中的伦理问题。住院医师培训教育工作者的教学必须基于对该实践领域中出现的重要伦理问题的概念、生物医学和社会心理方面的理解。临床伦理专业能力的四个方面为课程规划提供了一个有用的框架。医生应学会：（1）在临床护理中识别出现的伦理问题，并识别隐藏的价值观和未被承认的冲突；（2）以能导致符合伦理的合理行动方案的方式，清晰且批判性地思考这些问题；（3）应用实施符合伦理的合理行动方案所需的实际技能；（4）判断在处理临床情况时何时需要与具有额外专业知识或权威的个人或机构进行咨询。我们认为，通过相对适度地强调医学伦理的理论方面，这些实际目标是可以实现的。
