Le Coz P, Kachaner J
Faculté de Médecine de Marseille (EA 3783), 27 boulevard Jean Moulin, Marseille cedex 5, France.
Arch Pediatr. 2010 Feb;17 Suppl 1:S32-8. doi: 10.1016/S0929-693X(10)70006-3.
Every medical decision-making is to do justice to the one who suffers and who considers his pain as nonsensical. This requirement falls into 3 universal ethical principles, governing the patient-doctor relationship: the autonomy of the person even if it is a young child, beneficence and non-maleficence. Adhering to these principles gives medical decision-making its ethical dimension. It implies that the doctor makes the best use of the emotions that he feels in front of his patient and/or in front of his relatives: respect for autonomy, the beneficent compassion and the fear of maleficence in diagnosis and care. If a paediatrician combines these 3 affects harmoniously, his attitude is in keeping with the requirement of justice, which is the quintessence of Ethics. However, reality is often more complex, a source of conflicting emotions and, in fine, a source of an anguish whose benefit is yet to alert on the necessity to carry on looking for the right decision-making: the emotional revision consists of a meta-analysis of the objective and subjective data of the problem. It preciously helps to establish a compromise of justice. Eventually, in order to be just, the doctor must include the concern of equity amongst the criteria of his decision-making, in other words a fair allocation of the goods and of the care services. Unfortunately, this concern is undermined by geopolitical, socio-economic and cultural factors, which vary greatly according to the environmental conditions that might mar what should be optimal ethical decisionmaking. The doctor cannot solve these problems on his own, but he has to know them in order to deal with them.
每一个医疗决策都要公正地对待患者，患者会认为自己的痛苦毫无意义。这一要求可归纳为三条普遍的伦理原则，它们规范着医患关系：即使是幼儿，也要尊重其自主性，以及行善和不伤害原则。遵循这些原则赋予了医疗决策伦理层面的意义。这意味着医生要充分利用在患者及其亲属面前所感受到的情感：尊重自主性、行善的同情心以及对诊断和治疗中伤害行为的恐惧。如果儿科医生能和谐地融合这三种情感，他的态度就符合公正的要求，而公正正是伦理学的精髓。然而，现实往往更为复杂，是冲突情感的来源，最终也是一种痛苦的来源，其益处在于提醒人们有必要继续寻找正确的决策：情感修正包括对问题的客观和主观数据进行元分析。它有助于宝贵地达成公正的妥协。最终，为了做到公正，医生必须在其决策标准中纳入公平考量，换句话说，要公平分配资源和医疗服务。不幸的是，这种考量受到地缘政治、社会经济和文化因素的影响，这些因素会因环境条件的不同而有很大差异，而这些环境条件可能会破坏本应是最佳伦理决策的结果。医生无法独自解决这些问题，但他必须了解这些问题以便应对。
