Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK.
J Med Ethics. 2012 Jan;38(1):13-7. doi: 10.1136/jme.2011.043653. Epub 2011 Jun 27.
The value of conscience in healthcare ethics is widely debated. While some sources present it as an unquestionably positive attribute, others question both the veracity of its decisions and the effect of conscientious objection on patient access to health care. This paper argues that the right to object conscientiously should be broadened, subject to certain previsos, as there are many benefits to healthcare practice in the development of the consciences of practitioners. While effects such as the preservation of moral integrity are widely considered to benefit practitioners, this paper draws on the work of Hannah Arendt to offer several original arguments in defence of conscience that may more directly benefit patients, namely that a pang of conscience may be useful in rapidly unfolding situations in which there is no time to reflect satisfactorily upon activities and that, given the hierarchical nature of healthcare institutions, a right to defy authority on the basis of conscience may benefit junior staff who lack the institutional power to challenge the orders of superiors.
在医疗保健伦理中，良心的价值备受争议。一些观点认为良心是一种绝对积极的属性，而另一些观点则对其决策的真实性以及出于良心拒绝的行为对患者获得医疗保健的影响提出了质疑。本文认为，出于某些预先设定，出于良心的拒绝权应得到扩大，因为在从业者的意识发展方面，医疗实践会有许多益处。虽然人们普遍认为，诸如保持道德完整性之类的效果对从业者有益，但本文借鉴了汉娜·阿伦特的著作，提出了一些原始的论点来捍卫良心，这些论点可能更直接地使患者受益，即当出现没有足够时间对活动进行满意思考的快速展开的情况时，良心的谴责可能是有用的，并且鉴于医疗机构的等级性质，基于良心而反抗权威的权利可能会使缺乏机构权力来挑战上级命令的低级职员受益。
