Engelhardt H Tristram
Department of Philosophy, Rice University, Houston, TX, 77251-1892, USA.
HEC Forum. 2011 Sep;23(3):129-45. doi: 10.1007/s10730-011-9167-4.
The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social-historical construction (ASBH Core Competencies for Health Care Ethics Consultation, 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered.
美国生物伦理与人文学会（ASBH）发布了其《医疗保健伦理咨询核心能力》，此时愈发明显的是，世俗伦理是难以驾驭的多元性的，且在任何并非社会历史建构的现实中都没有根基（《医疗保健伦理咨询核心能力》，第2版。美国生物伦理与人文学会，伊利诺伊州格伦维尤，2011年）。《核心能力》没有认识到，医疗保健伦理咨询师的伦理并非通常意义上道德规范伦理中的伦理。其伦理是在特定司法辖区的法律以及可执行的医疗保健公共政策中确立的伦理。其规范性是一种法律规范性，因此违反这种伦理的错误性仅仅在于所涉及的法律处罚以及被施加处罚的可能性。伦理咨询的伦理是依法确立的伦理，这一事实解释了医院伦理咨询师的主要角色是充当准律师提供法律建议、协助风险管理以及进行调解的情况。这也表明了为什么这一系列角色取得了如此大的成功。本文展示了13世纪西方重生的道德哲学是如何导致现代性伦理，进而最终导致医院伦理咨询伦理的。它简要介绍了一种后道德伦理的出现历史。在此背景下，必须对《核心能力》的重要性进行批判性重新审视。
