Tamin Jacques
Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK.
Med Health Care Philos. 2013 Aug;16(3):499-506. doi: 10.1007/s11019-012-9426-4.
In the United Kingdom (UK), ethical guidance for doctors assumes a therapeutic setting and a normal doctor-patient relationship. However, doctors with dual obligations may not always operate on the basis of these assumptions in all aspects of their role. In this paper, the situation of UK occupational physicians is described, and a set of models to characterise their different practices is proposed. The interaction between doctor and worker in each of these models is compared with the normal doctor-patient relationship, focusing on the different levels of trust required, the possible power imbalance and the fiduciary obligations that apply. This approach highlights discrepancies between what the UK General Medical Council guidance requires and what is required of a doctor in certain roles or functions. It is suggested that using this modelling approach could also help in clarifying the sources of moral conflict for other doctors with "dual obligations" in their various roles.
在英国，针对医生的伦理指导假定存在一种治疗环境和正常的医患关系。然而，身负双重义务的医生在履行职责的各个方面未必总能基于这些假设开展工作。本文描述了英国职业医师的情况，并提出了一系列用以刻画其不同执业方式的模型。将这些模型中医生与工人之间的互动与正常的医患关系进行比较，重点关注所需的不同信任程度、可能存在的权力失衡以及适用的信托义务。这种方法凸显了英国医学总会的指导要求与医生在某些角色或职能中所需承担的责任之间的差异。有人认为，运用这种建模方法也有助于厘清其他身负“双重义务”的医生在其不同角色中道德冲突的根源。
