Jansen Lynn A
Madeline Brill Nelson Chair in Ethics Education & Associate Director, The Center for Ethics in Health Care, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd (UHN-86) Portland, OR 97239, USA.
J Med Philos. 2013 Feb;38(1):50-63. doi: 10.1093/jmp/jhs058. Epub 2013 Jan 5.
In an era of rapidly rising health care costs, physicians and policymakers are searching for new and effective ways to contain health care spending without sacrificing the quality of services provided. These proposals are increasingly articulated in terms of an ethical duty of stewardship. The duty of stewardship in medicine, however, is not at present well understood, and it is frequently conflated with other duties. This article presents a critical analysis of the notion of stewardship, which shows that it has an important and distinctive place in medical ethics. It claims that stewardship in medicine concerns the responsible use of a society's medical resources and it discusses the extent to which medical professionals are the proper stewards of these resources. The article argues that the duty of stewardship is best understood as a duty that applies in a space between the obligations of health care providers to provide beneficent care to their patients on the one hand and the obligations of citizens to bring about and support a just health care system on the other. Seen with clear eyes, stewardship in medicine is neither a consequence of beneficent medical care nor a substitute for justice.
在医疗成本迅速攀升的时代，医生和政策制定者正在寻找新的有效方法来控制医疗支出，同时又不牺牲所提供服务的质量。这些提议越来越多地依据管理职责的道德义务来阐述。然而，目前医学中的管理职责并未得到很好的理解，并且它经常与其他职责相混淆。本文对管理概念进行了批判性分析，表明它在医学伦理学中具有重要且独特的地位。它声称医学中的管理涉及对社会医疗资源的合理使用，并讨论了医疗专业人员在何种程度上是这些资源的恰当管理者。文章认为，管理职责最好被理解为一种适用于这样一个空间的职责：一方面是医疗服务提供者对患者提供有益护理的义务，另一方面是公民建立并支持公正医疗体系的义务。清醒地看待，医学中的管理既不是有益医疗护理的结果，也不是正义的替代品。
