Padela Aasim I, Malik Aisha Y, Curlin Farr, De Vries Raymond
Dev World Bioeth. 2015 Aug;15(2):98-106. doi: 10.1111/dewb.12045. Epub 2014 Apr 11.
Contemporary clinical ethics was founded on principlism, and the four principles: respect for autonomy, nonmaleficence, beneficence and justice, remain dominant in medical ethics discourse and practice. These principles are held to be expansive enough to provide the basis for the ethical practice of medicine across cultures. Although principlism remains subject to critique and revision, the four-principle model continues to be taught and applied across the world. As the practice of medicine globalizes, it remains critical to examine the extent to which both the four-principle framework, and individual principles among the four, suffice patients and practitioners in different social and cultural contexts. Using the four-principle model we analyze two accounts of surrogate decision making - one from the developed and one from the developing world - in which the clinician undertakes medical decision-making with apparently little input from the patient and/or family. The purpose of this analysis is to highlight challenges in assessing ethical behaviour according to the principlist model. We next describe cultural expectations and mores that inform both patient and clinician behaviors in these scenarios in order to argue that the principle of respect for persons informed by culture-specific ideas of personhood may offer an improved ethical construct for analyzing and guiding medical practice in a globalized and plural world.
当代临床伦理学建立在原则主义基础之上，其中尊重自主、不伤害、有利和公正这四项原则在医学伦理的论述和实践中仍然占据主导地位。这些原则被认为具有足够的包容性，能够为跨文化的医学伦理实践提供基础。尽管原则主义仍然受到批评和修正，但四原则模式仍在世界各地被传授和应用。随着医学实践的全球化，审视四原则框架以及其中的各项原则在不同社会和文化背景下满足患者和从业者需求的程度仍然至关重要。我们运用四原则模式分析了两个关于代理决策的案例——一个来自发达国家，一个来自发展中国家——在这两个案例中，临床医生在几乎没有患者和/或家属参与的情况下进行医疗决策。此次分析的目的是突出依据原则主义模式评估伦理行为时所面临的挑战。接下来，我们描述了在这些场景中影响患者和临床医生行为的文化期望和习俗，以论证基于特定文化的人格观念的尊重人的原则，可能为分析和指导全球化多元世界中的医疗实践提供一个更好的伦理架构。
