Gillon Raanan
J Med Ethics. 2015 Jan;41(1):111-6. doi: 10.1136/medethics-2014-102282.
This paper argues that the four prima facie principles-beneficence, non-maleficence, respect for autonomy and justice-afford a good and widely acceptable basis for 'doing good medical ethics'. It confronts objections that the approach is simplistic, incompatible with a virtue-based approach to medicine, that it requires respect for autonomy always to have priority when the principles clash at the expense of clinical obligations to benefit patients and global justice. It agrees that the approach does not provide universalisable methods either for resolving such moral dilemmas arising from conflict between the principles or their derivatives, or universalisable methods for resolving disagreements about the scope of these principles-long acknowledged lacunae but arguably to be found, in practice, with all other approaches to medical ethics. The value of the approach, when properly understood, is to provide a universalisable though prima facie set of moral commitments which all doctors can accept, a basic moral language and a basic moral analytic framework. These can underpin an intercultural 'moral mission statement' for the goals and practice of medicine.
本文认为，四条显见原则——行善、不伤害、尊重自主权和公正——为“践行良好的医学伦理”提供了一个良好且广泛可接受的基础。它回应了一些反对意见，这些意见认为这种方法过于简单化，与基于美德的医学方法不相容，认为当这些原则发生冲突时，它要求始终优先尊重自主权，而牺牲了使患者受益的临床义务和全球公正。它承认，这种方法既没有提供可普遍适用的方法来解决因原则之间或其衍生原则之间的冲突而产生的此类道德困境，也没有提供可普遍适用的方法来解决关于这些原则范围的分歧——这是长期公认的缺陷，但可以说在实践中，所有其他医学伦理方法也都存在这些缺陷。当正确理解时，这种方法的价值在于提供一套所有医生都能接受的、虽为显见但可普遍适用的道德承诺、一种基本的道德语言和一个基本的道德分析框架。这些可以为医学的目标和实践奠定一个跨文化的“道德使命宣言”的基础。
