Hastings Cent Rep. 2016 May;46(3):33-43. doi: 10.1002/hast.588.
This article takes the following two assumptions for granted: first, that gifts influence physicians and, second, that the influences gifts have on physicians may be harmful for patients. These assumptions are common in the applied ethics literature, and they prompt an obvious practical question, namely, what is the best way to mitigate the negative effects? We examine the negative effects of gift giving in depth, considering how the influence occurs, and we assert that the ethical debate surrounding gift-giving practices must be reoriented. Our main claim is that the failure of recent policies addressing gift giving can be traced to a misunderstanding of what psychological mechanisms are most likely to underpin physicians' biased behavior as a result of interaction with the medical industry. The problem with gift giving is largely not a matter of malicious or consciously self-interested behavior, but of well-intentioned actions on the part of physicians that are nonetheless perniciously infected by the presence of the medical industry. Substantiating this claim will involve elaboration on two points. First, we will retrace the history of policies regarding gift giving between the medical profession and the medical industry and highlight how most policies assume a rationalistic view of moral agency. Reliance on this view of agency is best illustrated by past attempts to address gift giving in terms of conflicts of interest. Second, we will introduce and motivate an alternate view of moral agency emerging from recent literature in social psychology on implicit social cognition. We will show that proper consideration of implicit social cognition paints a picture of human psychology at odds with the rationalistic model assumed in discussions of COIs. With these two pieces on the table we will be able to show that, without fully appreciating the social-psychological mechanisms (both cognitive and affective) of implicit cognition, policy-makers are likely to overlook significant aspects of how gifts influence doctors.
第一，礼物会影响医生；第二，礼物对医生的影响可能对患者有害。这些假设在应用伦理学文献中很常见，它们引出了一个明显的实际问题，即如何最大程度地减轻负面影响？我们深入探讨了送礼的负面影响，考虑了这种影响是如何产生的，并断言，围绕送礼行为的伦理争论必须重新定位。我们的主要观点是，最近针对送礼行为的政策之所以失败，可以追溯到对导致医生因与医疗行业互动而产生偏见的心理机制的误解。送礼问题主要不是恶意或有意识的自利行为的问题，而是医生出于善意的行为，但由于医疗行业的存在而受到严重影响。要证实这一说法，需要详细说明两点。首先，我们将追溯医学专业和医疗行业之间关于礼物的政策历史，并强调大多数政策如何假设道德代理的理性主义观点。这种代理观点的依赖最好通过过去尝试根据利益冲突来解决礼物问题来说明。其次，我们将介绍并激发社会心理学中关于内隐社会认知的最新文献中出现的一种替代道德代理观点。我们将表明，适当考虑内隐社会认知会描绘出与讨论利益冲突时所假设的理性主义模型不一致的人类心理图景。有了这两个观点，我们就可以表明，如果决策者没有充分理解内隐认知的社会心理机制（认知和情感），他们很可能会忽略礼物影响医生的重要方面。
