Persad Govind
Assistant professor in the Department of Health Policy and Management and the Berman Institute of Bioethics at Johns Hopkins University in Baltimore.
AMA J Ethics. 2017 Feb 1;19(2):183-191. doi: 10.1001/journalofethics.2017.19.2.pfor1-1702.
Approaches relying on fair procedures rather than substantive principles have been proposed for answering dilemmas in medical ethics and health policy. These dilemmas generally involve two questions: the epistemological (factual) question of which benefits an intervention will have, and the ethical (value) question of how to distribute those benefits. This article focuses on the potential of fair procedures to help address epistemological and factual questions in medicine, using the debate over antidepressant efficacy as a test case. In doing so, it employs concepts from social epistemology such as testimonial injustice (bias resulting from the exclusion of evidence) and hermeneutical injustice (bias resulting from a prevailing discussion framework's conceptual limitations). This article also explores the relevance of scientific consensus to determinations regarding medical evidence.
有人提出依靠公平程序而非实质性原则的方法来应对医学伦理和卫生政策中的困境。这些困境通常涉及两个问题：一是干预措施会带来哪些益处的认识论（事实）问题，二是如何分配这些益处的伦理（价值）问题。本文以关于抗抑郁药疗效的争论为测试案例，重点探讨公平程序在帮助解决医学中认识论和事实问题方面的潜力。在此过程中，本文运用了社会认识论中的概念，如证言不公正（因证据排除导致的偏见）和诠释学不公正（因主流讨论框架的概念局限性导致的偏见）。本文还探讨了科学共识与医学证据判定的相关性。
