Howe Edmund G
Professor of psychiatry and medicine and the director of ethics for the School of Medicine at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland, and a senior scientist at the Center for the Study of Traumatic Stress, and the editor-in-chief of the Journal of Clinical Ethics, and chairs an institutional review board at USUHS, and sees patients at the Walter Reed National Military Medical Center.
AMA J Ethics. 2017 Jun 1;19(6):550-557. doi: 10.1001/journalofethics.2017.19.6.ecas3-1706.
The case presents a physician's ethical conflict, due to limited resources, between his obligations to meet the needs of a community and those of his patient. Elements of the decision-making process (and who should make the decision) are discussed, including the limitations of what ethical reasoning can offer and risks of arbitrary outcomes. Additionally, potential benefits to physicians and their patients of discussing these conflicts, including reducing the physician's moral distress, are noted. I argue that physicians' abilities to make "right" decisions in such situations are limited, and I suggest ways in which physicians can try to preserve their relationships with patients.
该案例呈现了一名医生所面临的伦理冲突，即由于资源有限，他在满足社区需求的义务和对患者的义务之间产生了冲突。文中讨论了决策过程的要素（以及应由谁来做决策），包括伦理推理所能提供的局限性以及任意结果的风险。此外，还指出了讨论这些冲突对医生及其患者可能带来的益处，包括减轻医生的道德困扰。我认为医生在这种情况下做出“正确”决策的能力是有限的，并提出了医生可以尝试维护与患者关系的方法。
