Duthie Katherine, Jiwani Bashir, Steele Duncan
Alberta Health Services, Edmonton, Canada.
Fraser Health Ethics Services, Surrey, Canada.
HEC Forum. 2017 Dec;29(4):347-358. doi: 10.1007/s10730-017-9328-1.
Health care providers' interpretation of law can have intended and unintended effects on health care delivery in Canada. At times, health care providers encounter situations where they perceive the law to conflict with their sense of what is most ethically justified. In many cases, these health care providers feel especially torn because they assume that the legal requirements must dictate the decision, and cannot be explored or questioned. We challenge this assumption: the law is not as cut-and-dried as some assume; therefore, its significance to health care decisions should be carefully considered. Within a systematic ethics process, legal considerations can be a source of values and information and can create opportunities for further dialogue. This approach is justified because it appropriately reflects the relationship of the law to ethics. This way of thinking about the law and ethics also avoids potentially harmful consequences of legalistic approaches to decision-making, such as breakdowns in communication, adversarial relationships, and a reduction of ethically complex decisions to simple rule following.
医疗保健提供者对法律的解读可能会对加拿大的医疗保健服务产生有意和无意的影响。有时，医疗保健提供者会遇到他们认为法律与自己认为最符合道德规范的观念相冲突的情况。在许多情况下，这些医疗保健提供者会感到特别纠结，因为他们认为法律要求必须决定决策，不容探讨或质疑。我们对这一假设提出质疑：法律并非如一些人所认为的那样一成不变；因此，其对医疗保健决策的重要性应得到仔细考量。在系统的伦理程序中，法律考量可以成为价值观和信息的来源，并能创造进一步对话的机会。这种方法是合理的，因为它恰当地反映了法律与伦理的关系。这种对法律和伦理的思考方式还避免了法律主义决策方法可能产生的有害后果，比如沟通中断、敌对关系以及将复杂的伦理决策简化为简单的遵循规则。
