Berman Institute of Bioethics and Division of General Internal Medicine, Johns Hopkins University, Deering Hall 1809 Ashland Avenue, Baltimore, MD, 21205, USA.
Albert Einstein College of Medicine and Montefiore New Rochelle Hospital, New Rochelle, NY, USA.
J Gen Intern Med. 2018 Mar;33(3):370-375. doi: 10.1007/s11606-017-4234-4. Epub 2017 Dec 18.
Spurred on by recent health care reforms and the Triple Aim's goals of improving population health outcomes, reducing health care costs, and improving the patient experience of care, emphasis on population health is increasing throughout medicine. Population health has the potential to improve patient care and health outcomes for individual patients. However, specific population health activities may not be in every patient's best interest in every circumstance, which can create ethical tensions for individual physicians and other health care professionals. Because individual medical professionals remain committed primarily to the best interests of individual patients, physicians have a unique role to play in ensuring population health supports this ethical obligation. Using widely recognized principles of medical ethics-nonmaleficence/beneficence, respect for persons, and justice-this article describes the ethical issues that may arise in contemporary population health programs and how to manage them. Attending to these principles will improve the design and implementation of population health programs and help maintain trust in the medical profession.
受近期医疗改革和三重目标(改善人口健康结果、降低医疗成本和改善医疗护理体验)的推动,医学领域越来越重视人口健康。人口健康有可能改善患者护理和个体患者的健康结果。然而,在特定情况下,特定的人口健康活动可能不符合每个患者的最佳利益,这可能会给个体医生和其他医疗保健专业人员带来伦理紧张。由于个体医疗专业人员主要致力于个体患者的最佳利益,因此医生在确保人口健康支持这一道德义务方面发挥着独特的作用。本文使用广泛认可的医学伦理原则——不伤害/有益、尊重人格和公正——描述了当代人口健康计划中可能出现的伦理问题,以及如何管理这些问题。关注这些原则将改善人口健康计划的设计和实施,并有助于维护对医疗行业的信任。