Obregón José Miguel Viscarra, Anjos Marcio Fabri Dos
Universidade Estadual de Maringá, Departamento de Medicina, Disciplinas de Nefrologia e Bioética, Maringá, PR, Brasil.
Centro Universitário São Camilo, Ipiranga, São Paulo, SP, Brasil.
J Bras Nefrol. 2018 Oct-Dec;40(4):403-409. doi: 10.1590/1678-4685-jbn-2018-0011. Epub 2018 Apr 24.
The doctor-patient relationship is often discussed from the perspective of patient vulnerability. Little attention is given to the vulnerability of nephrologists in their professional practice, a reality often affected by profound cultural transformation arising from technological development. Nephrology is based on research and procedure instrumentalization, both permeated with technology. In addition, the relationship between nephrologists and institutions is governed by market rules. Recent data showed a shortage of new nephrologists and the need to improve the technical training of new professionals, foster the establishment of interventional nephrology, and attract more graduating physicians to this medical specialty. Bioethics offers a different perspective on the issue, since it takes the subjective concerns of medical doctors and the social environments they participate in into consideration in order to enhance their ethical autonomy. These ideas may be discussed as part of undergraduate or specialization programs, thus reinforcing the acknowledgement of vulnerability as a condition and of the relevance of adopting a reflective attitude toward the events of everyday life that interact with the morality of nephrologists, so that risks are adequately faced having bioethical parameters as a reference.
医患关系常常从患者易受伤害的角度进行讨论。而肾科医生在其专业实践中的易受伤害性却很少受到关注,这一现实往往受到技术发展带来的深刻文化变革的影响。肾脏病学基于研究和程序工具化,两者都渗透着技术。此外,肾科医生与机构之间的关系受市场规则支配。最近的数据显示,新肾科医生短缺,需要提高新专业人员的技术培训,促进介入肾脏病学的建立,并吸引更多的医学专业毕业生投身该领域。生物伦理学为这个问题提供了一个不同的视角,因为它考虑到医生的主观关切以及他们所参与的社会环境,以增强他们的伦理自主性。这些观点可以作为本科或专科课程的一部分进行讨论,从而强化对易受伤害性作为一种状况的认识,以及对采取反思态度对待与肾科医生道德相关的日常生活事件的相关性的认识,以便在以生物伦理参数为参考的情况下充分应对风险。