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应对临床环境中亲子关系误认带来的伦理挑战:来自一种非洲道德理论的见解

Managing ethical challenges around misattributed parentage within the clinical context: Insights from an African moral theory.

作者信息

Ewuoso Cornelius

出版信息

Dev World Bioeth. 2019 Mar;19(1):36-44. doi: 10.1111/dewb.12196. Epub 2018 Jul 8.

DOI:10.1111/dewb.12196
PMID:29984455
Abstract

This study argues the thesis that a set of guidelines - firmly rooted in a particular interpretation of African moral theory, specifically, Ubuntu - will do a better job than current medical ethics frameworks, in addressing ethical challenges around misattributed parentage within the clinical context. Incidental information such as information with significant personal/health implications raises unique challenges for medical professionals. For example, withholding information of misattributed paternity accidentally discovered in clinical interactions may be seen by a patient as a violation of his/her right-to-know. Contrarily, disclosure where a patient has not requested information - or where establishing paternity is not the purpose of clinical visit/interaction - may be taken by the patient as a violation of his/her right 'not-to-know'. Resolving these challenges remain a herculean task. African moral theory contains an under-emphasized value for addressing such ethical challenges around misattributed parentage in the field of transplant. I seek to contribute this knowledge; and enhance clinician-patient relationship. This study builds off three completed systematic reviews, which aimed to answer the following questions: "what are the ethical challenges regarding information health professionals face within the clinical contest?" and "what core aspects (or common themes) of Ubuntu can be identified in existing literature describing the same?" In this present study, I applied the definition of Ubuntu which captures the core aspects of the theory in ethical literature on the same, to address ethical issues around unsought information of misattributed parentage in the field of transplant.

摘要

本研究主张这样一个论点

一套深深植根于对非洲道德理论(具体而言是乌班图主义)的特定解释的指导方针,在应对临床环境中围绕错误认定亲子关系的伦理挑战方面,将比当前的医学伦理框架做得更好。附带信息,如具有重大个人/健康影响的信息,给医学专业人员带来了独特的挑战。例如,在临床互动中意外发现的错误认定亲子关系的信息不告知患者,可能会被患者视为侵犯其知情权。相反,在患者未要求提供信息的情况下披露信息——或者在确定亲子关系并非临床就诊/互动目的的情况下披露信息——可能会被患者视为侵犯其“不想知道”的权利。解决这些挑战仍然是一项艰巨的任务。非洲道德理论包含一种在移植领域中未得到充分重视的价值观,可用于应对围绕错误认定亲子关系的此类伦理挑战。我试图贡献这方面的知识,并加强医患关系。本研究基于三项已完成的系统评价,这些评价旨在回答以下问题:“临床环境中信息健康专业人员面临的伦理挑战有哪些?”以及“在描述相同内容的现有文献中,可以确定乌班图主义的哪些核心方面(或共同主题)?”在本研究中,我应用了乌班图主义的定义,该定义在关于同一主题的伦理文献中体现了该理论的核心方面,以解决移植领域中关于错误认定亲子关系的未寻求信息的伦理问题。

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