Malek Janet
Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Suite 310D, MS 420, Houston, TX, 77030, USA.
Biomedical Ethics Program, Houston Methodist Hospital System, Houston, TX, USA.
HEC Forum. 2019 Jun;31(2):91-102. doi: 10.1007/s10730-018-9363-6.
Ethical reasoning is an integral part of the work of a clinical ethics consultant (CEC). Ethical reasoning has a close relationship with an individual's beliefs and values, which, for religious adherents, are likely to be tightly connected with their spiritual perspectives. As a result, for individuals who identify with a religious tradition, the process of thinking through ethical questions is likely to be influenced by their religious worldview. The connection between ethical reasoning and one's spiritual perspective raises questions about the role that CECs' personal religious worldviews should play in their professional lives and their consultative work. This paper offers numerous arguments critiquing the inclusion of a consultant's own spiritual perspective in her work and has identified only limited circumstances under which such inclusion might be permissible. In particular, these arguments lead to the conclusion that a CEC's personal beliefs should never influence her ethical analysis or development of a recommendation. Further, religious appeals should not be used in communication during decision-making conversations other than to describe the patient or surrogate's stated perspective. There may be limited cases in which a CEC may share her spiritual worldview with a patient with the intent of building a collaborative relationship, but such situations should be approached with extreme caution.
伦理推理是临床伦理顾问(CEC)工作中不可或缺的一部分。伦理推理与个人的信仰和价值观密切相关,对于宗教信徒来说,这些信仰和价值观很可能与他们的精神观念紧密相连。因此,对于认同某一宗教传统的个人而言,思考伦理问题的过程很可能会受到其宗教世界观的影响。伦理推理与个人精神观念之间的联系引发了关于CEC个人宗教世界观在其职业生活和咨询工作中应扮演何种角色的问题。本文提出了诸多论据来批判在工作中纳入顾问自身的精神观念,并仅确定了在有限的情况下这种纳入可能是允许的。特别是,这些论据得出的结论是,CEC的个人信仰绝不应影响其伦理分析或建议的制定。此外,在决策对话的沟通中,除了描述患者或代理人陈述的观点外,不应使用宗教诉求。可能存在有限的情况,即CEC为了建立合作关系而与患者分享其精神世界观,但这种情况应极其谨慎地处理。