Toulmin S
Philosophy Department, Northwestern University, Evanston, Illinois 60201.
Ann N Y Acad Sci. 1988;530:7-15. doi: 10.1111/j.1749-6632.1988.tb35292.x.
Until the 1950's, moral aspects of clinical practice were handled in the USA within the medical profession. Over the last 30 years, these issues have become subjects for public debate, and have changed the public perception of medicine, in four steps. In the 1950's, moral theologians questioned the implications of medical technology at the edges of life. In the late '60s and '70s, these theologians were joined by political activists, whose zeal provoked a counter-reaction from physicians. In the late '70s and early '80s, the debate became largely theoretical; but in the late '80s it is once again "clinical", though respecting the rights of patients, their families, and other nonphysicians to participate in the relevant moral decisions. In part, these four steps reflect the special feature of American social history in the last 30 years; but in part they also had counterparts in Britain and elsewhere. Either way, the monopoly control over the ethics of medical practice exercised by doctors before the 1950s is unlikely to return.
直到20世纪50年代，美国临床实践中的道德问题都由医学界内部处理。在过去30年里，这些问题已成为公众辩论的话题，并分四个阶段改变了公众对医学的看法。20世纪50年代，道德神学家对处于生命边缘的医疗技术的影响提出质疑。20世纪60年代末和70年代，政治活动家加入了这些神学家的行列，他们的热情引发了医生们的反作用。20世纪70年代末和80年代初，这场辩论在很大程度上变成了理论性的；但在20世纪80年代末，它再次回到“临床”层面，不过要尊重患者、其家人以及其他非医生参与相关道德决策的权利。这些阶段部分反映了美国过去30年社会历史的特点；但部分在英国和其他地方也有类似情况。不管怎样，20世纪50年代以前医生对医疗实践伦理的垄断控制不太可能再度出现。
