医疗保健领域基于价值的竞争的伦理缺陷以及采用价值驱动方法的必要性。
Value based competition in health care's ethical drawbacks and the need for a values-driven approach.
作者信息
Groenewoud A Stef, Westert Gert P, Kremer Jan A M
机构信息
Radboud University Medical Center, Scientific Center for Quality of Healthcare, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.
出版信息
BMC Health Serv Res. 2019 Apr 27;19(1):256. doi: 10.1186/s12913-019-4081-6.
Value Based competition in Health Care (VBHC) has become a guiding principle in the quest for high quality health care for acceptable costs. Current literature lacks substantial ethical evaluation of VBHC.In this paper we describe how a single-minded focus on VBHC may cause serious infringements upon at least four medical ethical principles: 1) it tends to neglect patients' personal values; 2) it ignores the intrinsic value of the caring act; 3) it disproportionately replaces trust in professionals with accountability, and 4) it undermines solidarity.Health care needs a next step in VBHC. We suggest a 'Values-Driven Health Care' (VDHC) approach that a) takes patients' personal values as prescriptive and guiding; b) holds a value account that encompasses health care's intrinsic (gift) values; c) is based upon intelligent accountability that supports trust in trustworthy professionals, and d) encourages patients to raise their voices for the shared good of health care.
基于价值的医疗保健竞争（VBHC）已成为以可接受成本追求高质量医疗保健过程中的一项指导原则。当前文献对VBHC缺乏实质性的伦理评估。在本文中，我们描述了对VBHC的单一关注如何可能至少严重侵犯四项医学伦理原则：1）它往往忽视患者的个人价值观；2）它忽视了关怀行为的内在价值；3）它过度地用问责制取代了对专业人员的信任；4）它破坏了团结。医疗保健在VBHC方面需要更进一步。我们建议采用一种“价值驱动的医疗保健”（VDHC）方法，该方法a）将患者的个人价值观作为规范性和指导性的；b）持有一个包含医疗保健内在（馈赠）价值的价值账户；c）基于支持对值得信赖的专业人员的信任的明智问责制；d）鼓励患者为医疗保健的共同利益发声。
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