Eberly John Brewer, Frush Benjamin W
Perspect Biol Med. 2019;62(3):414-433. doi: 10.1353/pbm.2019.0024.
While conscience in medicine has been a source of debate for decades, the role of conscience in medical training remains largely unexamined. Insofar as conscience is addressed, trainees are typically urged to avoid practices that will conflict with their internal moral codes, refer to practitioners who will provide such practices, or even consider leaving the profession. This essay considers Lauris Kaldjian's articulation of two rival definitions of conscience: conscience as mere private and idiosyncratic moral belief, or conscience as a fundamental capacity for moral reasoning, akin to good clinical judgment. The authors propose that these definitions reflect two rival conceptions of medicine-medicine as product, or medicine as moral practice-and argue that the latter definition is vital to understanding both the purposed nature of medicine and the role of the conscience within that purpose. The authors conclude that because medicine is fundamentally moral and the conscience is the capacity for moral reasoning, medical education is essentially a training in conscience. Therefore, neglecting or disparaging conscience in medical training will have serious consequences for the future of trainees and the practice of medicine alike.
几十年来，医学中的良知一直是争论的焦点，但良知在医学培训中的作用在很大程度上仍未得到审视。就良知问题得到探讨而言，实习生通常被敦促避免从事与其内在道德准则相冲突的行为，将患者转介给会提供此类治疗的从业者，甚至考虑离开该职业。本文探讨了劳里斯·卡尔吉安（Lauris Kaldjian）对良知的两种相互对立的定义：良知是纯粹的个人化和特质性道德信念，还是类似于良好临床判断力的道德推理基本能力。作者们认为，这些定义反映了两种相互对立的医学观念——医学是产品，还是道德实践——并指出后一种定义对于理解医学的目的本质以及良知在该目的中的作用至关重要。作者们得出结论，由于医学本质上是道德的，而良知是道德推理能力，医学教育本质上就是良知的培养。因此，在医学培训中忽视或贬低良知将对实习生的未来以及医学实践都产生严重后果。
