University of Nevada Las Vegas, Las Vegas, NV, USA.
Med Health Care Philos. 2020 Sep;23(3):413-420. doi: 10.1007/s11019-020-09950-7.
Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is offered that describes the essence of defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: (1) defensive medicine is deceptive and undermines patient autonomy; (2) defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; (3) defensive medicine exposes patients to harm without benefit; (4) defensive medicine undermines trust in the profession; and (5) defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism.
防御性医疗已经无处不在。防御性医疗通常被认为是一个系统问题，是对抗性医疗环境的必然结果，因此需要关注系统反应和侵权改革。但是，防御性医疗也存在伦理和专业方面的问题，这些问题除了需要进行侵权改革之外，也应该加以考虑。本文从伦理和专业的角度来审视防御性医疗，展示防御性医疗是如何存在深刻问题的。首先，本文提出了一个防御性医疗的定义，描述了防御性实践的本质：以保护医生免受诉讼或其他不利后果为目标的临床行为。本文还考虑了反对防御性医疗的伦理论点：（1）防御性医疗是欺骗性的，破坏了患者的自主权；（2）防御性医疗将患者的利益置于医生的利益之下，违反了信托义务；（3）防御性医疗使患者遭受伤害而无获益；（4）防御性医疗破坏了对专业的信任；（5）防御性医疗违反了正义的义务。本文还考虑并驳斥了支持防御性医疗的可能论点。因此，防御性医疗是不道德和不专业的，应该被视为医学伦理和专业的挑战。
