Wellcome Centre for Ethics and Humanities and Oxford Uehiro Centre for Practical Ethics, University of Oxford, 16-17 St Ebbes Street, Littlegate House, Oxford, OX1 1PT, UK.
Oxford Uehiro Centre for Practical Ethics and Wellcome Centre for Ethics and Humanities, University of Oxford, 16-17 St Ebbes Street, Littlegate House, Oxford, OX1 1PT, UK.
J Bioeth Inq. 2020 Jun;17(2):229-243. doi: 10.1007/s11673-020-09976-9. Epub 2020 May 12.
Conflict of interests (COIs) in medicine are typically taken to be financial in nature: it is often assumed that a COI occurs when a healthcare practitioner's financial interest conflicts with patients' interests, public health interests, or professional obligations more generally. Even when non-financial COIs are acknowledged, ethical concerns are almost exclusively reserved for financial COIs. However, the notion of "interests" cannot be reduced to its financial component. Individuals in general, and medical professionals in particular, have different types of interests, many of which are non-financial in nature but can still conflict with professional obligations. The debate about healthcare delivery has largely overlooked this broader notion of interests. Here, we will focus on health practitioners' moral or religious values as particular types of personal interests involved in healthcare delivery that can generate COIs and on conscientious objection in healthcare as the expression of a particular type of COI. We argue that, in the healthcare context, the COIs generated by interests of conscience can be as ethically problematic, and therefore should be treated in the same way, as financial COIs.
医学中的利益冲突(COI)通常被认为是财务性质的:通常假设当医疗保健从业者的财务利益与患者利益、公共卫生利益或更普遍的专业义务发生冲突时,就会出现 COI。即使承认存在非财务 COI,道德问题也几乎完全保留给财务 COI。然而,“利益”的概念不能仅仅简化为其财务部分。一般个人,特别是医疗专业人员,有不同类型的利益,其中许多是非财务性质的,但仍可能与专业义务发生冲突。关于医疗保健提供的争论在很大程度上忽视了这种更广泛的利益概念。在这里,我们将重点关注医疗保健提供中涉及的健康从业者的道德或宗教价值观作为特定类型的个人利益,这些利益可能会产生 COI,并关注医疗保健中的良心反对作为特定类型的 COI 的表达。我们认为,在医疗保健环境中,由良心利益产生的 COI 在道德上可能同样有问题,因此应该以同样的方式对待,就像财务 COI 一样。