Department of Psychiatry, Mayanei HaYeshua Medical Center, Bnei Brak, Tel Aviv, Israel
Department of Psychiatry, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
J Med Ethics. 2020 Nov;46(11):732-735. doi: 10.1136/medethics-2020-106348. Epub 2020 Sep 21.
A recent update to the Geneva Declaration's 'Physician Pledge' involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi ('ultra-orthodox') religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public's best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach.
最近,《日内瓦宣言》的“医师誓言”进行了更新,其中涉及到医生有义务为了患者和医疗保健的利益分享医学知识。随着 COVID-19 的传播,每个国家都存在着不同的病毒表现形式。例如,在 Chareidi(“极端正统派”)宗教社区中,与同一国家内的其他社区相比,COVID-19 的传播和扩散率较高。虽然在大流行期间,人口密集的社区中病毒传播很常见,但已经提出了几个原因来解释公然违反公共卫生法规的现象。很容易指责 Chareidi 人口 COVID-19 的扩散,部分原因是他们回避社交媒体和对互联网的反感。然而,问题仍然存在:谁应该为他们的社区危机负责?从公共卫生的角度来看,伦理论点认为,医生需要与社区接触并分享医学知识。在大流行期间,公众的最大利益至关重要,应该凌驾于任何文化差异的考虑之上。因此,从所有迹象来看,医生有责任根据慈善、不伤害、功利主义伦理以及社会、程序和分配公正等伦理概念来促进人口健康,并分享医学知识。这包括减少健康差距的道德义务,并传达个人健康责任在更广泛的社会责任背景下具有影响的信息。这种伦理挑战显然需要创造性的渠道,包括在医生社区外联中具有适当文化敏感性的适度医学家长主义。