Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona.
J Emerg Med. 2022 Mar;62(3):413-418. doi: 10.1016/j.jemermed.2021.11.011. Epub 2022 Jan 20.
In our multicultural society, as well as when working internationally, emergency physicians (EPs) frequently see patients from cultures with communitarian or hierarchal structures. These groups may rely on traditional medical practices and view health care decisions through a lens other than patient autonomy. This leads to uncertainty about who can legitimately make decisions for patients and how to apply basic ethical principles. Because the commonly taught ethical principles (autonomy, beneficence, nonmaleficence, and distributive justice) are loosely defined, they provide little help to EPs when working with cultures that de-emphasize Western individualism.
The case illustrates this complexity by detailing how visiting EPs dealt with leaders from a communitarian culture who demanded that a preteen be treated for a femur fracture by a traditional bone healer rather than with modern techniques.
The Western-trained clinicians struggled with their ethical responsibility to protect the child's welfare within the social setting: What should beneficence look like in this situation and to whom did it apply? More broadly, this paper examines the bases on which health care professionals might justify overruling parental decisions. It also asks whether the lack of clarity of the most used Western ethical principles suggests the need to broaden clinical ethics education to include issues from other cultures and settings.
Despite principlism's shortcomings, the ease of teaching ethics to health care providers by grouping basic philosophical ideas suggests that we continue to use its structure. As educators and practitioners, we should, however, expand the concept of principlism to better address ethical values and issues found across different cultures.
在我们的多元文化社会中，以及在国际合作时，急诊医师经常会遇到来自具有社群或等级结构文化背景的患者。这些群体可能依赖传统的医疗实践，并通过不同于患者自主的视角来看待医疗决策。这导致了对谁可以合法地为患者做出决策以及如何应用基本伦理原则的不确定性。由于通常教授的伦理原则（自主性、善行、不伤害和分配公正）定义较为宽泛，因此当与强调西方个人主义的文化合作时，它们对急诊医师几乎没有帮助。
该案例通过详细说明社群文化背景下的领导层如何要求对一名未成年股骨骨折患者采用传统的接骨治疗而不是现代技术进行治疗，说明了这种复杂性。
这些受过西方训练的临床医生在其伦理责任与保护儿童福利的社会背景之间感到挣扎：在这种情况下，善行应该是什么样子，应该适用于谁？更广泛地说，本文探讨了医疗保健专业人员可能有理由推翻父母决策的依据。它还询问了最常用的西方伦理原则缺乏清晰度是否表明需要扩大临床伦理教育，以纳入来自其他文化和背景的问题。
尽管原则主义存在缺陷，但通过将基本哲学思想分组教授给医疗保健提供者的伦理教学的简便性表明，我们应继续使用其结构。但是，作为教育者和从业者，我们应该扩展原则主义的概念，以更好地解决不同文化中存在的伦理价值观和问题。
