Taylor Erin
Washington and Lee University, 320 Washington Hall, 24450, Lexington, VA, USA.
Health Care Anal. 2022 Dec;30(3-4):197-214. doi: 10.1007/s10728-022-00445-5. Epub 2022 Jun 6.
"Wicked" problems are characterized by intractable complexity, uncertainty, and conflict between individuals or institutions, and they inhabit almost every corner of medical ethics. Despite wide acceptance of the same ethical principles, we nevertheless disagree about how to formulate such problems, how to solve them, what would count as solving them, or even what the possible solutions are. That is, we don't always know how best to implement ethical ideals in messy real-world contexts. I sketch an implementation framework for medical ethics that can help clarify wicked problems and organize further ethics research toward their resolutions. This framework describes the procedural variables that work alongside substantive ethical ideals to deliver ethical decisions in complex real-world situations. Using controversial GM mosquito research as an example, I illustrate how the generalizable relationships between the variables clarify emerging ethical guidelines of research governance and provide a pathway to extend these guidelines in a way consistent with our ethical intuitions across a wide range of research and public health ethics.
“棘手”问题的特点是具有难以处理的复杂性、不确定性以及个人或机构之间的冲突，并且几乎存在于医学伦理的每一个角落。尽管相同的伦理原则已被广泛接受，但我们在如何阐述此类问题、如何解决它们、什么可算作解决它们，甚至可能的解决方案是什么等方面仍存在分歧。也就是说，我们并不总是知道在混乱的现实世界背景下如何最好地践行伦理理想。我勾勒了一个医学伦理的实施框架，它有助于厘清棘手问题，并组织进一步的伦理研究以解决这些问题。该框架描述了与实质性伦理理想协同发挥作用的程序变量，以便在复杂的现实世界情形中做出伦理决策。以有争议的转基因蚊子研究为例，我阐述了这些变量之间可推广的关系如何阐明新兴的研究治理伦理准则，并提供了一条途径，以一种与我们在广泛的研究和公共卫生伦理中的伦理直觉相一致的方式来扩展这些准则。
