Providence St. Vincent Medical Center, Women and Children's Services, 9205 SW Barnes Road, Portland, OR, 97225, USA.
Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital - General Campus, 501 Smyth Road, Box 806, Ottawa, ON, K1H 8L6, Canada.
BMC Med Ethics. 2023 Feb 11;24(1):9. doi: 10.1186/s12910-023-00887-z.
Moral values in healthcare range widely between interest groups and are principally subjective. Disagreements diminish dialogue and marginalize alternative viewpoints. Extremely premature births exemplify how discord becomes unproductive when conflicts of interest, cultural misunderstanding, constrained evidence review, and peculiar hierarchy compete without the balance of objective standards of reason. Accepting uncertainty, distributing risk fairly, and humbly acknowledging therapeutic limits are honorable traits, not relativism, and especially crucial in our world of constrained resources. We think dialogics engender a mutual understanding that: i) transitions beliefs beyond bias, ii) moves conflict toward pragmatism (i.e., the truth of any position is verified by subsequent experience), and iii) recognizes value pluralism (i.e., human values are irreducibly diverse, conflicting, and ultimately incommensurable). This article provides a clear and useful Point-Counterpoint of extreme prematurity controversies, an objective neurodevelopmental outcomes table, and a dialogics exemplar to cultivate shared empathetic comprehension, not to create sides from which to choose. It is our goal to bridge the understanding gap within and between physicians and bioethicists. Dialogics accept competing relational interests as human nature, recognizing that ultimate solutions satisfactory to all are illusory, because every choice has downside. Nurturing a collective consciousness via dialogics and pragmatism is congenial to integrating objective evidence review and subjective moral-cultural sentiments, and is that rarest of ethical constructs, a means and an end.
医疗保健中的道德价值观在利益群体之间差异很大，主要是主观的。分歧会减少对话，并使替代观点边缘化。早产儿的例子说明了当利益冲突、文化误解、有限的证据审查以及特殊的等级制度在没有客观理性标准平衡的情况下相互竞争时，不和谐会变得没有成效。接受不确定性、公平分配风险以及谦逊地承认治疗限制是值得尊敬的品质，而不是相对主义，尤其是在我们资源有限的世界中更为关键。我们认为对话论可以产生相互理解，即：i）超越偏见转变信念，ii）使冲突走向实用主义（即任何立场的真理都可以通过后续经验来验证），iii）认识到价值多元化（即人类价值观是不可还原的、冲突的，最终是不可通约的）。本文提供了一个关于极端早产争议的清晰而有用的观点对比，一个客观的神经发育结果表，以及一个对话论的范例，以培养共同的同理心理解，而不是制造选择的对立面。我们的目标是弥合医生和生物伦理学家之间的理解差距。对话论接受相互竞争的关系利益作为人性，认识到最终让所有人都满意的解决方案是虚幻的，因为每个选择都有缺点。通过对话论和实用主义培养集体意识，有利于整合客观的证据审查和主观的道德文化观念，这是最罕见的伦理结构之一，既是手段也是目的。
