Smith H L
Divinity School, Duke University, Durham, NC 27706.
Soc Sci Med. 1987;25(6):705-9. doi: 10.1016/0277-9536(87)90098-0.
Much popular and professional understanding of 'medical ethics' is nowadays located in quandary ethics, exotic life-and-death decision-making, and tertiary care settings. Medical ethics in the primary care setting is concerned with very different matters. Among these are issues having to do with basic self-understandings of health professionals and patients and their fiduciary relationships; with fundamental social, political and economic notions which will and do shape the allocation and distribution of health care resources; with the goals and purposes appropriate to medical interventions of various sorts; and with the care of the whole person rather than the limited attention to a particular illness or disease syndrome. The commitments of primary care medicine challenge in radical ways some cherished claims of modern liberal societies by questioning the limits of autonomous individualism and by affirming the indispensability of social justice.
如今，许多大众和专业人士对“医学伦理”的理解都局限于两难伦理、离奇的生死抉择以及三级医疗环境。基层医疗环境中的医学伦理关注的是截然不同的问题。其中包括与健康专业人员和患者对自身的基本理解及其信托关系相关的问题；与那些塑造医疗保健资源分配的基本社会、政治和经济观念相关的问题；与各类医疗干预措施所适合的目标和目的相关的问题；以及对人的全面照护，而非仅仅局限于对特定疾病或病症的关注。基层医疗的种种承诺通过质疑自主个人主义的局限性并肯定社会正义的不可或缺性，从根本上挑战了现代自由社会的一些珍视主张。
