Vo Holly, Campelia Georgina D, Olszewski Aleksandra E
J Clin Ethics. 2023 Spring;34(1):11-26. doi: 10.1086/723322.
AbstractRacism is a pervasive issue in patient care and a key social determinant of health. Clinical ethicists, like others involved in patient care, have a duty to recognize and respond to racism on both individual and systems-wide levels to improve patient care. Doing so can be challenging and, like other skills in ethics consultation, may benefit from specialized training, standardized tools and approaches, and practice. Learning from existing frameworks and tools, as well as building new ones, can help guide clinical ethicists to systematically approach racism as it affects clinical cases. Here, we propose an expansion of the commonly used four-box method to clinical ethics consultation, where racism is considered as a potential factor in each of the four boxes. We apply this method to two clinical cases to highlight ethically salient information that might be missed using the standard formulation of the four boxes but captured with the expanded version. We argue that this expansion of an existing clinical ethics consultation tool is ethically justified insofar as it () creates a more just approach, () supports individual consultants and services, and () facilitates communication in contexts where racism impinges on effecting good patient care.
摘要
种族主义是患者护理中普遍存在的问题，也是健康的关键社会决定因素。临床伦理学家与参与患者护理的其他人一样，有责任在个人层面和系统层面识别并应对种族主义，以改善患者护理。这样做可能具有挑战性，并且与伦理咨询中的其他技能一样，可能受益于专业培训、标准化工具和方法以及实践。借鉴现有框架和工具以及构建新的框架和工具，可以帮助指导临床伦理学家系统地处理影响临床病例的种族主义问题。在此，我们提议将常用的四象限法扩展到临床伦理咨询中，将种族主义视为四个象限中每个象限的潜在因素。我们将此方法应用于两个临床案例，以突出使用四象限标准表述可能遗漏但扩展版本能够捕捉到的伦理上显著的信息。我们认为，对现有临床伦理咨询工具进行这种扩展在伦理上是合理的，因为它（1）创造了一种更公正的方法，（2）支持个体咨询人员和服务，（3）在种族主义影响良好患者护理的情况下促进沟通。
