Institute of Ethics, History and Theory of Medicine, Medical Faculty, LMU Munich, Muenchen, Germany.
Institute of Ethics and History of Health in Society, Medical Faculty, University of Augsburg, Augsburg, Germany.
Bioethics. 2024 Mar;38(3):241-251. doi: 10.1111/bioe.13185. Epub 2023 Jun 27.
We propose a step-by-step methodological framework of translational bioethics that aims at changing medical practice according to normative-ethical requirements, which we will thus call "transformative medical ethics." The framework becomes especially important when there is a gap between widely acknowledged, ethically justified normative claims and their realization in the practice of biomedicine and technology (ought-is gap). Building on prior work on translational bioethics, the framework maps a process with six different phases and 12 distinct translational steps. The steps involve various research activities including conceptual philosophical inquiry and (socio-)empirical research. On the one hand, the framework can be used as a heuristic tool to identify barriers to the transformation process. On the other hand, it can provide guidance for researchers and practitioners to develop appropriate (conceptual action and practice) models, which are then implemented and evaluated in specific practice contexts. We use the example of realizing the norm of respect for autonomy in the practice of medical decision-making to illustrate the framework. Further research is required, for example, to theoretically underpin the framework, to apply it to other ought-is gaps, and to evaluate its feasibility and effectiveness in various practice areas. Overall, the framework of transformative medical ethics suggests a strategic process to investigate and promote practice change that is ethically informed in all phases.
我们提出了一个转化医学伦理学的逐步方法论框架，旨在根据规范伦理要求改变医学实践，我们将其称为“转化医学伦理学”。当广泛认可的、在伦理上合理的规范主张与其在生物医学和技术实践中的实现之间存在差距时（应该是差距），该框架变得尤为重要。该框架建立在转化生物伦理学的先前工作基础上，映射了一个具有六个不同阶段和 12 个不同转化步骤的过程。这些步骤涉及各种研究活动，包括概念哲学探究和（社会）经验研究。一方面，该框架可用作识别转化过程障碍的启发式工具。另一方面，它可以为研究人员和从业者提供指导，以制定适当的（概念性行动和实践）模型，然后在特定的实践环境中实施和评估这些模型。我们以在医学决策实践中实现尊重自主性规范为例来说明该框架。还需要进一步研究，例如从理论上为该框架提供依据，将其应用于其他应该是差距，并评估其在各种实践领域的可行性和有效性。总体而言，转化医学伦理学框架建议在所有阶段都以伦理为指导，对调查和促进实践变革进行战略规划。
