Joa Brandon
Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA.
Theology and Religious Studies, Villanova University College of Liberal Arts and Sciences, Villanova, PA, USA.
Linacre Q. 2023 Nov;90(4):408-421. doi: 10.1177/00243639231190133. Epub 2023 Jul 27.
The shift from physicians as owners or shareholders of practices to being employees of corporations is now a widespread trend with over 50% of physicians now considered employees. If continued, this trend will have profound effects on the medical profession and on physicians' personal lifestyles and sense of agency. However, ownership is not a morally neutral consideration but is important for safeguarding the traditions of virtue in the medical profession. Virtue develops within localized communities of practice and thrives in settings that embody principles such as solidarity, subsidiarity, and participation found in Catholic social teaching. Ownership increases physicians' investment in moral communities where they practice, affording physicians greater agency to benefit these communities according to their best judgment. This ownership can vary by type of organization and degree of shareholding. Because moral communities are the settings in which physicians form virtue, and ownership increases physicians' commitment and investment in communities, I make a principled argument that physicians who value developing virtue should consider having ownership of their practices when planning their careers. Ownership will be an important aspect of any medical ethics based on virtue rather than on principlism.
从医生作为医疗机构的所有者或股东转变为公司雇员，如今已成为一种普遍趋势，超过50%的医生现在被视为雇员。如果这种趋势持续下去，将对医疗行业以及医生的个人生活方式和自主感产生深远影响。然而，所有权并非一个道德中立的考量因素，而是维护医疗行业美德传统的重要因素。美德在局部的实践社群中得以发展，并在体现天主教社会教义中团结、辅助和参与等原则的环境中蓬勃生长。所有权增加了医生对其执业所在道德社群的投入，使医生有更大的自主权，能根据自己的最佳判断为这些社群谋福祉。这种所有权会因组织类型和持股比例而有所不同。由于道德社群是医生形成美德的环境，而所有权会增强医生对社群的承诺和投入，所以我提出一个有原则的观点：重视培养美德的医生在规划职业生涯时应考虑拥有自己的医疗机构。所有权将是任何基于美德而非原则主义的医学伦理的重要方面。
