Toulmin S
Soc Sci Med. 1986;23(8):783-7. doi: 10.1016/0277-9536(86)90276-5.
The author argues that conflicts of obligation may, but need not, give rise to issues of divided loyalties. Given this, the question then becomes under what circumstances and conditions a simple internal conflict may escalate into the problem of divided loyalties or fiduciary ambiguities. After discussing conflicts of obligation, it is asserted that loyalties are divided only when the demands of the various relationships involved are irreconcilable. As this is an extreme, the major problematic issues fall, then, in between, on multiple loyalties and ambiguous loyalties. How and where multiple loyalties arise, and under what conditions they may become ambiguous loyalties lead to the recognition that moral problems are created by leaving in ambiguity things about the relationships involved that would be better sorted out. Finally the author looks at situations in which physicians are systematically exposed to irresoluble ambiguity.
作者认为，义务冲突可能，但不一定会引发忠诚分歧问题。鉴于此，问题就变成了在何种情况和条件下，简单的内部冲突可能升级为忠诚分歧问题或信托义务模糊问题。在讨论了义务冲突之后，有人断言，只有当所涉及的各种关系的要求无法协调时，忠诚才会出现分歧。由于这是一种极端情况，那么主要的问题就介于两者之间，即多重忠诚和模糊忠诚。多重忠诚如何以及在何处产生，以及在何种条件下它们可能变成模糊忠诚，这导致人们认识到，对所涉及关系中本应更好厘清的事情含糊其辞会引发道德问题。最后，作者审视了医生系统性地面临无法解决的模糊性的情况。
