Roemer M I
Yale J Biol Med. 1980 May-Jun;53(3):251-66.
The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization.
亨利·西格里斯在1940年表示，医生所扮演的社会角色日益增加。然而，几个世纪以来，医学伦理准则一直专注于对个体患者的恰当行为，几乎忽视了医生对社会的责任。重大的医疗服务改革主要源自积极主动的非专业领导人和公民团体。私人医生在很大程度上对旨在使人们在经济上平等获得医疗服务以及改善医生供应与分配的运动持敌对态度。美国乃至全世界的医疗实践已严重商业化。作为回应，政府采取了各种策略来约束医生，并促使他们做出更具社会责任感的行为。但是，如果遵循广泛的以社会为导向的医学伦理准则，这种外部压力就不应该是必要的。医疗保健系统的变革会最为有效，但医学教育也可以进行彻底重塑，以阐明社区健康问题以及解决这些问题所需的政策。西格里斯在1941年提出了这样一种新的医学课程；如果当时引入了该课程，如今医学伦理的社会准则就不会显得那么乌托邦了。不妨召开一次国际会议，来探讨应该如何对医生进行教育，以实现世界卫生组织鼓舞人心的目标。
