Cattorini P, Mordacci R
Department of Medical Humanities, Scientific Institute H San Raffaele, Milan, Italy.
Thyroidology. 1993 Dec;5(3):73-6.
The physician might happen to play a double role in the clinical setting when he is the caregiver as well as the researcher for a patient at the same time. The dynamics and the ethical profile of the two relationships caregiver-patient and researcher-subject are different, and conflicts might arise: while the main responsibility of the caregiver is directed towards the patient "here and now", the researcher has a primary responsibility for future patients, the scientific community and the society at large. It has been suggested that in the clinical setting the researcher, provided that all the requirements for the ethical conduct of an experimentation be respected, has an "autonomy-in-trust", i.e. a wide discretional space in the decision-making process. While agreeing with such a proposal to some extent, we suggest that a more active and deeper participation of subjects in the experimental process, through an ongoing consent and joint decision-making process, would help in overcoming many possible conflicts.
在临床环境中，医生可能会同时扮演双重角色，即既是患者的护理者又是研究者。护理者与患者、研究者与受试者这两种关系的动态变化和伦理特征有所不同，可能会产生冲突：护理者的主要责任是针对当下的患者，而研究者主要对未来的患者、科学界及整个社会负责。有人提出，在临床环境中，只要尊重实验伦理行为的所有要求，研究者就拥有“基于信任的自主权”，即在决策过程中有很大的自由裁量空间。虽然在一定程度上同意这一提议，但我们认为，通过持续的同意和共同决策过程，让受试者更积极、深入地参与实验过程，将有助于克服许多可能出现的冲突。
