Doucet H
Faculté de théologie, Université Saint-Paul, Ottawa, Canada.
Schweiz Med Wochenschr. 1995 Jun 10;125(23):1138-44.
Intensive care, one of the greatest achievements of modern medicine, is not without its problems. In what sense could ethics contribute towards an intensive care medicine which would be humane and respectful of what it means to be sick? After having presented a phenomenology of what it means to be sick and in intensive care, the author proposes an ethical framework which could guide the decision-making of physicians specialized in the field. This framework has three levels. Level one deals with the basic values of benevolence and autonomy which are those of medicine itself. Level two deals with the implementation of these values, which bioethics sees as conflicting. Implementation is achieved by "conversation" between the physician and the patient. Finally, the physician is invited to question his or her own attitude towards the unavoidable dilemmas created by the paradoxes and contradictions of modern medicine.
重症监护作为现代医学最伟大的成就之一，也并非没有问题。从何种意义上讲，伦理学能够对一种人道且尊重患病意义的重症监护医学有所贡献呢？在阐述了患病及处于重症监护状态意味着什么的现象学之后，作者提出了一个伦理框架，该框架可指导该领域专科医生的决策。这个框架有三个层面。第一个层面涉及仁爱和自主的基本价值观，这些也是医学本身的价值观。第二个层面涉及这些价值观的实施，生物伦理学认为这些价值观相互冲突。实施是通过医生与患者之间的“对话”来实现的。最后，医生被要求审视自己对现代医学的悖论和矛盾所造成的不可避免的困境的态度。
