Donnelly W J
Medical Service, Edward Hines, Jr. Veterans Affairs Hospital, Hines, IL 60141.
Theor Med. 1994 Jun;15(2):141-8. doi: 10.1007/BF00994022.
Many alternatives or supplements to "principalism" seek to reconnect medical ethics with the thoughts, feelings, and motivations of the persons directly involved in ethically troublesome situations. This shift of attention, from deeds to doers, from principles to principals, acknowledges the importance of the moral agents involved in the situation-particular practitioners, patients, and families. Taking into account the subjective, lived experience of moral decision-making parallels recent efforts in the teaching of medicine to give the patient's subjectivity-his or her personal experience of being sick or disabled epistemological parity with scientific medicine's "objective," biomedically-oriented view of the person's sickness or disability. Moreover, the shift from principalism to principals signals a growing realization that ethical problems in the profession of medicine are inseparable from its practice. Philosophers and other humanists working in medicine should resist the temptation to institutionalize a professional role as solver of ethical problems, clarifier of values, or mediator of disputes and work instead to help practitioners practice medicine reflectively.
许多“原则主义”的替代方案或补充内容试图将医学伦理与直接卷入伦理困境的人员的思想、情感和动机重新联系起来。这种关注点的转变，从行为到行为者，从原则到当事人，承认了卷入特定情境的道德主体——具体的从业者、患者及其家属的重要性。考虑到道德决策的主观、实际体验，这与医学教学中最近的努力相呼应，即赋予患者的主观性——其患病或残疾的个人体验——与科学医学对患者疾病或残疾的“客观”、以生物医学为导向的观点同等的认识论地位。此外，从原则主义到当事人的转变表明，人们越来越意识到医学职业中的伦理问题与其实践不可分割。在医学领域工作的哲学家和其他人文学者应抵制将解决伦理问题、阐明价值观或调解纠纷的专业角色制度化的诱惑，而应致力于帮助从业者进行反思性的医学实践。
