Jecker N S
Department of Medical History and Ethics, University of Washington, School of Medicine, Seattle 98195.
JAMA. 1993 Feb 10;269(6):776-80.
Privacy beliefs associated with the family impede physicians' response to domestic violence. As a private sphere, the family is regarded as sacred, separate, and hidden from public view. Hence, physicians who look for or uncover violence in the family risk defilling a sacred object and violating norms of non-interference. Privacy beliefs also obfuscate the ethical analysis of physicians' duties to intercede on behalf of battered patients. Ethical principles of beneficence and nonmaleficence have been invoked to justify physicians' duties to abused patients; however, the principle of justice has not been invoked. Ethical analysis of physicians' duties in this area must be broadened to include the principle of justice. Justice is at stake because establishing conditions favorable to self-respect is a requirement of justice, and the response physicians make to battered patients carries important ramifications for supporting patients' self-respect and dignity. If justice forms part of the ethical foundation for physician intervention in domestic violence, mandatory steps that do not transgress the confidentiality of the physician-patient relationship or infringe the patient's autonomy should be taken, such as requiring domestic violence training in medical education and following treatment plans and protocols to identify abuse and provide assistance to battered patients.
与家庭相关的隐私观念阻碍了医生对家庭暴力的应对。家庭作为一个私人领域，被视为神圣、独立且不为公众所见的。因此，在家庭中寻找或发现暴力行为的医生有亵渎神圣之物并违反不干涉规范的风险。隐私观念也模糊了医生代表受虐患者进行干预职责的伦理分析。已援引行善和不伤害的伦理原则来证明医生对受虐患者的职责；然而，尚未援引正义原则。对医生在这一领域职责的伦理分析必须加以扩展，以纳入正义原则。正义受到威胁，因为创造有利于自尊的条件是正义的一项要求，而且医生对受虐患者的反应对支持患者的自尊和尊严具有重要影响。如果正义构成医生干预家庭暴力的伦理基础的一部分，那么就应采取不违反医患关系保密性或侵犯患者自主权的强制性措施，比如在医学教育中要求进行家庭暴力培训，并遵循治疗计划和方案来识别虐待行为并为受虐患者提供帮助。
