Peppin J F
Department of Surgery, University of Osteopathic Medicine and Health Sciences, Des Moines, IA, USA.
J Med Philos. 1997 Dec;22(6):623-41. doi: 10.1093/jmp/22.6.623.
Physician conflict of interest has been of concern since Hippocrates and rarely is this concern more evident than in the relationship between pharmaceutical sales representatives (PSR) and physicians. Given the acrimonious public debates concerning this issue a careful exploration of the concerns at sake and the conceptual arguments which support such concerns is called for. In this piece I will take as heuristic the conceptual philosophical framework argued for by H. Tristram Engelhardt. This framework would sanction interactions between PSRs and physicians given that such relationships are free and without coercion. Further, patients must be informed, uncoerced and free in choosing such relationships with physicians who engage in interactions with PSRs. I consider four major criticisms which claim that PSR-physician interactions are morally impermissible: 1) influence, 2) "patients do not choose, but they pay," 3) violation of ethical principles, and 4) erosion of the patient-physician relationship. Each is shown to be unpersuasive under Engelhardtian philosophy. As long as the principle of permission and informed consent obtain without coercion than the interaction between PSRs and physicians would be construed to be morally permissible.
自希波克拉底时代以来，医生的利益冲突就备受关注，而这种关注在制药销售代表（PSR）与医生的关系中表现得最为明显。鉴于围绕这个问题的激烈公开辩论，有必要仔细探讨其中涉及的问题以及支持这些问题的概念性论据。在本文中，我将采用H. 特里斯特拉姆·恩格尔哈特提出的概念性哲学框架作为启发。该框架将认可PSR与医生之间的互动，前提是这种关系是自由且无强制的。此外，患者在选择与与PSR互动的医生建立这种关系时，必须得到充分告知、未受强制且完全自由。我考虑了四项主要批评意见，它们声称PSR与医生之间的互动在道德上是不允许的：1）影响，2）“患者没有选择，但却要付费”，3）违反伦理原则，4）医患关系的侵蚀。在恩格尔哈特的哲学观点下，每一项批评都被证明是没有说服力的。只要允许原则和知情同意在没有强制的情况下得到落实，那么PSR与医生之间的互动就会被视为在道德上是允许的。
