Apologies in the Healthcare System: From Clinical Medicine to Public Health
Apologies in the Healthcare System: From Clinical Medicine to Public Health
复制标题
医疗保健系统中的道歉：从临床医学到公共卫生
DOI：
--
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
N. Davidovitch
中科院分区：
文献类型：
--
作者：
M. Alberstein;N. Davidovitch
近年来，正式和非正式的倡议，促进了包括道歉在医学教育和临床实践。许多国家甚至通过法律对医疗道歉进行了规范。虽然已经有很多关于道歉的潜力，以促进效率和成功的道歉的条件的讨论，重点主要仍然是医患关系。(1)文献和许多干预计划都集中在医生和病人之间的互动后，医疗错误已经发生或造成一些伤害。这些互动已经概念化的个人主义设置，几乎没有讨论集体和文化层面的道歉。此外，也没有提到公共卫生活动造成集体创伤后道歉的案例。这些案件涉及国家活动，如人体实验或公共卫生干预，这些活动出了问题，与通常的医患互动有着根本的不同。在这篇文章中，我们从更广泛的角度探讨了道歉在医疗系统中的作用。本文首先探讨了医疗系统内的道歉的现状，并试图指出目前的个人主义观点的局限性，医疗道歉的概念。文章提出，以克服这些局限性，丰富现有的话语提到道歉的文化和集体方面。它解决了道歉的社会团结方面的意义，并展示了在每一个道歉的情况下，需要文化身份之间的冲突的方式。接下来，文章的主要部分扩大了道歉的辩论，提出了一个公共卫生的角度道歉集体创伤事件后，如绝育法或有缺陷的人体实验在各种设置的应用。本文展示了一些公共卫生道歉未能解决医疗保健问题的文化层面，以及如何强调这一层面可以帮助公共卫生实践的道歉。最后，文章回到道歉的临床设置，并显示在这个更常见的情况下，文化和身份的关注的相关性。我们主张，公共卫生角度的道歉，应丰富讨论更个性化的临床医疗道歉。我们的分析也对将健康相关的道歉引入医疗和法律的教育以及日常实践具有启示意义。二、保健系统中的道歉：条件和限制道歉与法律传统上被认为是一种私人行为，通常不受法律的机构的鼓励或强制执行。(2)道歉被认为是人际关系的一个方面，而现代法律的作用是在个人无法自行解决争端时将破裂的人际关系外化。(3)法治概念的基础是受法律管辖并拥有法律的权利的个人之间的异化关系。(4)在传统的正式法律观念下，道歉是不必要的，因为法律的权利确定应该通过给予补救和正式调整当事人之间的关系来平衡错误。道歉通常表现为一种言语行为，即说话人通过说出在受话人中产生特定效果的话语来实施的行为。(5)然而，道歉的成功或失败取决于是否满足基本条件。道歉作为现代文化中的一种言语行为，需要具备一定的条件，才能真实地表达出来。道歉的条件通常规定如下：（8）1。承认合法的规则、道德规范或社会关系被破坏。对犯罪的适当承认包括犯罪者的身份和犯罪的适当细节。…
I INTRODUCTION In recent years, both formal and informal initiatives have promoted the inclusion of apologies in medical education and clinical practices. Many countries have even regulated medical apologies through law. Although there has been much discussion of the potential for apology to promote efficiency and the conditions for a successful apology, the focus has mainly remained the doctor-patient relationship. (1) The literature and many intervention programs have focused on the interactions between doctors and patients after a medical mistake has occurred or some harm has resulted. These interactions have been conceptualized in individualistic settings, with almost no discussion of the collective and cultural dimensions of apology. Moreover, no reference has been made to cases of apology following collective trauma caused by public health activities. These cases involve state activities such as human experimentation or public health interventions that went wrong and are fundamentally different from the usual doctor-patient interaction. In this article, we explore the role of apologies in healthcare systems from a broader perspective. The article begins by exploring the current state of apology within the healthcare system and tries to point out the limitations of the current individualistic point of view under which medical apologies are conceptualized. The article offers to overcome these limitations and enrich the existing discourse by referring to the cultural and collective aspects of apology. It addresses the significance of apology in terms of social solidarity and demonstrates the ways in which each apology situation entails a clash between cultural identities. Next, the main part of the article expands the debate on apology by presenting a public health perspective of apologies following collective traumatic events such as the application of sterilization laws or flawed human experimentations in various settings. The article shows how some public health apologies have failed to address the cultural dimension of a healthcare problem and how an emphasis on this dimension can help the public health practice of apology. Finally, the article returns to apologies in the clinical setting and shows the relevance of culture and identity concerns in this more common context. We claim that the public health perspective of apologies should enrich discussion of the more individualistic-oriented clinical medical apologies. Our analysis also has implications for introducing health-related apologies into medical and legal education and everyday practices. II APOLOGIES IN THE HEALTHCARE SYSTEM: CONDITIONS AND LIMITATIONS A. Apologies and the Law Apology is traditionally considered as a private act and usually not encouraged or enforced by legal institutions. (2) Apology is considered an aspect of interpersonal relationships, while the role of modern law is to externalize broken interpersonal relationships when individuals are unable to settle disputes on their own. (3) The notion of the rule of law is based on alienated relationships between separate individuals who are governed by law and possess legal rights. (4) Apology, under a classic formal perception of law, is unnecessary since the legal determination of rights is supposed to balance the wrong by giving a remedy and officially regulating the relationship between the parties. Apology is usually presented as a speech act--an act that a speaker performs by uttering words that produce a particular effect in the addressee. (5) Yet apology can fail or succeed depending on whether basic conditions are met. Apology as a speech act in modern culture (6) requires a few conditions (7) in order to be authentic and achieve full expression. The conditions of apology are usually stipulated as follows: (8) 1. Acknowledgement that a legitimate rule, moral norm, or social relationship was broken. Proper acknowledgement of the offense includes the identity of the offender and appropriate details of the offense. …