Avoiding cheap grace. Medical harm, patient safety, and the culture(s) of forgiveness.
Avoiding cheap grace. Medical harm, patient safety, and the culture(s) of forgiveness.
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避免廉价的恩典。
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发表时间：
2003
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通讯作者：
N. Berlinger
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作者：
N. Berlinger
Dena Davis将宗教伦理学家在临床问题上的工作定义为描述真实的人真正相信什么以及他们如何真正行动。(2)如果是这样的话，那么来自宗教和文化相关方面的见解可能有助于负责满足患者安全新标准的医院管理者认识到宽恕长期以来在个人之间和社区内发挥的恢复作用，并将宽恕纳入他们处理导致伤害，死亡，或其他创伤）随之而来的是一个广泛的“宗教研究”，而不是严格的“神学”或“教义”的角度来看待宽恕，一个融合了犹太教和基督教社会伦理，仪式研究，医学社会学和医学人类学的见解，以及临床医生本身。也就是说，从基督教神学家Dietrich Bonhoeffer那里借来的几个概念--其中包括“廉价的恩典”--是我反对所谓“宽恕作为自我解释原则”的论点的组成部分。“我在这里的意思是一种制定宽恕的方式，这样它的关系特征-各种行为者为了宽恕而相互采取的行动-就被遗忘了。这种对宽恕的关系性理解可能会被一种廉价的仁慈所取代，这种仁慈在将宽恕表述为自动的过程中，要么承认受害者没有作为宽恕代理人的角色，要么假设这个人应该在没有披露、道歉、问责、赔偿或我们可能置于正义原则之下的其他物品的情况下提供宽恕。在医疗伤害的情况下，专业护理人员，包括临床医生，牧师，社会工作者或牧师，也可能对病人和家人施加压力，要求他们自动原谅-提醒他们“好人是宽恕的”，或者向他们保证，提供宽恕会给他们带来“关闭”，或者告诉他们，毕竟，没有人想伤害他们--即使病人和家属的痛苦延长了，因为他们不知道到底发生了什么，或者因为那些直接负责的人没有承认他们的痛苦。在避免非关系性的宽恕方法时，我们必须记住，“宽恕”是一个两面神的词。它有着相互矛盾的含义--参与和分离--在日常谈话和学术话语中经常被混淆或没有充分区分。在犹太教和基督教的传统中，宽恕的最深层含义是超然。宽恕作为廉价的恩典，作为权利而不是结果，忽视了这一深刻的意义，拒绝询问那些因医疗错误而受到伤害的人可能需要什么才能达到超然，或者迫使他们参与或默许，甚至进入一个神圣的，救赎的角色，而不是让超然随着时间的推移而发生-基督教圣经称之为kairos，适当的时间，而不是chronos，时间顺序一旦正义得到伸张(4)主张在医疗伤害后宽恕的定义，将超然作为这一过程的最终目标，并不意味着受伤的病人-或犯了错误的临床医生-应该简单地鼓励“超然”于医疗伤害事件，以及他们对这些事件的感受。宽恕不仅仅意味着超脱。即使在世俗的人际关系中，宽恕作为超然也可能不令人满意：在我们成功地从痛苦的情境中情感上超然出来之后，如果我们认为这样做是在为不良行为开脱，而不是肯定改变了的行为，我们可能仍然会犹豫是否要说“我原谅你”。关于犹太教和基督教传统的一个警告是：虽然它们对西方文化和西方医学的影响并不总是被承认的，但它们并不普遍。…
Dena Davis defines the job of the religious ethicist working on clinical issues as describing what real people really believe and how they really act. (2) If so, then insights from religion and related aspects of culture may help hospital administrators charged with meeting new standards for patient safety to recognize the restorative role that forgiveness has long played between individuals and within communities and to incorporate forgiveness into their systems for dealing with medical mistakes that lead to injury, death, or other trauma) What follows is a broad "religious studies" rather than a strictly "theological" or "doctrinal" perspective on forgiveness, one that incorporates insights from Jewish and Christian social ethics, ritual studies, sociology of medicine, and medical anthropology, as well as from clinicians themselves. That said, several concepts borrowed from Christian theologian Dietrich Bonhoeffer--"cheap grace" among them--are integral to my argument against what might be termed "forgiveness as self-interpreting principle." What I mean here is a way of formulating forgiveness so that its relational character--the actions that various actors undertake in relation to one another so forgiveness can take place--is forgotten. This relational understanding of forgiveness may be replaced by a cheap grace that, in formulating forgiveness as automatic, either acknowledges no role for the injured person as agent of forgiveness, or assumes that this person should offer forgiveness in the absence of disclosure, apology, accountability, compensation, or other goods that we might place under the principle of justice. In cases of medical harm, a cheap grace approach on the part of professional caregivers, including clinicians, chaplains, social workers, or pastors, may also place pressure on a patient and family to forgive automatically--by reminding them that "good people are forgiving," or by assuring them that offering forgiveness will bring them "closure," or by telling them that, after all, nobody meant to harm them--even as the patient's and family's distress is prolonged because they do not know what really happened, or because there is no acknowledgment of their suffering by those directly responsible for it. In avoiding non-relational approaches to forgiveness, we must keep in mind that "forgiveness" is a Janus-faced word. It holds contradictory meanings--to engage and to detach--that are often conflated or insufficiently distinguished in everyday conversation as well as scholarly discourse. In the Jewish and Christian traditions, the deepest meaning of forgiveness is detachment. Forgiveness as cheap grace, as entitlement rather than outcome, ignores this deep meaning by refusing to ask what those harmed through medical mistakes may need in order to achieve detachment, or by pressuring them into engagement or acquiescence, even into a divine, salvific role, instead of allowing detachment to take place over time--in what the Christian Bible refers to as kairos, the appropriate time, as opposed to chronos, chronological time--once justice has been secured. (4) Arguing for a definition of forgiveness after medical harm that holds detachment as the ultimate goal of the process does not mean that injured patients--or clinicians who have made errors--should simply be encouraged to "detach" from incidents of medical harm, and from their feelings concerning these incidents. Forgiveness entails more than detachment. Even in mundane interpersonal situations, forgiveness-as-detachment can be unsatisfying: after we have succeeded in emotionally detaching ourselves from a painful situation, we may still hesitate to say "I forgive you" if we believe that, by doing so, we are excusing bad behavior rather than affirming changed behavior. One caution about the Jewish and Christian traditions is in order: while they are powerful if not always acknowledged influences upon Western culture and Western medicine, they are not universal. …