TELLING THE TRUTH AND MEDICAL-ETHICS
TELLING THE TRUTH AND MEDICAL-ETHICS
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DOI：
10.1136/bmj.291.6508.1556
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发表时间：
1985-01-01
影响因子：
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通讯作者：
GILLON, R
中科院分区：
文献类型：
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作者：
GILLON, R
在这一系列文章中，我讨论了任何适当的医学伦理学哲学理论所要求的指导行动的四个原则：尊重人的原则，特别是尊重他们的自主权;仁慈原则;不伤害原则;正义原则。许多道德辩论要么源于对范围的分歧（关于什么样的实体应该受到什么样的道德关注），要么源于对这四个原则的相对重要性的分歧。在接下来的四篇文章中，我将研究医学伦理学背景下的冲突例子，这些冲突主要是一方面尊重自主性原则与另一方面仁慈和不伤害原则之间的冲突。讲真话”多有智慧，就多有愁烦;加增知识的，就加增忧伤”（传道书1：18）。因此，莫里斯·戴维森博士在他1957年的医学伦理学著作中开始了他关于讲真话的一章。然而，戴维森反对这样一种倾向，即”许多医生对病人隐瞒事实，特别是在重病的情况下，并坚持必须不惜一切代价对他们隐瞒真相。他认为这是一种完全不合理的”恋物癖”，并认为诚实地回答那些想了解自己病情的病人很少会造成真实的伤害。他们可能有”至关重要的职责”，只有在得到这些信息的情况下才能履行，而从长远来看，未能泄露简单的事实是”最大痛苦的常见原因。戴维森坦率地承认，在医生中，他持有这些观点是不寻常的，但他仍然不相信他的同事反对这种坦率的论点”只是逃避公认的极其不愉快的责任的借口。“虽然我同情戴维森的立场，但我认为相反的立场需要更多的考虑。在医疗实践中，无论是在致命或严重疾病的背景下，还是在告知患者治疗或研究的风险时，欺骗的案例通常基于三个主要论点（哲学家Sissela Bok在她的书中优雅地剖析了许多其他论点）。
In this series I have discussed four principles for guiding action that seem to be required by any adequate philosophical theory of medical ethics: a principle of respect for persons, notably for their autonomy; a principle of beneficence; a principle of non-maleficence; and a principle of justice. Much moral debate stems either from disagreement about scope (about what sorts ofentity are owed what sorts of moral concern) or from disagreement about the relative importance of these four principles. In the next four articles I shall look at examples of conflicts in the context of medical ethics that are primarily between the principle ofrespect for autonomy on one hand and the principles of beneficence and non-maleficence on the other. I shall start with the issue of telling the truth.Telling the truth" In much wisdom is much grief: and he that increaseth knowledge increaseth sorrow"-(Ecclesiastes i, 18). Thus Dr Maurice Davidson began his chapter on truth telling in his 1957 book on medical ethics.'Davidson, however, argued against the tendency of" so many medical practitioners to withhold the facts from their patients, especially in cases ofgrave illness, and to insist that the truth must at all costs be kept from them." Rejecting this as a" fetich," which was wholly unjustifiable, he argued that real harm rarely resulted from honesty in response to patients who wanted reliable information about their condition. They might have" vitally important duties" that they could carry out only if they were given such information, and failure to divulge the plain facts was in the long run" a frequent cause of the greatest distress." As Davidson freely admitted, he was unusual among doctors in holding these views, but he remained unconvinced that the arguments of his colleagues against such frankness were" anything but an excuse for evading what is admittedly an extremely unpleasant duty." Sympathetic as I am to Davidson's position, I think the opposing position needs more consideration. The case for deception in medical practice, whether in the context of fatal or grave disease or in informing patients of the risks of treatment or research, is usually based on three major arguments (elegantly dissected, among many others, by the philosopher Sissela Bok in her book Lying/).