Why health services research needs bioethics.
Why health services research needs bioethics.
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为什么卫生服务研究需要生物伦理学。
DOI：
10.1136/medethics-2017-104247
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发表时间：
2017
影响因子：
4.1
通讯作者：
Frith L
中科院分区：
文献类型：
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作者：
Frith L
近20年前，托尼·霍普（Tony Hope）在《经验医学伦理学》（Empirical Medical Ethics）杂志上发表了一篇社论，主张承认在“经验伦理学”方面所做的工作越来越多，并认为它作为医学伦理学研究的新方向的重要性。从那时起，经验伦理学蓬勃发展，关于“经验”数据在伦理推理中的作用的辩论产生了越来越多的文献，JME和其他生物伦理学期刊定期发表经验研究。虽然生物/医学伦理学在伦理分析中努力“纳入”或使用更多的经验数据，取得了不同程度的成功，并受到一些批评，但更多的经验学科并没有相应的意愿来接受伦理分析。这是一个特别缺乏应用研究领域，认为他们的作用主要影响政策和做法，如卫生服务研究。卫生服务研究是流行病学、社会学、经济学和其他分析科学在卫生服务研究中的综合。其“主要目标......是确定组织，管理，融资和提供高质量护理的最有效方法;减少医疗差错;并提高患者安全性”。2.卫生服务研究汇集了各种学科，似乎最好包括伦理学。然而，如果你搜索卫生服务研究期刊和会议计划，很少考虑伦理作为一个实质性的话题，往往很少关注干预或政策可能引起的伦理问题。伦理和伦理问题通常仅限于优先事项设定的讨论，偶尔还有卫生技术评估，卫生服务研究的其他领域很少参与伦理辩论。在《卫生服务研究百科全书》中，3伦理学仅仅是从研究伦理学批准的角度来处理的。虽然伦理学的认可显然很重要，但这只是伦理学对更广泛的卫生服务研究所能做出的贡献中的一小部分。一般来说，伦理学在很大程度上被忽视了（除了一些值得注意的例外，如Trisha Geenhalgh和玛丽迪克森-伍兹的工作）。人们担心在整个卫生服务研究中做出道德判断，抵制纳入被视为主观意见的观点，因为这种观点在以自然科学为模型的知识体系中没有地位。价值观被视为个人的，并引入了一种形式的偏见，讨论应该是关于“科学”，而不是意见。正如韦伯所说，“每当一个科学家提出他个人的价值判断时，对事实的充分理解就停止了。”塞耶4认为，这种观点，即任何道德评估只是不合理的主观意见，是明显的尝试在一个关键的社会科学，那里一直不愿意作出道德判断，由于夸大了民族中心主义或误判的恐惧。这方面的一个例子是，在一次关于她的书《基因》的采访中，
It is nearly 20years since Tony Hope wrote an editorial in this journal on Empirical Medical Ethics, 1 arguing for both a recognition of the increasing amount of work being done in ‘empirical ethics’ and for its importance as a new direction for medical ethics research. Since then empirical ethics has flourished, with debates over the role of ‘empirical’data in ethical reasoning producing a growing body of literature and the JME and other bioethics journals regularly publishing empirical studies. While bio/medical ethics has grappled with ‘incorporating’or using more empirical data in ethical analysis, with varying degrees of success, and some criticism, there has not been a corresponding willingness of more empirical disciplines to embrace ethical analysis. This is a particular lack for applied research areas that see their role as predominately influencing policy and practice, such as health services research. Health services research ‘is the integration of epidemiological, sociological, economic, and other analytic sciences in the study of health services.’Whose ‘main goals… are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety’. 2 Health services research brings together a wide variety of disciplines and would seem ideally placed to include ethics. However, if you search health services research journals and conference programmes there is very little consideration of ethics as a substantive topic and often scant attention paid to the ethical issues that might be raised by an intervention or policy. Ethics and ethical issues are generally confined to discussions over priority setting, and occasionally health technology assessment, with other areas of health service research seldom engaging in ethical debate. In the Encyclopaedia of Health Services Research, 3 ethics is addressed simply in terms of research ethics approval for studies. While ethical approval is clearly important—it is only one small part of what ethics can contribute to wider health services research. Generally ethics has largely been ignored (with some notable exceptions such as the work of Trisha Geenhalgh and Mary Dixon-Woods). There is a fear of making ethical judgements across health services research, with resistance to the inclusion of what is seen as subjective opinion that has no place in a body of knowledge that models itself on the natural sciences. Values are seen as personal and introduce a form of bias into discussions that should be about ‘science’not opinion. As Weber put it,‘Whenever a person of science introduces his personal value judgement, a full understanding of the facts ceases’. Sayer 4 argues that this view, that any ethical assessment is merely unjustified subjective opinion, is apparent in attempts at a critical social science, where there has been reluctance to make ethical judgements due to an exaggerated fear of ethnocentrism or misjudgement. An example of this is, in an interview about her book The Gene, the