PDF(Pubmed)
Abstract：
The shape and function of ethical imperatives may vary if the context is an interaction between strangers, or those who are well acquainted. This idea, taken up from Stephen Toulmin\'s distinction between an \"ethics of strangers\" and an \"ethics of intimacy\", can be applied to encounters in healthcare. There are situations where healthcare personnel (HCP) know their patients (corresponding to an \"ethics of intimacy\") and situations where HCP do not know their patients (corresponding to \"an ethics of strangers\"). Does it make a difference for normative imperatives that follow from central concepts and principles in medical ethics whether HCP know their patients or not? In our view, this question has not yet been answered satisfactorily. Once we have clarified what is meant by \"knowing the patient\", we will show that the distinction is particularly relevant with regard to some thorny questions of autonomy in healthcare (e.g., regarding advance directives or paternalism in the name of autonomy), whereas the differences with regard to imperatives following from the principles of justice and beneficence seem to be smaller. We provide a detailed argument for why knowing the patient is ethically valuable in encounters in healthcare. Consequently, healthcare systems should provide fertile ground for HCP to get to know their patients, and structures that foster therapeutic continuity. For this to succeed, a number of questions still need to be clarified, which is an important task for medical ethics.
摘要：
如果上下文是陌生人之间的互动，那么道德准则的形状和功能可能会有所不同，或熟悉的人。这个想法,从StephenToulmin对“陌生人伦理”和“亲密伦理”的区分中获得，可以应用于医疗保健中的遭遇。在某些情况下，医护人员（HCP）了解他们的患者（对应于“亲密伦理”），而在某些情况下，HCP不了解他们的患者（对应于“陌生人伦理”）。DoitmakeadifferencefornormativeemorativesthatfollowedfromcentralconceptsandprinciplesinmedicaletherHCPknowtheirpatientsornot?Inourview,这个问题还没有得到令人满意的回答。一旦我们澄清了“了解病人”的含义，我们将证明，这种区别与医疗保健中一些棘手的自治问题特别相关(例如，关于以自治名义的预先指令或家长制)，而从正义和慈善原则出发的必要性差异似乎更小。我们提供了详细的论据，说明为什么在医疗保健中认识患者在道德上是有价值的。因此,医疗保健系统应该为HCP了解患者提供肥沃的土壤，以及促进治疗连续性的结构。为了成功，还有一些问题需要澄清，这是医学伦理学的一项重要任务。
