摘要
医生道德形象是医生道德行为的综合体现,包括医生对所从事职业道德属性的认识,关心与帮助患者的道德价值追求,为患者健康服务的道德责任,它引导着医生的行为内容和行动方式。同时医生的道德形象要受到患者评价,评价影响着医生道德形象坚持或改变,所以医生道德影响也隐含着医生与患者彼此的要求与期待,是医患关系的投射。在当前社会中,医患之间在对医生道德形象认识上存在较大分歧,分歧主要来自三方面:一是对医生道德责任边界定位的差异。医务人员倾向以“守规则”来解释责任,使责任具体可把握,却可能在规则未至之处有意无意地“祛责”;患者则希望医生都是美德楷模,但要求过高会使医生对责任心生距离即“怯责”。二是医患双方在技术话语与道德话语上的博弈。医者希望将道德形象简单化,凸显技术形象,以强化医师在医疗活动中的主导地位;而患者则希望自身需求和意见能够受到医师的重视,对道德形象有更高要求,以弥补自身在医生技术权威下的弱势。三是道德与利益间的权衡。主要是医生是否该求利,求利的程度,求道德名声还是物质利益等义利问题上的矛盾。要消弭分歧以建设和谐医患关系,需要医患双方在观念及行为上进行协调。首先,将“好人医生”作为形象建设的定位。“好人”一方面明确医生职业所具有的道德属性,另一方面需以做得好与活得好相结合为旨归,兼具内在与外在善。其次,医患双方接纳医生道德形象的层次性。对医生道德形象的不同层次的认识、要求都应该得到尊重与包容。第三,实现技术话语与道德话语相交融。医生在诊疗中应以患者为主体,技术话语为患者服务,注重患者在道德话语中的要求;同时又根据患者情况与情境,选择两种话语融合的方式,体现主导性。第四,设计相应机制进行保障。包括各方的平等对话机制、保障权责统一的机制和起“公正旁观者”作用的监督机制。
The moral image of doctors is a comprehensive embodiment of doctors’moral behavior,including:the doctors’understanding of the professional moral attributes they are engaged in,the moral value of caring for and helping patients,and the moral responsibility for serving patients’health.It guides the content and behavior of doctors.At the same time,the moral image of doctors should be evaluated by patients,and the evaluation will affect the persistence or change of the moral image of doctors.Therefore,the moral impact of doctors also implies the requirements and expectations of doctors and patients,which is the projection of the doctor-patient relationship.In the current society,there are major differences between doctors and patients in the moral image of doctors,which mainly come from three aspects:one is the difference in the positioning of doctors’moral responsibility boundaries.Medical personnel tend to explain their responsibilities by“observing the rules”,so as to make their responsibilities specific and understandable,but they may“dismiss”consciously or unintentionally where the rules are not yet reached;while patients want doctors to be model virtues,but excessive demands will make doctors the distance to responsibility,that is“cowardice”.The second is the game between doctors and patients on technical discourse and moral discourse.Doctors hope to simplify the moral image and highlight the technical image to strengthen the dominant position of physicians in medical activities;while patients hope that their needs and opinions can be valued by doctors and have higher requirements on moral image to make up for their weakness under the technical authority of doctors.The third is the balance between morality and interests.It is mainly the contradiction on whether the doctor should seek profit,the degree of profit,the moral reputation or the material benefit,and other contradictions.To eliminate differences and build a harmonious doctor-patient relationship,it is necessary for the doctors and patients to coordinate in their concepts and behaviors.Firstly,the“good doctor”as the image construction positioning.On the one hand,a good person should be clear about the moral attributes of medical profession.On the other hand,he should combine doing well with living well and be good both internally and externally.Secondly,both the doctor and the patient accept the hierarchy of the doctor’s moral image.Different levels of understanding and requirements of doctors’moral image should be respected and tolerated.Thirdly,the integration of technical discourse and moral discourse should be realized.In the diagnosis and treatment,doctors should take patients as the main body,serve patients with technical discourse,and pay attention to the requirements of patients in moral discourse.At the same time,according to the patient’s situation and situation,two ways of discourse fusion are selected to reflect the dominance.Fourth,the corresponding mechanisms should be designed to provide safeguards.It includes an equal dialogue mechanism for all parties,a mechanism to guarantee the unification of powers and responsibilities,and a supervisory mechanism to play the role of a“just bystander”.
作者
莫楠
MO Nan(School of Health,Fujian Medical University,Fuzhou 350122,China)
出处
《中国医学伦理学》
2020年第5期583-589,共7页
Chinese Medical Ethics
基金
福建省社会科学规划一般项目“公共卫生信息活动中的道德冲突与伦理风险研究”(FJ2018B164)
福建省中青年教师教育科研项目“当前医生道德形象的医患认识研究——以福建省为例”(JAS160208)
福建医科大学教育教学改革研究项目“基于互联网+人文医学执业技能培养的医学伦理学题库建设与运用研究”(J17030)。
关键词
医生道德形象
医患关系
责任
技术
利益
Moral Image of Doctor
Doctor-patient Relationship
Responsibility
Technology
Interests
