Abstract

Statements of the core ethical and professional responsibilities of medical professionals are incomplete in ways that threaten fundamental goals of medicine. First, in the absence of explicit guidance for responding to cases in which there is significant uncertainty or disagreement about the relative therapeutic, prophylactic or diagnostic merits of available interventions they perpetuate self-defeating practices. Second, without addressing the role of advertising in shaping patient and community preferences they risk creating moral loopholes that bypass and undermine professional duties of fidelity, honesty and transparency. In both cases, these flaws are exacerbated by an individualism that ignores the critical role of health systems in managing and reducing uncertainty and conflict over best practices, and in communicating with and shaping the expectations of the public. These points are illustrated with examples from the response to COVID-19 and suggestions for reform are proposed.

摘要

关于医学专业人员的核心道德和专业责任的陈述，以威胁医学基本目标的方式，是不完整的。首先，由于缺乏明确的指导方针来应对那些存在严重不确定性或对可用干预措施的相对治疗，预防或诊断优点存在分歧的案例，因此，这些措施会使自残行为长期存在。其次，如果不解决广告在塑造患者和社区偏好方面的作用，他们就有可能造成道德漏洞，从而绕过并破坏忠实，诚实和透明的专业职责。在这两种情况下，个人主义都会加剧这些缺陷，而忽略了卫生系统在管理和减少最佳实践中的不确定性和冲突方面的关键作用，这会加剧个人缺陷，与公众沟通并塑造公众的期望。通过对COVID-19的回应举例说明了这些观点，并提出了改革建议。