新世纪的医师职业精神医师宣言.docx

新世纪的医师职业精神医师宣言.docx

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新世纪的医师职业精神医师宣言

新世纪的医师职业精神—医师宣言

新世纪的医师职业精神—医师宣言

《新世纪的医师职业精神———医师宣言》是由美国内科学基金、ACP基金和欧洲内科医学联盟共同发起和倡议,首次发表于2002年《美国内科医学年刊》和《柳叶刀》杂志。

到目前为止,已有包括美国、英国、法国、德国、加拿大等国在内的36个国家和地区的120个国际医学组织认可和签署了该宣言。

中国医师协会于2005年正式签署该宣言,加入推行《医师宣言》的活动。

《医师宣言》为当代医师提出了21世纪医学职业道德的行为规范和行为准则。

中国医师协会认为,《医师宣言》所提出的三项基本原则和十条职业责任完全符合世界各国医师职业道德要求;在医患矛盾突出的今天,实施《医师宣言》不仅是医师行业自律的体现,而且也有助于医师良好社会形象的树立。

本刊全文发表中英文《新世纪的医师职业精神———医师宣言》,希望它能作为医师职业道德的教材,贯穿在医学教育的各个阶段和整个过程,并最终体现在医学工作者的职业生涯中。

“德为医之本,德高则医粹”。

认真学习《医师宣言》,树立良好职业精神,既有利于医师职业生涯的发展,更有利于为人民的健康服务。

做人民满意的医师是医学工作者的崇高目标,任重而道远,让我们携起手来,脚踏实地,为实现这一目标作出不懈的努力。

前言

医师专业精神是医学与社会达成契约的基础。

它要求将患者的利益置于医师的利益之上，要求制定并维护关于能力和正直的标准，还要求就健康问题向社会提供专业意见。

医学界和社会必须清楚了解医师专业精神的这些原则和责任。

医学与社会达成承诺的本质是公众对医师的信任，这种信任是建立在医师个人以及全行业的正直基础上。

目前，医学界面临着科技爆炸、市场力量介入医疗体系、医疗卫生实施中存在的问题、生物恐怖主义以及全球化所带来的压力。

结果，医师发现越来越难以承担他们对患者和社会所肩负的责任。

在这种情况下，重申医师专业精神根本的、普遍的原则和价值——即所有医师追求的理想，变得尤为重要。

医学虽然植根于不同的文化和民族传统之中，但是医学工作者扮演的都是治病救人的角色，它的根源可以追溯到希波克拉底。

实际上，医学界必须和错综复杂的政治力量、法律力量以及市场力量相抗争。

而且，医疗的实施与实践具有很大的差异，任何普遍性的原则都可以因这些差异而表现出各种复杂而微妙的形式。

尽管有这些差异存在，共同的宗旨仍然凸显出来并形成这一宣言的基础，它表现为3项基本原则以及一系列明确的职业责任。

thephysiciansworkingwithinthemremaincommittedbothtopatients'welfareandtothebasictenetsofsocialjustice.Moreover,thecharterisintendedtobeapplicabletodifferentculturesandpoliticalsystems.

Preamble

Professionalismisthebasisofmedicine'scontractwithsociety.Itdemandsplacingtheinterestsofpatientsabovethoseofthephysician,settingandmaintainingstandardsofcompetenceandintegrity,andprovidingexpertadvicetosocietyonmattersofhealth.Theprinciplesandresponsibilitiesofmedicalprofessionalismmustbeclearlyunderstoodbyboththeprofessionandsociety.Essentialtothiscontractispublictrustinphysicians,whichdependsontheintegrityofbothindividualphysiciansandthewholeprofession.

Atpresent,themedicalprofessionisconfrontedbyanexplosionoftechnology,changingmarketforces,problemsinhealthcaredelivery,bioterrorism,andglobalisation.Asaresult,physiciansfinditincreasinglydifficulttomeettheirresponsibilitiestopatientsandsociety.Inthesecircumstances,reaffirmingthefundamentalanduniversalprinciplesandvaluesofmedicalprofessionalism,whichremainidealstobepursuedbyallphysicians,becomesallthemoreimportant.

Themedicalprofessioneverywhereisembeddedindiverseculturesandnationaltraditions,butitsmemberssharetheroleofhealer,whichhasrootsextendingbacktoHippocrates.Indeed,themedicalprofessionmustcontendwithcomplicatedpolitical,legal,andmarketforces.Moreover,therearewidevariationsinmedicaldeliveryandpracticethroughwhichanygeneralprinciplesmaybeexpressedinbothcomplexandsubtleways.Despitethesedifferences,commonthemesemergeandformthebasisofthischarterintheformofthreefundamentalprinciplesandasasetofdefinitiveprofessionalresponsibilities.

Fundamentalprinciples

Principleofprimacyofpatients'welfare

Thisprincipleisbasedonadedicationtoservingtheinterestofthepatient.Altruismcontributestothetrustthatiscentraltothephysician–patientrelationship.Marketforces,societalpressures,andadministrativeexigenciesmustnotcompromisethisprinciple.

Principleofpatients'autonomy

Physiciansmusthaverespectforpatients'autonomy.Physiciansmustbehonestwiththeirpatientsandempowerthemtomakeinformeddecisionsabouttheirtreatment.Patients'decisionsabouttheircaremustbeparamount,aslongasthosedecisionsareinkeepingwithethicalpracticeanddonotleadtodemandsforinappropriatecare.

Principleofsocialjustice

Themedicalprofessionmustpromotejusticeinthehealthcaresystem,includingthefairdistributionofhealthcareresources.Physiciansshouldworkactivelytoeliminatediscriminationinhealthcare,whetherbasedonrace,gender,socioeconomicstatus,ethnicity,religion,oranyothersocialcategory.

Asetofprofessionalresponsibilities

Commitmenttoprofessionalcompetence

Physiciansmustbecommittedtolifelonglearningandberesponsibleformaintainingthemedicalknowledgeandclinicalandteamskillsnecessaryfortheprovisionofqualitycare.Morebroadly,theprofessionasawholemuststrivetoseethatallofitsmembersarecompetentandmustensurethatappropriatemechanismsareavailableforphysicianstoaccomplishthisgoal.

Commitmenttohonestywithpatients

Physiciansmustensurethatpatientsarecompletelyandhonestlyinformedbeforethepatienthasconsentedtotreatmentandaftertreatmenthasoccurred.Thisexpectationdoesnotmeanthatpatientsshouldbeinvolvedineveryminutedecisionaboutmedicalcare;rather,theymustbeempoweredtodecideonthecourseoftherapy.Physiciansshouldalsoacknowledgethat,inhealthcare,medicalerrorsthatinjurepatientsdosometimesoccur.Wheneverpatientsareinjuredasaconsequenceofmedicalcare,patientsshouldbeinformedpromptlybecausefailuretodososeriouslycompromisespatients'andsocietaltrust.Reportingandanalysingmedicalmistakesprovidesthebasisforappropriatepreventionandimprovementstrategiesandforappropriatecompensationtoinjuredparties.

Commitmenttopatients'confidentiality

Earningthetrustandconfidenceofpatientsrequiresthatappropriateconfidentialitysafeguardsbeappliedtodisclosureofpatients'information.Thiscommitmentextendstodiscussionswithpeopleactingonapatient'sbehalfwhenobtainingthepatient'sownconsentisnotfeasible.Fulfillingthecommitmenttoconfidentialityismorepressingnowthaneverbefore,giventhewidespreaduseofelectronicinformationsystemsforcompilingdataonpatientsandanincreasingavailabilityofgeneticinformation.Physiciansrecognise,however,thattheircommitmenttoconfidentialitymustoccasionallyyieldtoover-ridingconsiderationsinthepublicinterest（forexample,whenpatientsendangerothers）.

Commitmenttomaintainingappropriaterelationshipswithpatients

Giventheinherentvulnerabilityanddependencyofpatients,certainrelationshipsbetweenphysiciansandpatientsmustbeavoided.Inparticular,physiciansshouldneverexploitpatientsforanysexualadvantage,personalfinancialgain,orotherprivatepurpose.

Commitmenttoimprovingqualityofcare

Physiciansmustbededicatedtocontinuousimprovementinthequalityofhealthcare.Thiscommitmententailsnotonlymaintainingclinicalcompetencebutalsoworkingcollaborativelywithotherprofessionalstoreducemedicalerror,increasepatients'safety,minimiseoveruseofhealthcareresources,andoptimisetheoutcomesofcare.Physiciansmustactivelyparticipateinthedevelopmentofbettermeasuresofqualityofcareandtheapplicationofqualitymeasurestoassessroutinelytheperformanceofallindividuals,institutions,andsystemsresponsibleforhealthcaredelivery.Physicians,bothindividuallyandthroughtheirprofessionalassociations,musttakeresponsibilityforassistinginthecreationandimplementationofmechanismsdesignedtoencouragecontinuousimprovementinthequalityofcare.

Commitmenttoimprovingaccesstocare

Medicalprofessionalismdemandsthattheobjectiveofallhealthcaresystemsbetheavailabilityofauniformandadequatestandardofcare.Physiciansmustindividuallyandcollectivelystrivetoreducebarrierstoequitablehealthcare.Withineachsystem,thephysicianshouldworktoeliminatebarrierstoaccessbasedoneducation,laws,finances,geography,andsocialdiscrimination.Acommitmenttoequityentailsthepromotionofpublichealthandpreventivemedicine,aswellaspublicadvocacyonthepartofeachphysician,withoutconcernfortheself-interestofthephysicianortheprofession.

Commitmenttoajustdistributionoffiniteresources

Whilemeetingtheneedsofindividualpatients,physiciansarerequiredtoprovidehealthcarethatisbasedonthewiseandcost-effectivemanagementoflimitedclinicalresources.Theyshouldbecommittedtoworkingwithotherphysicians,hospitals,andpayerstodevelopguidelinesforcost-effectivecare.Thephysician'sprofessionalresponsibilityforappropriateallocationofresourcesrequiresscrupulousavoidanceofsuperfluoustestsandprocedures.Theprovisionofunnecessaryservicesnotonlyexposespatientstoavoidableharmandexpensebutalsodiminishestheresourcesavailableforothers.

Commitmenttoscientificknowledge

Muchofmedicine'scontractwithsocietyisbasedontheintegrityandappropriateuseofscientificknowledgeandtechnology.Physicianshaveadutytoupholdscientificstandards,topromoteresearch,andtocreatenewknowledgeandensureitsappropriateuse.Theprofessionisresponsiblefortheintegrityofthisknowledge,whichisbasedonscientificevidenceandphysicians'experience.

Commitmenttomaintainingtrustbymanagingconflictsofinterest

Medicalprofessionalsandtheirorganisationshavemanyopportunitiestocompromisetheirprofessionalresponsibilitiesbypursuingprivategainorpersonaladvantage.Suchcompromisesareespeciallythreateninginthepursuitofpersonalororganisationalinteractionswithfor-profitindustries,includingmedicalequipmentmanufacturers,insurancecompanies,andpharmaceuticalfirms.Physicianshaveanobligationtorecognise,disclosetothegeneralpublic,anddealwithconflictsofinterestthatariseinthecourseoftheirprofessionaldutiesandactivities.Relationshipsbetweenindustryandopinionleadersshouldbedisclosed,especiallywhenthelatterdeterminethecriteriaforconductingandreportingclinicaltrials,writingeditorialsortherapeuticguidelines,orservingaseditorsofscientificjournals.

Commitmenttoprofessionalresponsibilities

Asmembersofaprofession,physiciansareexpectedtoworkcollaborativelytomaximisepatients'care,berespec