新世纪的医师职业精神医师宣言.docx

1、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

2、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

3、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

4、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。the physicians working within them remain committed both to patients welfare and to the basic tenets of social justice. Moreover, the charter is intended to be applicable to different cultures and politic

5、al systems.PreambleProfessionalism is the basis of medicines contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health. The principles an

6、d responsibilities of medical professionalism must be clearly understood by both the profession and society. Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and the whole profession.At present, the medical profession is confronte

7、d by an explosion of technology, changing market forces, problems in healthcare delivery, bioterrorism, and globalisation. As a result, physicians find it increasingly difficult to meet their responsibilities to patients and society. In these circumstances, reaffirming the fundamental and universal

8、principles and values of medical professionalism, which remain ideals to be pursued by all physicians, becomes all the more important.The medical profession everywhere is embedded in diverse cultures and national traditions, but its members share the role of healer, which has roots extending back to

9、 Hippocrates. Indeed, the medical profession must contend with complicated political, legal, and market forces. Moreover, there are wide variations in medical delivery and practice through which any general principles may be expressed in both complex and subtle ways. Despite these differences, commo

10、n themes emerge and form the basis of this charter in the form of three fundamental principles and as a set of definitive professional responsibilities.Fundamental principlesPrinciple of primacy of patients welfareThis principle is based on a dedication to serving the interest of the patient. Altrui

11、sm contributes to the trust that is central to the physicianpatient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle.Principle of patients autonomyPhysicians must have respect for patients autonomy. Physicians must be honest with their

12、 patients and empower them to make informed decisions about their treatment. Patients decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.Principle of social justiceThe medical profession must

13、 promote justice in the healthcare system, including the fair distribution of healthcare resources. Physicians should work actively to eliminate discrimination in healthcare, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.A set of professional

14、responsibilitiesCommitment to professional competencePhysicians must be committed to lifelong learning and be responsible for maintaining the medical knowledge and clinical and team skills necessary for the provision of quality care. More broadly, the profession as a whole must strive to see that al

15、l of its members are competent and must ensure that appropriate mechanisms are available for physicians to accomplish this goal.Commitment to honesty with patientsPhysicians must ensure that patients are completely and honestly informed before the patient has consented to treatment and after treatme

16、nt has occurred. This expectation does not mean that patients should be involved in every minute decision about medical care; rather, they must be empowered to decide on the course of therapy. Physicians should also acknowledge that, in healthcare, medical errors that injure patients do sometimes oc

17、cur. Whenever patients are injured as a consequence of medical care, patients should be informed promptly because failure to do so seriously compromises patients and societal trust. Reporting and analysing medical mistakes provides the basis for appropriate prevention and improvement strategies and

18、for appropriate compensation to injured parties.Commitment to patients confidentialityEarning the trust and confidence of patients requires that appropriate confidentiality safeguards be applied to disclosure of patients information. This commitment extends to discussions with people acting on a pat

19、ients behalf when obtaining the patients own consent is not feasible. Fulfilling the commitment to confidentiality is more pressing now than ever before, given the widespread use of electronic information systems for compiling data on patients and an increasing availability of genetic information. P

20、hysicians recognise, however, that their commitment to confidentiality must occasionally yield to over-riding considerations in the public interest (for example, when patients endanger others).Commitment to maintaining appropriate relationships with patientsGiven the inherent vulnerability and depen

21、dency of patients, certain relationships between physicians and patients must be avoided. In particular, physicians should never exploit patients for any sexual advantage, personal financial gain, or other private purpose.Commitment to improving quality of carePhysicians must be dedicated to continu

22、ous improvement in the quality of healthcare. This commitment entails not only maintaining clinical competence but also working collaboratively with other professionals to reduce medical error, increase patients safety, minimise overuse of healthcare resources, and optimise the outcomes of care. Phy

23、sicians must actively participate in the development of better measures of quality of care and the application of quality measures to assess routinely the performance of all individuals, institutions, and systems responsible for healthcare delivery. Physicians, both individually and through their pr

24、ofessional associations, must take responsibility for assisting in the creation and implementation of mechanisms designed to encourage continuous improvement in the quality of care.Commitment to improving access to careMedical professionalism demands that the objective of all healthcare systems be t

25、he availability of a uniform and adequate standard of care. Physicians must individually and collectively strive to reduce barriers to equitable healthcare. Within each system, the physician should work to eliminate barriers to access based on education, laws, finances, geography, and social discrim

26、ination. A commitment to equity entails the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician, without concern for the self-interest of the physician or the profession.Commitment to a just distribution of finite resourcesWhile meeting the ne

27、eds of individual patients, physicians are required to provide healthcare that is based on the wise and cost-effective management of limited clinical resources. They should be committed to working with other physicians, hospitals, and payers to develop guidelines for cost-effective care. The physici

28、ans professional responsibility for appropriate allocation of resources requires scrupulous avoidance of superfluous tests and procedures. The provision of unnecessary services not only exposes patients to avoidable harm and expense but also diminishes the resources available for others.Commitment t

29、o scientific knowledgeMuch of medicines contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use. The profession i

30、s responsible for the integrity of this knowledge, which is based on scientific evidence and physicians experience.Commitment to maintaining trust by managing conflicts of interestMedical professionals and their organisations have many opportunities to compromise their professional responsibilities

31、by pursuing private gain or personal advantage. Such compromises are especially threatening in the pursuit of personal or organisational interactions with for-profit industries, including medical equipment manufacturers, insurance companies, and pharmaceutical firms. Physicians have an obligation to

32、 recognise, disclose to the general public, and deal with conflicts of interest that arise in the course of their professional duties and activities. Relationships between industry and opinion leaders should be disclosed, especially when the latter determine the criteria for conducting and reporting clinical trials, writing editorials or therapeutic guidelines, or serving as editors of scientific journals.Commitment to professional responsibilitiesAs members of a profession, physicians are expected to work collaboratively to maximise patients care, be respec