道德损伤视角下医师专业精神建设的启示

Enlightenment on the Construction of Medical Professionalism from the Perspective of Moral Injury

医学的目的是在救死扶伤的过程中坚守并发展治疗。医师专业精神是医师临床能力、不同主体之间的关系及价值观念的综合表达。实践中,正是通过高水准的专业精神,在具体诊疗行为中践行医学的宗旨和目标———始终以患者利益为中心。与此同时,兑现着医学对社会公众的承诺和期待。为此,无私奉献、自我牺牲、单向纯粹利他都被内化成专业精神的基本要求:医生不仅要在技术上达到至效,还要在德性上达到至真、至善、至美。而当这些特质因不可抗的原因可能会被夸大或不能达成时,根深蒂固的价值体系同现实需求之间便会产生裂隙。近几年,疫情给医疗系统和医务人员带来了巨大的影响,医生的道德信仰、角色期望、价值体系也因此受到了前所未有的冲击而形成道德损伤。国际上关于医疗领域道德损伤的相关研究也受到了一定的关注。因此,借鉴国际上道德损伤的相关研究,重新审视强调单向纯粹利他、奉献而弱化甚至忽视个人福祉的医师专业精神与当前的医疗实践的关系,着手建构医生—患者—医疗团队—医疗机构—执业环境—卫生系统—其他利益相关者为主的道德损伤预警—修复系统,并确保它良性运转,不仅在极端时期,更能在普通的诊疗日常中支持医生积极、安全、健康地执业,践行救死扶伤的使命。

The purpose of medicine is to preserve and develop the treatment in the process of saving lives and helping injuries.Medical professionalism is a comprehensive expression of physician's clinical abilities,relationships and values between different subjects.In practice,white robed doctors utilize high standards of professionalism to practice the medical purpose and goals of“always centering on the interests of the patient”in specific diagnosis and treatment behaviors.At the same time,fulfilling the promises and expectations of medicine to the public.For these reasons,selfless dedication,self-sacrifice,and one-way pure altruism are all internalized into the basic requirements of medical professionalism:doctors should not only have the skill to revive the dead,but also have the benevolence of evangelists;they not only need to achieve maximum efficiency in technology,but also achieve the highest truth,goodness,and beauty in virtue.When these qualities are exaggerated or unattainable due to uncontrollable reasons,there will be a rift between the entrenched value systems and practical needs.In recent years,the global epidemic has had a huge impact on the medical system and medical staff,and the moral beliefs,role expectations,and value systems of doctors have also been impacted unprecedentedly,resulting in moral injury.The international research on moral injury in medical field has also received attention.China is currently in the adjustment period of epidemic related policies,with medical personnel bearing the brunt.Therefore,referring to relevant international research on moral injury to re-examine the relationship between the medical professionalism,which emphasizes one-way pure altruism,dedication and weakening or even neglecting personal well-being,and current medical practices.And constructing a moral injury early warning-repair system that focuses on doctors,patients,medical teams,medical institutions,medical environments,health systems,and other stakeholders,and ensuring its healthy operation.Not only in extreme periods,but also in ordinary daily diagnosis and treatment,it can support doctors to actively,safely,and healthily fulfill their mission of saving lives and helping injuries.