Metaethical and Pedagogic Issues ST Medical centers are a primary context for医疗服务的地点大多为医疗中心,故医 medical ethics, as well as medical care.疗中心也即医学伦理的主要背景。不论 Whether physicians, philosophers, or是医师、哲学家还是神学家,大多数医 theologians,, most medical ethicists are学伦理学研究者主要在医学院或其附 primarily based in medical schools and属的教学医院工作,他们的主要受众 eaching hospitals, and their principal audiences除了他们的业内同行之外,便是医科学 ae( apart from one another) medical students生及住院医生。这样的背景从一定程度 and residents. This setting partially explains the I上解释了为何在医学伦理学中案例分 primary role of actual case analysis in medical析远多于理论著述。医生和护士可没有 ethics, by contrast with much ethical writing耐心听那些理论论证或是凭空想象出 Physicians and nurses have little patience with的包括了许多世俗伦理的测试用例。 the theoretical dialectic or fanciful test-cases that constitute much current secular ethics Nor do they readily accept the main theoretical他们也不乐意接受主流的理论观点。康 alternatives. The Kantian ideal of persons as德相信,人是理性的,自身即是目的 rational ends-in-themselves is hard to reconcile但这一理论与医务工作者面对的现实 with the reality of patients whose mat却大相径庭一疾病往往会摧毁患者 judgment, sense of self and self-interests, and I的判断力及自我意识,使其无法做出对 dignity are subverted by illness. Likewise, the自己最有利的决定。同样,希波克拉底 scope of the Hippocratic maxim, 'Strive to help的箴言“尽力救治,以无害为先”比功 but above all, do no harm" is far narrower thanI利主义的原则“每个个体作为且仅作为 the Utilitarian principle" veryone counts for|一个”在范围上要狭隘得多。有些医生 one and no more than one" Some physicians会考虑到患者家庭、医务人员或未来患 will give some weight to the welfare of a l者的利益(例如试用新药很难对现有患 patient's family, hospital sta, or future patients者有利),但他们几乎肯定不会考虑患 ( e.g. in drug trials unlikely to benefit current者的朋友、继承人或雇主的利益,尽管 atients),but they will almost certainly ignore这些人可能受到医疗决策的严重影响 the friends, heirs or employers who may be seriously affected by treatment decisionsMetaethical and Pedagogic Issues ST TT Medical centers are a primary context for medical ethics, as well as medical care. Whether physicians, philosophers, or theologians, most medical ethicists are primarily based in medical schools and teaching hospitals, and their principal audiences are (apart from one another) medical students and residents. This setting partially explains the primary role of actual case analysis in medical ethics, by contrast with much ethical writing. Physicians and nurses have little patience with the theoretical dialectic or fanciful test-cases that constitute much current secular ethics. 医疗服务的地点大多为医疗中心，故医 疗中心也即医学伦理的主要背景。不论 是医师、哲学家还是神学家，大多数医 学伦理学研究者主要在医学院或其附 属的教学医院工作，他们的主要受众， 除了他们的业内同行之外，便是医科学 生及住院医生。这样的背景从一定程度 上解释了为何在医学伦理学中案例分 析远多于理论著述。医生和护士可没有 耐心听那些理论论证或是凭空想象出 的包括了许多世俗伦理的测试用例。 Nor do they readily accept the main theoretical alternatives. The Kantian ideal of persons as rational ends-in-themselves is hard to reconcile with the reality of patients whose mature judgment, sense of self and self-interests, and dignity are subverted by illness. Likewise, the scope of the Hippocratic maxim, "Strive to help but above all, do no harm" is far narrower than the Utilitarian principle, "Everyone counts for one and no more than one." Some physicians will give some weight to the welfare of a patient's family, hospital staff, or future patients (e.g. in drug trials unlikely to benefit current patients), but they will almost certainly ignore the friends, heirs or employers who may be seriously affected by treatment decisions. 他们也不乐意接受主流的理论观点。康 德相信，人是理性的，自身即是目的。 但这一理论与医务工作者面对的现实 却大相径庭——疾病往往会摧毁患者 的判断力及自我意识，使其无法做出对 自己最有利的决定。同样，希波克拉底 的箴言“尽力救治，以无害为先”比功 利主义的原则“每个个体作为且仅作为 一个”在范围上要狭隘得多。有些医生 会考虑到患者家庭、医务人员或未来患 者的利益（例如试用新药很难对现有患 者有利），但他们几乎肯定不会考虑患 者的朋友、继承人或雇主的利益，尽管 这些人可能受到医疗决策的严重影响