观察行动主义的万花筒:护理伦理学和全球生物伦理学的参与,以改善健康安全

Sidney Kabinoff
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摘要

在公共卫生危机期间,美国利用国家统计方法来确保其人口的健康,这将国家结构置于(主要是经济)健康安全的中心。这种方法的公平性依赖于资源的分配,从机构“涓滴”到个人。然而,在这方面,“公平”是先验地确定的,即不涉及正在接受卫生资源的具体个人。这忽视了流行病和大流行病对弱势群体造成的不成比例损害所产生的情境需要。如果将护理伦理融入到分配正义中,国家主义方法可以对全球社会产生更公平的影响。在这篇论文中,我展示了护理伦理如何能够充实健康安全。首先,我展示了护理伦理是如何在任何可以体现的地方发挥作用的——不仅仅是在一对一的临床环境中——而是在公共卫生危机充分影响的(国际)国家背景下。其次,我为国家机构提供了一种方法,以认识到在这些背景下参与护理伦理所必需的社会体现,特别是在公共卫生危机期间通过弱势群体的社会行动主义体现的社会体现。第三,我展示了行动主义的社会体现是如何通过与国家机构的接触而生存的,以这种方式在宏观尺度上模仿临床接触。最后,我为这种相遇赋予了一种关怀的伦理,将关怀的价值观与分配的标准结合起来。
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Looking into the kaleidoscope of activism: the engagement of care ethics and global bioethics for a refined health security
During public health crises, the United States utilizes a statist approach for securing its population’s health, which places state structures at the center of a (mainly economic) health security. The fairness of this approach relies on a distribution of resources to “trickle down” from institutions to individuals. Yet, “fairness,” in this regard, is determined a priori, that is, without reference to specific individuals who are receiving resources of health. This ignores contextual needs that arise from the disproportionate damage that epidemics and pandemics have on vulnerable populations. A statist approach can make a more equitable impact on global society if it integrates care ethics into its distributive justice. In this paper, I demonstrate how an ethic of care can substantiate health security. First, I show how an ethic of care can be engaged anywhere embodiment is recognizable—not just in the one-on-one setting of the clinical encounter—but in the (inter)national contexts through which public health crises have a full effect on. Second, I provide a methodology for state institutions to recognize the social embodiment necessary to engage an ethic of care in these contexts, specifically engaging the social embodiment that manifests through the social activism of vulnerable populations during public health crises. Third, I demonstrate how the social embodiment that activism lives through forces an encounter with state institutions, mimicking in this manner a clinical encounter on a macrocosmic scale. Finally, I assign an ethic of care to this encounter, meshing caring values to the criteria of distribution.
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