利益冲突Conflicts of Interest.ppt

* * * * * * * * * * * * 利益衝突Conflicts of Interest Conflicts of interest利益衝突 利益衝突 利益衝突是「一種複雜的狀況，此時當事人對於主要利益的專業判斷容易受到次要利益的不當影響」。 Conflict of interest is a set of conditions in which professional judgement concerning a primary interest (such as patients' welfare or the validity of research) tends to be unduly influenced by a secondary interest (such as financial gain). Thompson DF. Understanding financial conflicts of interest. N Engl J Med 1993; 329: 573-576 倫理ETHICS John Williams- Director of Ethics WMA 倫理反應出一個人的價值觀及面對倫理情境做決定時的行為原則。 Ethics identifies values and principles for decision-making and behaviour and resolves conflicts over ethical issues. 倫理情境：不知到怎樣做才對的情境。 An ethical issue: a situation where it is not clear what is the right thing to do. 臨床人員的利益 Three Primary Interests主要利益 Patient Health and well being Clinical Research Education of future health professionals Secondary Interests 次要利益 Financial gain promotion grants for research publication of research results desire of fame family obligations 認識「利益衝突」 Understanding Conflicts of Interest 任何專業都有主要利益及次要利益 Any professional has a primary as well as a myriad of secondary interests 當次要利益影響到專業判斷時，便有「利益衝突」 。 A conflict of interest occurs when the secondary interests “unduly influence” the persons “professional judgments concerning a primary interest” 認識「利益衝突」 利益衝突是「一種狀況，不是一個行為。 Conflict of interest is a condition not a behaviour. 利益衝突 vs 責任衝突 Conflicts of Interest vs Conflicts of Commitment 利益衝突 COI between primary and secondary interests Secondary interests are not part of physician’s duty Secondary interests should not influence on professional judgment 責任衝突 COC arises between primary interests e.g, caring of a patient and educating medical students and completing research study Not very problematic from ethical point of view 對於醫生本身除在醫院診所看病以外，又投資其他如抽血驗尿的檢驗中心、或是影像學中心，而轉介病人到這種地方做進一步的檢驗，各醫療團體也開始重視這種現象，也列入利益衝突。 過度使用檢查的動機 令人驚訝的是，許多醫師認為他們不會受到與企業互動的影響。結論是接受越多禮物的醫師不見得就對企業所提供的資料持比較正面的態度； 這項研究的作者認為醫師其實比我們一般所認為的更