探討生殖醫學公司化之影響【全球瞭望】 試閱
Addressing the Consequences of the Corporatization of Reproductive Medicine
輔助生殖技術的商業化與公司化，在澳洲與英國催生出了一個由診所、產品與服務所組成的市場。雖然這在某種程度上擴大了病患的選擇，但由商業動機所主導並塑造的「選擇」，未必意味著更高品質的醫療照護。目前，對診所（包括公司化診所）及臨床醫師的監管，主要聚焦於醫病關係及診所與消費者之間的互動。然而，公司化診所對股東與投資人的責任、醫療專業人員對其所任職公司的責任，以及臨床醫師與公司對病患與整體醫療系統所應承擔的義務之間的衝突，至今尚未獲得足夠關注。以公司治理與商業倫理為基礎的監管架構，如利害關係人模型與「企業社會責任」等，可能難以有效應用在醫療領域中，因為在這方面存在明顯的局限性，也就是說現行的治理架構可能無法充分滿足病患或醫療系統的需求。筆者主張發展新的監管方式，更明確地界定公司與受雇臨床醫師對病患與社會所應承擔的義務，並支持這些義務的實踐。文中也探討了可以應用在澳洲這樣多司法管轄的環境，以及單一司法管轄的英國環境中的具體機制。
In Australia and the UK, commercialization and corporatization of assisted reproductive technologies have created a marketplace of clinics, products, and services. While this has arguably increased choice for patients, ‘choice’, shaped by commercial imperatives may not mean better-quality care. At present, regulation of clinics (including clinic–corporations) and clinicians focuses on the doctor–patient dyad and the clinic–consumer dyad. Scant attention has been paid to the conflicts between the clinic–corporation’s duty to its shareholders and investors, the medical profession’s duty to the corporations within which they practice, and the obligations of both clinicians and corporations to patients and to health systems. Frameworks of regulation based in corporate governance and business ethics, such as stakeholder models and ‘corporate social responsibility’, have well-recognized limits and may not translate well into healthcare settings. This means that existing governance frameworks may not meet the needs of patients or health systems. We argue for the development of novel regulatory approaches that more explicitly characterize the obligations that both corporations and clinicians in corporate environments have to patients and to society, and that promote fulfilment of these obligations. We consider mechanisms for application in the multi-jurisdictional setting of Australia, and the single jurisdictional settings of the UK.
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