Chin J J
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Singapore Med J. 2002 Mar;43(3):152-5.
For centuries, physicians have been allowed to interfere and overrule patient's preferences with the aim of securing patient benefit or preventing harm. With the radical rise in emphasis on individual control and freedom, medical paternalism no longer receives unquestioned acceptance by society as the dominant mode for decision-making in health care. But neither is a decision-making approach based on absolute patient autonomy a satisfactory one. A more ethical and effective approach is to enhance a patient's autonomy by advocating a medical beneficence that incorporates patients' values and perspectives. This can be achieved through a model for shared decision making, acknowledging that though the final choices reside ultimately in patients, only through physician beneficence can the patient be empowered to make meaningful decisions that serve them best. For such a model to function effectively, the restoration of trust in doctor-patient relationship and the adoption of patient-centred communication are both crucial.
几个世纪以来，医生被允许进行干预并否决患者的偏好，目的是确保患者受益或防止伤害。随着对个人控制和自由的重视急剧增加，医疗家长主义不再被社会毫无质疑地接受为医疗保健决策的主导模式。但基于绝对患者自主权的决策方法也不是令人满意的方法。一种更符合伦理且有效的方法是通过倡导包含患者价值观和观点的医疗慈善来增强患者的自主权。这可以通过共享决策模型来实现，承认尽管最终选择最终在于患者，但只有通过医生的慈善行为，患者才能有能力做出最符合自身利益的有意义的决策。为了使这样的模型有效运作，恢复医患关系中的信任以及采用以患者为中心的沟通都至关重要。
