Runeson Ingrid, Hallström Inger, Elander Gunnel, Hermerén Göran
Lund University, Sweden.
Nurs Ethics. 2002 Nov;9(6):583-98. doi: 10.1191/0969733002ne553oa.
Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child's view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children's participation in decision making concerning their health care.
对一所大学医院收治的24名儿童（年龄在5个月至18岁之间）进行了总计135小时的观察，目的是描述他们参与自身护理决策的程度。采用5分制对他们的参与情况进行评分。同时还评估了每种情况下被认为是最佳参与的程度。结果表明，儿童并非总是被允许以被认为是最佳的程度参与决策。在任何情况下，都没有判定儿童参与或被迫做出对其来说过于困难的决策。还结合讨论和决策过程描述了儿童、父母和工作人员之间的互动。这表明父母在困难情况下并不总是支持自己的孩子，而且医护人员经常在不提供其他选择或询问孩子意见的情况下告知他们将要发生的事情。然而，工作人员在决定是支持孩子的观点还是遵循医院常规时可能会面临伦理冲突。将儿童视为具有潜在自主性的个体非常重要，并且工作人员应意识到他们的核心职责之一是促进儿童参与有关其医疗保健的决策。
