Tai Michael Cheng-tek, Tsai Tsung-po
Department of Social Medicine, Chungshan Medical University, 110 Chien-kuo N Rd, Sec 1, Taichung, Taiwan.
Croat Med J. 2003 Oct;44(5):558-61.
Through the ages health professionals have depended on patients' co-operation and obedience as essential aspects of cure. The Code of Ethics of the American Medical Association in 1848, section 6, stated that "the obedience of a patient to the prescription of his physician should be prompt and implicit..." But A Patient's Bill of Rights published by the American Hospital Association in 1973 said that "the patient has the right to refuse treatment to the extent permitted by law..." At a quick glance, these two statements seem to put these two parties in conflict. The situation could even be more complicated when cultural elements are added to the consideration of who makes the final decision. A survey taken in the summer of 2002 in Taiwan showed that in a Confucian society, the family element often determines the course of decision and the patient's autonomy is overlooked. The head of the family, not the patient himself or herself, usually makes the decision, especially when the medical decision has something to do with a life or death situation.
长期以来，医疗专业人员一直依赖患者的合作与服从作为治疗的基本要素。1848年美国医学协会的《伦理守则》第6条规定，“患者应迅速且绝对地服从医生的处方……” 但美国医院协会1973年发布的《患者权利法案》称，“在法律允许的范围内，患者有权拒绝治疗……” 乍一看，这两种说法似乎使医患双方陷入了冲突。当在考虑谁做出最终决定时加入文化因素，情况可能会更加复杂。2002年夏天在台湾进行的一项调查显示，在一个儒家社会中，家庭因素往往决定决策过程，而患者的自主权被忽视。通常由家庭户主而非患者本人做出决定，尤其是当医疗决策涉及生死攸关的情况时。
