Randers Ingrid, Mattiasson Anne-Cathrine
Department of Neurotec, Center of Excellence in Elderly Care Research, Karolinska Institutet, Stockholm, Sweden.
J Adv Nurs. 2004 Jan;45(1):63-71. doi: 10.1046/j.1365-2648.2003.02861.x.
The aim of this study was to deepen understanding of the relationship between autonomy and integrity in interactions between patients and individual health care workers in real-life care situations.
The data reported here are from a 6- and 12-month follow-up of the teaching of ethics to health care professionals working with older people. The data collection method used was participant observation. Health professionals' caring behaviour in everyday situations was observed from the point of view of patients' autonomy and integrity. Theoretical frameworks relating to autonomy and integrity were used to analyse the data.
The structural framework was useful for identifying the two concepts and their relationship in everyday situations. The data suggest that the two concepts are ethically complex. Autonomy is grounded in respect for patients' ability to choose, decide and take responsibility for their own lives. Autonomy varies within and between individuals and is dependent on context and on those involved. It stresses the intrinsic value of patients, which marks their worth independently of others. Integrity, however, is bound to patients' very existence, no matter what their physical and mental conditions, and must be respected regardless of their ability to act autonomously.
The concepts of autonomy and integrity appear to presuppose one another and to be indivisible if older adult patients' dignity is to be maintained. This implies that when patients' autonomy is supported their integrity is protected and, consequently, their dignity upheld.
本研究旨在加深对现实生活护理情境中患者与个体医护人员互动时自主性与完整性之间关系的理解。
此处报告的数据来自对为照顾老年人的医护专业人员进行伦理教学的6个月和12个月随访。所采用的数据收集方法为参与观察。从患者自主性和完整性的角度观察医护专业人员在日常情境中的护理行为。运用与自主性和完整性相关的理论框架对数据进行分析。
该结构框架有助于在日常情境中识别这两个概念及其关系。数据表明这两个概念在伦理上较为复杂。自主性基于对患者选择、决策及对自身生活负责能力的尊重。自主性在个体内部和个体之间存在差异，且取决于情境及相关人员。它强调患者的内在价值，这使其价值独立于他人。然而，完整性与患者的生存息息相关，无论其身心状况如何，且无论其自主行动能力如何都必须得到尊重。
自主性和完整性的概念似乎相互预设，若要维护老年患者的尊严，二者不可分割。这意味着当患者的自主性得到支持时，其完整性得到保护，从而其尊严得以维护。
