Olsen D P
Center for Health Policy and Ethics, Yale University School of Nursing, New Haven, CT 06536-0740, USA.
J Psychiatr Ment Health Nurs. 2003 Dec;10(6):705-12. doi: 10.1046/j.1365-2850.2003.00659.x.
The dominant rights-based approach to the ethics of coercion in psychiatric treatment guides clinicians in deciding whether treatment should be compelled or the patient's autonomy respected, but provides no guidance across the remaining broad continuum of influence that clinicians exert with patients. The assumptions of the rights-based approach lead to three dichotomous decisions: (1) 'Is the treatment voluntary?'; (2) 'Is the patient competent?' and (3) 'Are the consequence of no treatment dangerous?'. The assumptions of a relational approach lead to ethical guidance across the full range in the intensity and types of influence which may be ethically justified or required in psychiatric treatment. These assumptions are: (1) influence is inherent in the clinical relationship; (2) the relevant factors are continuous and (3) all decisions are subjective. While the rights-approach emphasizes defining competence and developing techniques to predict future patient dangerousness, the relational approach emphasizes patient-clinician responsibilities in ethical relationships and understanding all factors which legitimately bear on the use of influence. An initial list of such factors is offered.
精神科治疗中基于权利的强制伦理主导方法指导临床医生决定是否应强制治疗或尊重患者自主权，但对于临床医生对患者施加的其余广泛影响范围却没有提供指导。基于权利的方法的假设导致三个二分法决策：（1）“治疗是自愿的吗？”；（2）“患者有行为能力吗？”以及（3）“不治疗的后果危险吗？”。关系方法的假设为精神科治疗中可能在伦理上合理或必要的影响强度和类型的整个范围提供伦理指导。这些假设是：（1）影响在临床关系中是固有的；（2）相关因素是连续的；（3）所有决策都是主观的。虽然基于权利的方法强调界定行为能力并开发预测患者未来危险性的技术，但关系方法强调伦理关系中患者与临床医生的责任以及理解所有合法影响影响使用的因素。本文提供了此类因素的初步清单。
