Ward Michael, Savulescu Julian
Nuffield Department of Anaesthetics, University of Oxford, UK.
Best Pract Res Clin Anaesthesiol. 2006 Dec;20(4):545-63. doi: 10.1016/j.bpa.2006.09.003.
Individuals have different values. They seek to express their individuality even when receiving medical care. It is a part of modern medical practice and respect for patient autonomy to show respect for different values. We give an account of what it means to respect different values and challenging patients in medical practice. Challenging choices are often choices which are perceived by many to be either irrational or against a person's interests, such as engaging in harmful or excessively risky activities. When the medical profession is involved in such choices, the basic medical principle of acting in a person's best interests is challenged. Often doctors refuse to respect controversial choices on paternalistic grounds. We should all respect and facilitate the controversial choices of competent individuals, subject to resource limitations, our own and others well-being and autonomy, and the public interest. But more importantly, sometimes such choices make for a better, more autonomous life. Sometimes, such choices reflect considerations of global well-being or altruism, or idiosyncratic attitudes to risk. Sometimes, they reflect unusual values. However, in some other cases, controversial choices are irrational and are not expressions of our autonomy. Doctors should assist patients to make rational if individual choices. The patient also bears the responsibility for bringing his beliefs to the attention of the clinician.
个体具有不同的价值观。即使在接受医疗护理时，他们也试图表达自己的个性。尊重不同的价值观是现代医疗实践的一部分，也是对患者自主权的尊重。我们阐述了在医疗实践中尊重不同价值观以及向患者提出质疑意味着什么。具有挑战性的选择通常是许多人认为不合理或违背个人利益的选择，比如从事有害或风险过高的活动。当医疗行业涉及此类选择时，为患者谋求最大利益这一基本医疗原则就受到了挑战。医生常常基于家长式作风拒绝尊重有争议的选择。在资源有限、自身及他人的福祉与自主权以及公共利益的前提下，我们都应该尊重并促成有行为能力的个体做出有争议的选择。但更重要的是，有时此类选择能造就更美好、更自主的生活。有时，此类选择反映了对全球福祉或利他主义的考量，或者对风险的特殊态度。有时，它们反映了不同寻常的价值观。然而，在其他一些情况下，有争议的选择是不合理的，并非我们自主权的体现。医生应协助患者做出合理的个人选择。患者也有责任让临床医生了解自己的信念。
