Rodriguez-Osorio Carlos A, Dominguez-Cherit Guillermo
Department of Critical Care Medicine, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Curr Opin Crit Care. 2008 Dec;14(6):708-13. doi: 10.1097/MCC.0b013e328315a611.
Medical literature has increasingly emphasized the need to observe patients' autonomy; however, not all experts agree with this principle. This discord is based on varying credence between the concepts of autonomy and beneficence. In critically ill patients, this conflict involves the patient's family and creates a particular family-physician relationship. The purpose of this review is to assess the evidence on medical decision making and the family-physician relationship.
The many studies published on this topic reveal that people's preferences around the medical decision-making process vary substantially. Although it is clear that a shared decision approach is popular and desirable to some, it is not universally favored; some patients prefer to leave final treatment decisions up to the doctor. This finding shows a robust moral pluralism, which requires special attention in multicultural societies. For critically ill patients, the diversity of opinion extends to the family, which creates a complex family-physician dynamic and necessitates utilization of particular interaction strategies.
Clinicians must understand the range of preferences in a society and should offer the opportunity to participate in treatment by sharing decision-making responsibility. This would involve assessing the preferences of patients and their families in order to provide care accordingly. Clinicians should then ensure proper information is provided for informed decision making and minimize factors that could have potential adverse effect.
医学文献越来越强调尊重患者自主权的必要性；然而，并非所有专家都认同这一原则。这种分歧源于自主权和行善原则这两个概念之间不同的可信度。在重症患者中，这种冲突涉及患者家属，并形成了一种特殊的医患关系。本综述的目的是评估有关医疗决策和医患关系的证据。
关于这一主题发表的众多研究表明，人们在医疗决策过程中的偏好差异很大。虽然共享决策方法显然受到一些人的欢迎和青睐，但并非普遍如此；一些患者更愿意将最终治疗决策留给医生。这一发现体现了强烈的道德多元主义，在多元文化社会中需要特别关注。对于重症患者，意见分歧延伸至家属，这导致了复杂的医患动态关系，需要采用特定的互动策略。
临床医生必须了解社会中的各种偏好，并应通过分担决策责任提供参与治疗的机会。这将涉及评估患者及其家属的偏好，以便相应地提供护理。然后，临床医生应确保提供适当信息以做出明智决策，并尽量减少可能产生潜在不利影响的因素。
