Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, Scotland, UK.
J Gen Intern Med. 2010 Jul;25(7):741-5. doi: 10.1007/s11606-010-1292-2. Epub 2010 Mar 6.
Personal autonomy is widely valued. Recognition of its vulnerability in health care contexts led to the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. In this paper, we suggest that a strong focus on decision situations is problematic, especially when combined with a tendency to stress the importance of patients' independence in choosing. It distracts attention from other important aspects of and challenges to autonomy in health care. Relational understandings of autonomy attempt to explain both the positive and negative implications of social relationships for individuals' autonomy. They suggest that many health care practices can affect autonomy by virtue of their effects not only on patients' treatment preferences and choices, but also on their self-identities, self-evaluations and capabilities for autonomy. Relational understandings de-emphasise independence and facilitate well-nuanced distinctions between forms of clinical communication that support and that undermine patients' autonomy. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy.
个人自主性受到广泛重视。在医疗保健环境中,人们认识到其脆弱性,因此将尊重自主性作为生物医学伦理学的一个关键关注点。尊重自主性原则通常与允许或帮助患者自行决定接受或不接受哪些医疗干预措施有关。在本文中,我们认为,过分关注决策情况存在问题,尤其是与强调患者在选择时独立性的倾向相结合时更是如此。这会分散人们对医疗保健中自主性的其他重要方面和挑战的注意力。对自主性的关系理解试图解释社会关系对个人自主性的积极和消极影响。它们表明,许多医疗保健实践可以通过其不仅对患者的治疗偏好和选择,而且对他们的自我认同、自我评估和自主性能力产生影响,从而影响自主性。关系理解淡化了独立性,并有助于在支持和破坏患者自主性的临床沟通形式之间做出精细的区分。这些理解支持对良好医患关系的价值的认可,并能够丰富对尊重自主性原则的具体规定。