University of the West of England, Faculty of Health and Life Sciences, Alexander Warehouse, Gloucester Docks, Gloucester, GL1 2LG, UK.
J Med Ethics. 2013 Sep;39(9):587-90. doi: 10.1136/medethics-2011-100079. Epub 2012 May 16.
In their recent article, Erbay et al considered whether a seriously injured patient should be able to refuse treatment if the refusal was based on a (mis)interpretation of religious doctrine. They argued that in such a case 'what is important…is whether the teaching or philosophy used as a reference point has been in fact correctly perceived' (p 653). If it has not been, they asserted that this eroded the patient's capacity to make an autonomous decision and that therefore, in such cases, it is the role of the healthcare professional (HCP) to 'assist patients to think more clearly and rationally' (p 653). There are, however, a number of problems with the reasons why Erbay et al suggest we should help patients to rationalise their decisions and how HCPs should go about this. In this article, the author explores some of their main arguments regarding consent and rationality (particularly in relation to religious beliefs), as well as Erbay et al's normative claim that HCPs have an obligation to promote autonomy by helping patients to come to a 'rational' decision. Ultimately, the author agrees that the (temporary) solution to the dilemma presented in this scenario (which was to insert an intravenous cannula into the patient in order to allow an infusion of fluids in the event that he changed his mind) seemed both pragmatic and ethically permissible. However, it is suggested that the arguments which underpin this conclusion in Erbay et al's article are largely unsound.
在他们最近的文章中，Erbay 等人考虑了如果一个重伤患者基于（错误）对宗教教义的解读而拒绝治疗，那么他是否应该被允许拒绝治疗。他们认为，在这种情况下，“重要的是……所使用的教义或哲学是否被正确理解”（第 653 页）。如果没有，他们断言，这削弱了患者做出自主决策的能力，因此，在这种情况下，医疗保健专业人员的角色是“帮助患者更清楚、更理性地思考”（第 653 页）。然而，Erbay 等人认为我们应该帮助患者使他们的决定合理化的原因，以及医疗保健专业人员应该如何做到这一点，存在一些问题。在本文中，作者探讨了他们关于同意和理性的一些主要论点（特别是与宗教信仰有关），以及 Erbay 等人的规范性主张，即医疗保健专业人员有义务通过帮助患者做出“理性”的决定来促进自主性。最终，作者同意，在这种情况下（即如果患者改变主意，就向他插入静脉内导管以允许输液），所提出的两难困境的暂时解决方案（即向他插入静脉内导管以允许输液）似乎既实用又符合伦理。然而，有人认为，Erbay 等人文章中支持这一结论的论点在很大程度上是站不住脚的。
