Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
Psychosomatics. 2013 Mar-Apr;54(2):103-10. doi: 10.1016/j.psym.2012.06.003. Epub 2012 Dec 4.
Psychiatric consultations involving the evaluation of patients' medical decision-making capacity often seem to have little to do with truly compromised patient autonomy.
The authors seek to examine hidden ethical dilemmas that lead to capacity evaluation requests.
The authors utilize the "principlism" approach to biomedical ethics to illustrate some common moral issues in patient care that are poorly captured by the "autonomy-versus-paternalism" paradigm.
Patient autonomy sometimes comes into conflict with ethical imperatives to do "good," to avoid harm, and to deliver care fairly, as well as with the autonomy of others. Consultation psychiatrists are well positioned to unearth these dilemmas and begin to address them.
Effective engagement of everyday ethics in clinical medicine is hindered by reflexive resort to capacity evaluations when moral problems arise. Greater attention to matters of values, aggressive urges, and obligations to others can enhance the negotiation of routine ethical dilemmas.
涉及评估患者医疗决策能力的精神科咨询似乎与真正受损的患者自主性关系不大。
作者试图探讨导致能力评估请求的隐藏伦理困境。
作者利用生物医学伦理学的“原则主义”方法，说明了患者护理中一些常见的道德问题，这些问题很难被“自主性与家长主义”范式所捕捉。
患者的自主性有时与做好事、避免伤害和公平提供护理的道德要求相冲突，也与他人的自主性相冲突。会诊精神科医生处于发现这些困境并开始解决这些困境的有利位置。
当出现道德问题时，习惯性地诉诸能力评估会阻碍日常伦理在临床医学中的有效应用。更多地关注价值观、冲动和对他人的义务等问题，可以增强对常规伦理困境的协商。
