Krishna Lalit Kumar Radha, Alsuwaigh Rayan, Miti Prabha Techna, Wei Sim Shin, Ling Khoo Hui, Manoharan Devasena
Department of Palliative Medicine, National Cancer Center, Singapore
Yong Loo Lin School of Medicine, University of Singapore, Singapore.
Am J Hosp Palliat Care. 2014 Sep;31(6):645-54. doi: 10.1177/1049909113500136. Epub 2013 Aug 13.
Conceptions of personhood are critical to the preservation of dignity and quality of life key to a good death and pivotal to the provision of patient centred care. Increasingly there is speculation that this role may be wider still. It has been posited that it is Confucian inspired conceptions of personhood replete with its `dualistic' view of personhood that sees family members as part of the individual's personhood that predispose to the prevailing practices of collusion and the trumping of patient autonomy. In a nation where family centric decision making still dominates end of life decision making, the need to appropriately conceptualise local conceptions of personhood are clear. To this end a mixed methods study of 30 Singaporean oncology and palliative care patients was undertaken. Data accrued revealed local conceptions of personhood to be evolving ideas that are determined by four equally important closely related dimensions. Here Innate Personhood which represents the belief that all persons irrespective of their clinical condition and level of development are deserving of personhood, Individual Personhood which relates to consciousness related faculties, Relational Personhood which relates to the social and familial connections important to the person and Societal Personhood which relates to the roles played in society; combine to proffer the Ring Theory of Personhood. This concept provides a better means of providing for the specific needs of patients with life threatening illnesses whilst providing a unique insight into the role families play in the manner local patients conceive themselves to be.
人格观念对于维护尊严和生活质量至关重要，而尊严和生活质量是善终的关键，也是提供以患者为中心的护理的核心。越来越多的人猜测，这一作用可能更为广泛。有人认为，受儒家思想启发的人格观念及其“二元”人格观将家庭成员视为个人人格的一部分，这导致了目前勾结行为盛行和患者自主权被忽视的现象。在一个以家庭为中心的决策仍主导临终决策的国家，恰当界定当地人格观念的必要性显而易见。为此，对30名新加坡肿瘤和姑息治疗患者进行了一项混合方法研究。收集到的数据显示，当地的人格观念是不断演变的观念，由四个同等重要且密切相关的维度决定。这里的“先天人格”代表一种信念，即所有的人无论其临床状况和发育水平如何都应被视为人；“个体人格”与意识相关能力有关；“关系人格”与对个人重要的社会和家庭联系有关；“社会人格”与在社会中所扮演的角色有关。这四个维度共同构成了人格的环理论。这一概念为满足危及生命疾病患者的特殊需求提供了更好的方式，同时也为了解家庭在当地患者自我认知方式中所起的作用提供了独特的视角。
