Reach Gérard
Department of Endocrinology, Diabetes, and Metabolic Diseases, Avicenne Hospital AP-HP, and EA 3412, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bobigny, France.
Patient Prefer Adherence. 2013 Dec 12;8:15-24. doi: 10.2147/PPA.S55022.
The application of the principle of autonomy, which is considered a cornerstone of contemporary bioethics, is sometimes in obvious contradiction with the principle of beneficence. Indeed, it may happen in chronic care that the preferences of the health care provider (HCP), who is largely focused on the prevention of long term complications of diseases, differ from those, more present oriented, preferences of the patient. The aims of this narrative review are as follows: 1) to show that the exercise of autonomy by the patient is not always possible; 2) where the latter is not possible, to examine how, in the context of the autonomy principle, someone (a HCP) can decide what is good (a treatment) for someone else (a patient) without falling into paternalism. Actually this analysis leads to a paradox: not only is the principle of beneficence sometimes conflicting with the principle of autonomy, but physician's beneficence may enter into conflict with the mere respect of the patient; and 3) to propose a solution to this paradox by revisiting the very concepts of the autonomous person, patient education, and trust in the patient-physician relationship: this article provides an ethical definition of patient education.
自主性原则被视为当代生物伦理学的基石，但其应用有时与 beneficence 原则明显相悖。事实上，在慢性病护理中，主要关注疾病长期并发症预防的医护人员（HCP）的偏好可能与更注重当下的患者偏好不同。本叙述性综述的目的如下：1）表明患者行使自主性并非总是可行；2）在患者无法行使自主性的情况下，探讨在自主性原则的背景下，某人（医护人员）如何在不陷入家长作风的情况下为他人（患者）决定什么是好的（一种治疗方法）。实际上，这种分析导致了一个悖论：不仅 beneficence 原则有时与自主性原则相冲突，而且医生的 beneficence 可能与对患者的单纯尊重发生冲突；3）通过重新审视自主人的概念、患者教育以及医患关系中的信任来提出解决这一悖论的方案：本文提供了患者教育的伦理定义。
