Bommier C, Mamzer M F, Desmarchelier D, Hervé C
Laboratoire d'Ethique Médicale et de Médecine, Légale, Université Paris Descartes, PRES Sorbonne Paris Cité, France.
J Int Bioethique. 2013 Dec;24(4):137-58, 185. doi: 10.3917/jib.243.0135.
The purpose of this research, led in the wake of years of pressure to reject paternalism, was to study whether controlled practice of nonverbal communication by doctors inheres a continued risk of paternalistic attitudes in oncology clinic interviews (chosen to illustrate the doctor-patient relationship). This study involved qualitative descriptive research based on interview observations and questionnaires and mobilized recognized theory borrowed from sociology and anthropology. We found that the legislative framework governing the doctor-patient relationship has simply shifted the paternalism issue from verbal communication over to a new area that doctors have not yet mastered and patients have not yet understood, i.e., nonverbal communication. This study shows that all the laws framing the doctor-patient relationship can be circumvented, and that by controlling nonverbal communication, the doctor can fall back into paternalism. The rejection of paternalism therefore needs to lead to an appropriate reading of the patient's story, which in ethical terms can only happen if hospital structures are made non-paternalizing by design, if doctors learn to understand the patient's different chronemic timeframe, and if doctors committedly engage in the Hippocratic Oath codified through the ethics of care.
在多年来抵制家长式作风的压力下开展的这项研究，旨在探讨医生对非语言沟通的控制行为在肿瘤门诊访谈（选取该场景以阐释医患关系）中是否依然存在家长式态度的风险。本研究采用基于访谈观察和问卷调查的定性描述性研究方法，并运用了从社会学和人类学借鉴而来的公认理论。我们发现，规范医患关系的立法框架只是将家长式作风问题从言语沟通转移到了一个医生尚未掌握且患者也尚未理解的新领域，即非语言沟通。这项研究表明，所有规范医患关系的法律都可能被规避，而且通过控制非语言沟通，医生可能会重新陷入家长式作风。因此，抵制家长式作风需要对患者的故事进行恰当解读，从伦理角度而言，只有在医院结构设计上做到非家长式、医生学会理解患者不同的时间观念以及医生坚定践行通过关怀伦理编纂的希波克拉底誓言的情况下，才有可能实现。
