Gustavsson Erik, Sandman Lars
Division of Health and Society, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden,
Med Health Care Philos. 2015 Feb;18(1):13-22. doi: 10.1007/s11019-014-9568-7.
In this paper we explore the relation between health-care needs and patients' desires within shared decision-making (SDM) in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to arise due to the double focus on a patient's need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine.
在本文中，我们探讨了在医疗保健资源分配优先次序的背景下，共同决策（SDM）中医疗保健需求与患者愿望之间的关系。我们首先概述医疗保健需求概念的一些一般特征以及共同决策和愿望的概念。其次，我们将讨论如何区分医疗保健的需求和愿望。第三，我们提出三个案例，所有这些案例都旨在引出并讨论一些似乎因同时关注患者需求和患者愿望而产生的问题。这些问题涉及以下主题：需求的客观性和道德力量、微观层面上对何种患者出现的预测、对资源分配优先次序排名的影响、评估和比较效益方面的困难以及对循证医学的影响。
