Gaucher Nathalie, Payot Antoine
Division of Paediatric Emergency Medicine, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Clinical Ethics' Unit, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Acta Paediatr. 2017 Jan;106(1):14-20. doi: 10.1111/apa.13590. Epub 2016 Oct 16.
Policy statements regarding antenatal consultations for preterm labour are guided by physicians' concerns for upholding the legal doctrine of informed consent, through the provision of standardised homogeneous medical information. This approach, led by classical in-control conceptions of patient autonomy, conceives moral agents as rational, independent, self-sufficient decision-makers. Recent studies on these antenatal consultations have explored patients' perspectives, and these differ from guidelines' suggestions. Relational autonomy - which understands moral agents as rational, emotional, creative and interdependent - resonates impressively with these new data.
A model for antenatal consultations is proposed. This approach encourages clinicians to explore individual patients' lived experiences and engage in trusting empowering relationships. Moreover, it calls on physicians to enhance patients' relational autonomy by becoming advocates for their patients within healthcare institutions and professional organisations, while calling for broadscale policy changes to encourage further funding and support in investigations of the patient's voice.
关于早产产前咨询的政策声明,是由医生通过提供标准化的同类医学信息来维护知情同意这一法律原则的关切所指导的。这种由经典的患者自主控制观念主导的方法,将道德主体视为理性、独立、自给自足的决策者。最近关于这些产前咨询的研究探讨了患者的观点,而这些观点与指南的建议不同。关系自主性——将道德主体理解为理性、情感、有创造力且相互依存的——与这些新数据产生了惊人的共鸣。
提出了一种产前咨询模式。这种方法鼓励临床医生探索个体患者的生活经历,并建立信任的赋能关系。此外,它呼吁医生通过在医疗机构和专业组织中成为患者的倡导者来增强患者的关系自主性,同时呼吁进行大规模的政策变革,以鼓励在对患者声音的调查中提供更多资金和支持。