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医疗保健中的契约理论与伙伴关系。对约翰·罗尔斯和塞拉·本哈比卜哲学的哲学探究。

Contract theories and partnership in health care. A philosophical inquiry to the philosophy of John Rawls and Seyla Benhabib.

作者信息

Määttä Sylvia, Lützén Kim, Öresland Stina

机构信息

Associate Professor, Centre for Equity in Healthcare/Institute for Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.

Senior professor, Department of Women's and Children's Health, Pediatric Oncology Research, Karolinska Institutet, Stockholm, Sweden.

出版信息

Nurs Philos. 2017 Jul;18(3). doi: 10.1111/nup.12164. Epub 2016 Dec 23.

Abstract

Over the last 20 years, a paternalistic view in health care has been losing ground. The question about less asymmetrical positions in the healthcare professional-patient relationship is, for example, being addressed by the increased emphasis on person-centred care, promoted in disciplines such as medicine and nursing. Partnership is considered as a key component in person-centred care. Although the previous studies have addressed the attributes inherent in partnership, there is still potential for further discussion on how the various interpretations of partnership influence their use in healthcare literature. A vague understanding might also affect education and evaluation. As we see it, the philosophical underpinnings of the idea of partnership have not been sufficiently explored and discussed. The study reveals that partnership originates in the term "partener" defined as a relationship between individuals or groups characterized by cooperation and responsibility. Etymologically speaking, partnership is hence bound by a contract, which in this study is discussed in the frame of Rawls' contract theory, which in turn intersects with Benhabib and her distinction between "the abstract" and "the concrete Other." Further, the expression "equal partnership," which often appears in the context of person-centredness, is explored in relation to the philosophies of Rawls and Benhabib. The opportunity for partnership, as well as the risk of partnership becoming a tempting magnet with a vague and imprecise meaning, is discussed. Without exploration, reflection and discussion of the philosophical underpinnings, partnership carries a substantial risk of becoming an indistinct idea used in health care.

摘要

在过去20年里,医疗保健中的家长式观点逐渐失势。例如,医疗保健专业人员与患者关系中较少不对称地位的问题,正通过医学和护理等学科对以患者为中心的护理的日益重视来解决。伙伴关系被视为以患者为中心的护理的关键组成部分。尽管先前的研究已经探讨了伙伴关系所固有的属性,但对于伙伴关系的各种解释如何影响其在医疗保健文献中的应用,仍有进一步讨论的空间。模糊的理解也可能影响教育和评估。在我们看来,伙伴关系理念的哲学基础尚未得到充分的探索和讨论。该研究表明,伙伴关系起源于“伙伴”一词,被定义为个人或群体之间以合作和责任为特征的关系。从词源学上讲,伙伴关系因此受合同约束,在本研究中,这是在罗尔斯的契约理论框架内进行讨论的,而罗尔斯的契约理论又与本哈比及其对“抽象他人”和“具体他人”的区分相交。此外,经常出现在以患者为中心背景下的“平等伙伴关系”这一表述,是结合罗尔斯和本哈比的哲学进行探讨的。文中讨论了伙伴关系的机会,以及伙伴关系成为一个具有模糊和不精确含义的诱人概念的风险。如果不探索和反思其哲学基础,伙伴关系在医疗保健中极有可能沦为一个模糊不清的概念。

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