Wilson-Barnett J
King's College (KQC), London University.
J Med Ethics. 1989 Mar;15(1):12-6. doi: 10.1136/jme.15.1.12.
Principles of autonomy and self-determination have been upheld as vital to modern-day medical and ethical practice. However, the complexities of current health care and changes in the expectation of some patients and their families justify a review of such concepts. Their limitations and relativities may suggest that other descriptions of partnership and negotiated goal-setting, while based on respect for autonomy, reflect more modern and ideal multi-disciplinary practices. Discussion should extend beyond the 'classic' participants of patient and doctor to a more realistic picture where other health carers are included. It is therefore apposite that other professional relationships are considered as they affect areas of doctors' and patients' responsibilities. Such partnership between members of the team may not be without problems and conflict, but the principle of negotiated agreements could result in more long-term harmony, and greater patient welfare.
自主和自决原则一直被视为现代医学和伦理实践的关键所在。然而，当前医疗保健的复杂性以及部分患者及其家属期望的变化，使得对这些概念进行审视成为必要。它们的局限性和相对性可能表明，基于尊重自主权的伙伴关系及协商目标设定的其他描述，更能反映现代理想的多学科实践。讨论不应局限于患者和医生这两个“经典”参与者，而应涵盖其他医护人员，以呈现更现实的情况。因此，考虑其他专业关系对医患责任领域的影响是恰当的。团队成员之间的这种伙伴关系可能并非没有问题和冲突，但协商达成协议的原则可能会带来更持久的和谐以及更大的患者福祉。
