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挪威《患者权利法案》中的患者体位构建。

Construction of patients' position in Norway's Patients' Rights Act.

机构信息

Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.

出版信息

Nurs Ethics. 2019 Nov-Dec;26(7-8):2278-2287. doi: 10.1177/0969733018791345. Epub 2018 Aug 23.

DOI:10.1177/0969733018791345
PMID:30139296
Abstract

BACKGROUND

Since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948, human rights as set out in government documents have gradually changed, with more and more power being transferred to individual.

OBJECTIVES

The aim of this article is to analyze how the position of the patient in need of care is constructed in Norway's renamed and revised Patients' and Service Users' Rights Act (originally Patients' Rights Act, 1999) and published comments which accompanying this legislation from the Norwegian Ministry of Health and Care Service.

RESEARCH DESIGN

A constructivist design was used, and Fairclough's critical discourse approach was adopted to analyze the text of the Patients' and Service Users' Rights Act and comments.

FINDINGS

The analysis identified three discourses: (a) political discourse, containing ethical discourses about priority and economy, in which patients are constructed as powerless individuals; (b) expert discourse, containing a theme about patients' trust in the healthcare team and its knowledge, in which patients are constructed as helpless individuals lacking knowledge; and (c) patient participation and patient autonomy discourse, containing ethical discourses about decision-making, in which patients are constructed not only as individuals with needs and rights but also as "troublesome."

CONCLUSION

Dominant paternalistic discourses in the legal text validate the power of medicine, the healthcare system, and heath personnel over the needs, rights, participation, and autonomy of the patient.

摘要

背景

自 1948 年联合国通过《世界人权宣言》以来,政府文件中规定的人权逐渐发生变化,越来越多的权力被转移到个人手中。

目的

本文旨在分析挪威重新命名和修订的《患者和服务使用者权利法案》(原名《患者权利法案》,1999 年)以及挪威卫生和保健服务部发布的伴随该立法的评论中,如何构建有护理需求的患者的地位。

研究设计

采用建构主义设计,采用 Fairclough 的批判性话语分析方法分析《患者和服务使用者权利法案》及评论的文本。

发现

分析确定了三个话语:(a)政治话语,包含关于优先级和经济的伦理话语,在这些话语中,患者被构建为无能为力的个体;(b)专家话语,包含关于患者对医疗团队及其知识的信任的主题,在这些话语中,患者被构建为缺乏知识的无助个体;(c)患者参与和患者自主权话语,包含关于决策的伦理话语,在这些话语中,患者不仅被构建为有需求和权利的个体,而且还被构建为“麻烦”。

结论

法律文本中的主导家长式话语证实了医学、医疗体系和卫生人员的权力凌驾于患者的需求、权利、参与和自主权之上。

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