National Cancer Centre Singapore, Singapore.
Nurs Ethics. 2019 Nov-Dec;26(7-8):1955-1967. doi: 10.1177/0969733018806705. Epub 2018 Oct 14.
Appropriate and balanced decision-making is sentinel to goal setting and the provision of appropriate clinical care that are attuned to preserving the best interests of the patient. Current family-led decision-making in family-centric societies such as those in Singapore and other countries in East Asia are believed to compromise these objectives in favor of protecting familial interests. Redressing these skewed clinical practices employing autonomy-based patient-centric approaches however have been found wanting in their failure to contend with wider sociocultural considerations that impact care determinations. Evaluation of a number of alternative decision-making frameworks set out to address the shortcomings of prevailing atomistic and family-centric decision-making models within the confines of end-of-life care prove these alternative frameworks to be little better at protecting the best interests of vulnerable patients. As a result, we propose the Welfare Model that we believe is attentive to the relevant socio-culturally significant considerations of a particular case and better meets the needs of end-of-life care goals of preserving the welfare of patients. Employing a multi-professional team evaluation guided by regnant psychosocial, legal, and clinical standards and the prevailing practical and clinical realities of the particular patient's setting the Welfare Model provides a clinically relevant, culturally sensitive, transparent, and evidence-based approach to care determinations.
恰当和平衡的决策对于目标设定和提供适当的临床护理至关重要，这有助于维护患者的最佳利益。在新加坡和东亚其他国家等以家庭为中心的社会中，目前以家庭为主导的决策被认为是以牺牲保护家庭利益为代价来实现这些目标的。然而，采用以自主为基础的以患者为中心的方法来纠正这些有偏差的临床实践，已经被发现无法应对影响护理决策的更广泛的社会文化因素。评估了一些替代决策框架，旨在解决生命末期护理中普遍存在的原子论和以家庭为中心的决策模型的缺陷，这些替代框架在保护弱势患者的最佳利益方面并没有更好的效果。因此，我们提出了福利模型，我们认为该模型关注特定情况下相关的社会文化重要因素，并更好地满足了生命末期护理的目标，即保护患者的福利。该模型采用多专业团队评估，以占主导地位的心理社会、法律和临床标准以及特定患者环境中的现行实际和临床现实为指导，为护理决策提供了一种具有临床相关性、文化敏感性、透明度和循证的方法。
