Institute of Ethics, Dublin City University, Dublin, Ireland.
J Eval Clin Pract. 2019 Dec;25(6):1063-1069. doi: 10.1111/jep.13185. Epub 2019 May 31.
According to many of its proponents, shared decision making ("SDM") is the right way to interpret the clinician-patient relationship because it respects patient autonomy in decision-making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, this paper argues that standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy.
根据其众多支持者的观点，共享决策（SDM）是解释医患关系的正确方式，因为它在决策情境中尊重了患者的自主权。特别是，医学伦理学家声称，SDM 尊重患者的关系自主性，这种自主性被理解为一种依赖于人际关系以及更广泛的医疗保健和社会条件并只能由其维持的能力。本文对这一说法提出了质疑。通过考虑关系自主性的两种主要方法，本文认为标准的 SDM 实际上破坏了患者的自主权。它还概述了尊重关系自主性原则所产生的义务，这些义务在 SDM 的标准解释中没有被涵盖，并且对于确保临床实践与尊重患者自主权之间的一致性是必要的。
