Durham University, Stockton Road, Durham, DH1 3LE, England, UK.
Health Care Anal. 2020 Mar;28(1):4-24. doi: 10.1007/s10728-019-00384-8.
Professional control in the selection of treatment options for patients is changing. In light of social and legal developments emphasising patient choice and autonomy, and restricting medical paternalism and judicial deference, this article examines how far patients and families can demand NHS treatment in England and Wales. It considers situations where the patient is an adult with capacity, an adult lacking capacity and a child. In all three cases, there is judicial support for professional autonomy, but there are also inconsistencies that have potential to elevate the importance of patient and family preferences. In combination, they may be perceived by healthcare professionals as an obligation to follow patient preferences, even where doing so conflicts with other professional obligations. It is argued that a more nuanced approach to shared decision-making could help clarify the boundaries of decision-making responsibility.
专业人员在为患者选择治疗方案方面的控制正在发生变化。鉴于强调患者选择和自主权、限制医疗家长主义和司法遵从的社会和法律发展，本文探讨了在多大程度上患者和家属可以要求在英格兰和威尔士获得国民保健服务治疗。本文考虑了三种情况：有能力的成年患者、无能力的成年患者和儿童。在所有三种情况下，都有司法支持专业自主权，但也存在不一致之处，这些不一致之处有可能提高患者和家属偏好的重要性。总的来说，医护人员可能会认为有义务遵循患者的偏好，即使这样做与其他专业义务相冲突。有人认为，采取更细致入微的方法来共同决策，可以帮助澄清决策责任的界限。
