当患者的自主决定权损害其获得公平治疗的权益时，临床医生该怎么做？
What Should Clinicians Do When a Patient's Autonomy Undermines Her Being Treated Equitably?
作者信息
Scharf Amy, Voigt Louis, Vardhana Santosha, Matsoukas Konstantina, Wall Lisa M, Arevalo Maria, Diamond Lisa C
机构信息
Member of the ethics committee at Memorial Sloan Kettering Cancer Center in New York City.
Associate professor of clinical medicine and anesthesiology at Weill Cornell Medical College in New York City.
出版信息
AMA J Ethics. 2021 Feb 1;23(2):E97-108. doi: 10.1001/amajethics.2021.97.
Abstract
Language and cultural barriers can impede communication between patients and clinicians, exacerbating health inequity. Additional complications can arise when family members, intending to protect their loved ones, ask clinicians to lie or not disclose to patients their diagnoses, prognoses, or intervention options. Clinicians must express respect for patients' and families' cultural, religious, and social norms regarding health care decision making, but they might also be ethically troubled by some decisions' effects on patients' health outcomes. This article suggests strategies for clinicians trying to overcome linguistic and cultural barriers to equitable patient care.
摘要
语言和文化障碍会阻碍患者与临床医生之间的沟通，加剧健康不平等。当家庭成员为保护亲人而要求临床医生说谎或不向患者透露其诊断、预后或干预方案时，还会引发其他并发症。临床医生必须尊重患者及其家属在医疗决策方面的文化、宗教和社会规范，但他们也可能会在伦理上对某些决策对患者健康结果的影响感到困扰。本文为临床医生试图克服语言和文化障碍以实现公平的患者护理提供了策略。
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J Cancer Educ. 2021 Aug;36(4):795-803. doi: 10.1007/s13187-020-01706-4.
2
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J Pain Symptom Manage. 2020 May;59(5):1147-1152. doi: 10.1016/j.jpainsymman.2020.01.014. Epub 2020 Jan 31.
3
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Adv J Emerg Med. 2019 Jun 2;3(4):e38. doi: 10.22114/ajem.v0i0.123. eCollection 2019 Fall.
4
A Systematic Review of the Impact of Patient-Physician Non-English Language Concordance on Quality of Care and Outcomes.患者-医生非英语语言一致对医疗质量和结果的影响的系统评价。
J Gen Intern Med. 2019 Aug;34(8):1591-1606. doi: 10.1007/s11606-019-04847-5. Epub 2019 May 30.
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