Menon Sumytra, Entwistle Vikki A, Campbell Alastair V, van Delden Johannes J M
Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Asian Bioeth Rev. 2020 Mar 5;12(1):27-36. doi: 10.1007/s41649-020-00111-9. eCollection 2020 Mar.
Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making.
在世界上许多社区，家庭参与有行为能力患者的医疗保健决策的程度各不相同。对于谁应该做出治疗决策、如何做出决策以及为何做出决策，存在不同的态度。大多数司法管辖区的法律和职业道德准则都反映并支持这样一种观点，即即使包括医疗保健专业人员在内的其他人不同意，有行为能力的患者也应能够自行做出治疗决策。这种思维方式与一些文化规范形成对比，这些文化规范在某些情况下更强调家庭作为决策实体，甚至将有行为能力的患者排除在外。患者、家庭成员和医疗保健专业人员的不同组合之间可能会产生紧张关系，医疗保健专业人员在引导家庭参与决策过程时必须谨慎行事。这些紧张关系可能涉及对哪种治疗方案最佳的意见分歧，以及/或者在决策过程中谁应该有发言权或影响力。虽然一些相关的文化、法律和政策考量因社区而异，但医疗保健专业人员在平衡决策方面的法律和专业准则以及尊重患者及其自主权的伦理原则时，仍需应对一些伦理问题。本文将强调并提出，这些问题的部分解决方案可能在于对自主权的关系性理解，从原则上讲，这为医疗保健专业人员和家庭支持患者决策的干预措施提供了正当理由。
