Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
Center for Neurotechnology and Department of Philosophy, University of Washington, Seattle, WA, USA.
Theor Med Bioeth. 2022 Aug;43(4):277-288. doi: 10.1007/s11017-022-09580-5. Epub 2022 May 17.
The clinical relationship (or doctor-patient relationship) has been underexplored in dementia care. This is in part due to the way that the clinical relationship has been articulated and understood in bioethics. Robert Veatch's social contract model is representative of a standard view of the clinical relationship in bioethics. But dementia presents formidable challenges to the standard clinical relationship, including ambiguity about when the clinical relationship begins, how it weathers changes in narrative identity of patients with dementia, and how the intimate involvement of family fits alongside a paradigmatically dyadic relationship. Drawing on work in recent feminist theory, a critique is offered of the standard clinical relationship in bioethics as underwritten by an individualistic conception of autonomy. An alternative view of the clinical relationship in dementia, one that embraces a relational account of autonomy, is put forward.
在痴呆症护理中，临床关系（或医患关系）一直未得到充分探讨。这在一定程度上是由于临床关系在生命伦理学中的表述和理解方式。罗伯特·维特的社会契约模型是生命伦理学中标准临床关系的代表。但是，痴呆症给标准的临床关系带来了巨大的挑战，包括临床关系何时开始、如何经受住痴呆症患者叙事身份变化的考验，以及家庭的亲密介入如何与典型的二元关系相契合等问题。本研究借鉴了最近女性主义理论的研究成果，对生命伦理学中标准临床关系进行了批判，认为其基础是自主的个人主义概念。本文提出了一种在痴呆症中重新看待临床关系的观点，即接受自主的关系论。
