Perspect Biol Med. 2022;65(2):232-241. doi: 10.1353/pbm.2022.0019.
Hospitals have both a regulatory and an ethical mandate to craft a safe discharge plan for all patients. These plans can become a source of conflict between clinicians and patients when they have differing conceptions of safety and best interests. In bioethics principles this conflict can be characterized as the tension between the patient's right to make medical decisions in accordance with their values, or autonomy, and the clinician's obligation to provide best care to their patients, or beneficence. Employed independently, these principles can be limiting and may not accommodate the nuanced narrative of patients who lack decisional capacity but have expressed clear preferences about where they wish to live. Utilizing case-based discussion, this article explores how the inclusion of Robert Perske's dignity of risk principal in bioethics consultation can support clinicians in expanding their conceptions of beneficence and safety, providing the team with the freedom to craft discharge plans that keep the patient at the center of the narrative.
医院有监管和伦理方面的要求,要为所有患者制定安全的出院计划。当临床医生和患者对安全和最佳利益有不同的概念时,这些计划可能成为两者之间冲突的根源。在生命伦理学原则中,这种冲突可以被描述为患者按照自己的价值观做出医疗决策的权利(自主性)与临床医生为患者提供最佳护理的义务(善行)之间的紧张关系。单独使用这些原则可能会受到限制,并且可能无法适应那些缺乏决策能力但明确表达了他们希望居住的地方的患者的细微叙述。本文通过案例讨论,探讨了在生命伦理学咨询中纳入罗伯特·珀斯克的风险尊严原则如何支持临床医生扩大善行和安全的概念,为团队提供制定出院计划的自由,使患者成为叙述的中心。