Akhtar Muhammad Umair, Bhatti Muhammad Esswan, Fredericks Salim
Royal College of Surgeons in Ireland - Bahrain.
Nurs Ethics. 2025 May;32(3):875-891. doi: 10.1177/09697330241272794. Epub 2024 Aug 22.
BackgroundThe principle of respect for autonomy (PRA) is a central tenet of bioethics. In the quest for a global bioethics, it is pertinent to ask whether this principle can be applied as it is to cultures and societies that are devoid of the Western sociopolitical historical pressures that led to its emergence. Relational autonomists have argued for a more inclusive approach to patient autonomy which takes into account factors such as interdependency and social relations. However, at the outset of any relational approach, it is necessary to identify underlying factors that influence patient autonomy in non-Western cultures.ObjectiveTo conduct a review of the literature to uncover the mechanisms through which social, cultural, and religious factors influence and impact the application of the PRA in healthcare decision-making in non-Western cultures and societies.MethodsWe conducted a systematic review through a comprehensive search of three major electronic databases of biomedical sciences. Returned citations were imported to Covidence, full texts were assessed for eligibility, included articles were thoroughly reviewed and data was synthesized. PRISMA guidelines were followed.ResultsOur search retrieved 590 non-duplicate results, 50 of which were included after screening and full-text eligibility checks. The included studies were predominantly qualitative in nature, with few quantitative, mixed-methods, and review studies included. Our synthesis of data identified nine key factors that influenced patients' autonomous decision-making through cultural, social, religious, or intersectional pathways.ConclusionTwo main conclusions emerge from this review. Firstly, there is a notable dearth of bioethical research examining the influence of diverse factors on patients' inclination towards different conceptions of autonomy. Secondly, the analysis of prevalent collectivist cultures and deference of autonomy adds value to the solution-oriented relational autonomy debate. This raises questions regarding how decision-making can be truly autonomous in the presence of such large-scale factors, warranting further attention.
背景
尊重自主性原则（PRA）是生物伦理学的核心宗旨。在寻求全球生物伦理学的过程中，有必要探讨这一原则是否能够直接应用于那些缺乏导致其产生的西方社会政治历史压力的文化和社会。关系自主性论者主张采用一种更具包容性的方法来对待患者自主性，这种方法要考虑到相互依存和社会关系等因素。然而，在任何关系方法的起始阶段，有必要确定在非西方文化中影响患者自主性的潜在因素。
目的
对文献进行综述，以揭示社会、文化和宗教因素影响和冲击PRA在非西方文化和社会的医疗保健决策中应用的机制。
方法
我们通过全面检索生物医学科学的三个主要电子数据库进行了系统综述。将检索到的文献导入Covidence，评估全文的合格性，对纳入的文章进行深入审查并综合数据。遵循PRISMA指南。
结果
我们的检索得到590个非重复结果，经过筛选和全文合格性检查后，其中50个被纳入。纳入的研究主要是定性研究，只有少数定量研究、混合方法研究和综述研究。我们对数据的综合分析确定了九个关键因素，这些因素通过文化、社会、宗教或交叉途径影响患者的自主决策。
结论
本次综述得出两个主要结论。首先，显著缺乏生物伦理学研究来考察各种因素对患者倾向于不同自主性概念的影响。其次，对普遍存在的集体主义文化和自主性的顺从性的分析为以解决问题为导向的关系自主性辩论增添了价值。这就引发了关于在存在如此大规模因素的情况下决策如何能够真正自主的问题，值得进一步关注。
