Supporting Patient Autonomy: The Importance of Clinician-patient Relationships
Supporting Patient Autonomy: The Importance of Clinician-patient Relationships
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DOI：
10.1007/s11606-010-1292-2
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发表时间：
2010-07-01
影响因子：
5.7
通讯作者：
McCaffery, Kirsten
中科院分区：
文献类型：
--
作者：
Entwistle, Vikki A.;Carter, Stacy M.;McCaffery, Kirsten
个人自主权受到广泛重视。认识到其在卫生保健方面的脆弱性，导致将尊重自主作为生物医学伦理中的一个关键问题。尊重自主性的原则通常与允许或使患者自己决定他们将接受或不接受哪些卫生保健干预措施有关。在这篇文章中，我们认为，强烈关注决策情况是有问题的，特别是当与强调患者在选择时独立的重要性的倾向相结合时。它分散了人们对卫生保健自主权的其他重要方面和挑战的注意力。自主性的关系理解试图解释社会关系对个人自主性的积极和消极影响。他们认为，许多卫生保健做法不仅影响患者的治疗偏好和选择，而且影响他们的自我认同、自我评估和自主能力，从而影响自主性。关系理解淡化了独立性，促进了支持和损害患者自主性的临床沟通形式之间的细微差别。这些理解支持对良好的患者-专业关系的价值的认识，并可以丰富尊重自主原则的规范。
Personal autonomy is widely valued. Recognition of its vulnerability in health care contexts led to the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. In this paper, we suggest that a strong focus on decision situations is problematic, especially when combined with a tendency to stress the importance of patients' independence in choosing. It distracts attention from other important aspects of and challenges to autonomy in health care. Relational understandings of autonomy attempt to explain both the positive and negative implications of social relationships for individuals' autonomy. They suggest that many health care practices can affect autonomy by virtue of their effects not only on patients' treatment preferences and choices, but also on their self-identities, self-evaluations and capabilities for autonomy. Relational understandings de-emphasise independence and facilitate well-nuanced distinctions between forms of clinical communication that support and that undermine patients' autonomy. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy.