Relational Capacity: Broadening the Notion of Decision-Making Capacity in Paediatric Healthcare
Relational Capacity: Broadening the Notion of Decision-Making Capacity in Paediatric Healthcare
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DOI：
10.1007/s11673-016-9735-z
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发表时间：
2016-12-01
影响因子：
2.4
通讯作者：
Elger, Bernice S.
中科院分区：
文献类型：
--
作者：
Ruhe, Katharina M.;De Clercq, Eva;Elger, Bernice S.
问题出现时，适用于目前的程序概念化的决策能力，儿科医疗保健：它强调内容中立和理性认知，以及其隐含的假设，即能力是一种能力，居住在一个人危及儿童的决策地位。本文的目的是挑战这种占主导地位的帐户的能力，并提供了一种替代的能力应如何理解儿科护理。首先，发展心理学家让皮亚杰的能力的概念后的影响进行了讨论，其次是检查维果斯基的语境主义儿童的发展，强调社会互动和学习的决策能力。在绘制自主权和能力之间的相似之处，关系自主权的实质性方法，强调了决定的内容的重要性。然后，作者提供了一个关系的重新概念化的能力，导致重点从个人，包括重要的社会其他人，如父母和医生。在这一新办法中，成人决策过程的结果被接受为儿童作出良好决定的指导因素。如果孩子做出了不被成年人认可的选择，新的概念强调双方的相互交流和参与。
Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children's position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity is discussed, followed by an examination of Vygostky's contextualist view on children's development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults' decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties.