WESTERN BIOETHICS ON THE NAVAJO RESERVATION - BENEFIT OR HARM
WESTERN BIOETHICS ON THE NAVAJO RESERVATION - BENEFIT OR HARM
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DOI：
10.1001/jama.274.10.826
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发表时间：
1995-09-13
影响因子：
120.7
通讯作者：
RHODES, LA
中科院分区：
文献类型：
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作者：
CARRESE, JA;RHODES, LA
目标。-了解纳瓦霍人关于负面信息讨论的观点，并考虑西方生物伦理学观点的局限性。解决ethnography.Setting。——亚利桑那州东北部的纳瓦霍印第安人保留地。- 34名纳瓦霍人，包括病人、生物医学保健提供者和传统治疗师。-举报人解释，患者和提供者应以积极的方式思考和说话，避免以消极的方式思考或说话；86%的受访者认为提前护理计划是对纳瓦霍传统价值观的危险违背，这些发现与纳瓦霍传统文化中最重要的概念hozho一致，hozho结合了美、善、秩序、和谐以及一切积极或理想的概念。-讨论负面信息与纳瓦霍人的“hozho”概念相冲突，并被这些纳瓦霍线人视为潜在的有害行为。符合“患者自决法案”的政策，旨在让所有住院的纳瓦霍患者了解提前的护理计划，在道德上存在问题，需要重新评估。
Objective.-To understand the Navajo perspective regarding the discussion of negative information and to consider the limitations of dominant Western bioethical perspectives.Design.-Focused ethnography.Setting.-Navajo Indian reservation in northeast Arizona.Participants.-Thirty-four Navajo informants, including patients, biomedical health care providers, and traditional healers.Results.-Informants explained that patients and providers should think and speak in a positive way and avoid thinking or speaking in a negative way; 86% of those questioned considered advance care planning a dangerous violation of traditional Navajo values, These findings are consistent with hozho, the most important concept in traditional Navajo culture, which combines the concepts of beauty, goodness, order, harmony, and everything that is positive or ideal.Conclusions.-Discussing negative information conflicts with the Navajo concept hozho' and was viewed as potentially harmful by these Navajo informants, Policies complying with the Patient Self-determination Act, which are intended to expose all hospitalized Navajo patients to advance care planning, are ethically troublesome and warrant reevaluation.