Advocating Mandatory Patient 'Autonomy' in Healthcare: Adverse Reactions and Side Effects
Advocating Mandatory Patient 'Autonomy' in Healthcare: Adverse Reactions and Side Effects
复制标题
DOI：
10.1007/s10728-007-0075-3
复制
发表时间：
2008-12-01
影响因子：
1.9
通讯作者：
Elwyn, Glyn
中科院分区：
文献类型：
--
作者：
Davies, Myfanwy;Elwyn, Glyn
促进病人自主权已成为卫生服务遇到的一个关键当务之急。我们将研究过度促进病人自主权的潜在负面影响，并考虑对病人获得的影响，他们的经验和提供公平的服务，重点是这种趋势的极端表现，即要求病人参与医疗保健决策是强制性的。强制性自主的倡导者认为，病人对自己、对社会和对医疗系统都有责任独立地做出关于他们的医疗保健的决定。强制性自主的模式可以与那些寻求确定患者的决策偏好和理解他们选择自由的更广泛限制的选择性自主的模式形成对比。当作为决策责任的选择成为强制性的，它就不再促进能动性，而当自主选择被理解为一种个人主义实践时，它将有助于西方价值观的文化主导地位。此外，考虑到原则主义伦理学需要考虑到个人生活的社会和文化背景，我们认为，如果强制性的自主权被过分强调为英国国民保健服务（NHS）正在进行的患者选择的一部分，受过教育和富裕的人将更有能力行使选择权，而那些在主张偏好方面有经验和有资源的人则会受到损害来利用选择。我们认为，促进自治需要采取措施，使社会，文化和经济实力较弱的群体能够为决策做出贡献，并支持那些可能因决策责任转移而感到被遗弃的个人。直到个人选择的限制可以理解和解决，我们主张在共同决策中使用的可选自主权的模式，并为实践，政策，教育和研究提出建议。
Promoting patient autonomy has become a key imperative in health service encounters. We will examine the potential negative effects of over-promoting patient autonomy and consider the impact on patient access, their experience and the provision of equitable services by focusing on an extreme manifestation of this trend, i.e. calls for patient involvement in health care decision making to be mandatory. Advocates of mandatory autonomy hold that patients have a duty to themselves, to society and to the medical system to make decisions on their health care independently. Models of mandatory autonomy may be contrasted to those of optional autonomy that seek to ascertain patients' decisional preferences and to understand wider limitations on their freedom to choose. Where choice as decisional responsibility becomes mandatory it ceases to promote agency and where autonomous choice is understood as an individualistic practice it will contribute to the cultural dominance of Western values. Moreover, taking a view that principlist ethics needs to take account of the social and cultural contexts of individual lives, we argue that if mandatory autonomy were to be over-emphasised as part of an ongoing move towards patient choice in UK National Health Service (NHS), educated and affluent people would be more able to exercise choices at the expense of people who are experienced in asserting preferences and who have the resources to make use of choices. We will argue that the promotion of autonomy needs to be tempered by steps to enable less powerful social, cultural and economic groups to contribute to decision making and to support individuals who may feel abandoned by having decisional responsibility transferred to them. Until constraints on individual choice can be understood and addressed, we advocate the model of optional autonomy used in shared decision making and make recommendations for practice, policy, education and research.