Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities
Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities
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DOI：
10.1186/s12910-020-00495-1
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发表时间：
2020-06-30
影响因子：
2.7
通讯作者：
Gastmans, Chris
中科院分区：
文献类型：
--
作者：
Gomez-Virseda, Carlos;de Maeseneer, Yves;Gastmans, Chris
背景 尊重自主权是临终伦理的首要原则。然而，实证研究表明，仅关注个人自主权行使的决策并不能很好地符合患者临终时的偏好。人们一再提倡需要一种更加切合实际的方法来满足临终实践中所经历的现实生活中的复杂性。在这方面，“关系自治”的概念可能是一个合适的替代方法。关系自主甚至被提出作为姑息治疗、共同决策和预先护理计划的基本概念。然而，临终关怀中的关系自主性远未得到明确的概念化或实际操作。主体在这里，我们基于生活现实和概念思维之间的对话，对临终关怀中的自主性进行了一种关系描述。我们首先表明，患者和护理人员在临终实践中所经历的自主权的复杂性尚未得到充分认识。其次，我们批判性地思考如何利用关系自主的概念来解决这些复杂性。我们的建议将不同的伦理观点纳入对话，并纳入自治关系理论的多维、社会嵌入、标量和时间方面。我们从临终关怀的一个案例开始我们的反思，并在整个分析过程中使用该案例作为说明。结论 本文对自主权提出了一种关系性解释，它回应了该原则的主流解释中发现的主要缺陷，并且可以应用于临终关怀实践。
Background Respect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients' preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of 'relational autonomy' may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized. Main body Here, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis. Conclusion This article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices.