What Does the Evolution From Informed Consent to Shared Decision Making Teach Us About Authority in Health Care?
What Does the Evolution From Informed Consent to Shared Decision Making Teach Us About Authority in Health Care?
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DOI：
10.1001/amajethics.2020.423
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发表时间：
2020-05-01
影响因子：
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通讯作者：
Childress, Marcia Day
中科院分区：
文献类型：
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作者：
Childress, James F;Childress, Marcia Day
本文探讨了知情同意的法律的学说和伦理规范及其不足，特别是其集中在医生披露的信息，而不是对病人的理解，这导致了发展的共同决策，以加强知情同意。作为一个模糊和不精确的标题，共同决策包括几种不同的方法。狭义的方法预设了自主的个人主义帐户，而更广泛的方法认为自主关系，并认为建立在良好的沟通基础上的临床医生-患者关系可以帮助决策和促进自主选择。共同决策面临着概念、规范和实践方面的挑战，但由于其目标是尊重、保护和促进患者的自主选择，它代表了医学领域的一个重要文化变革。
This article examines the legal doctrine and ethical norm of informed consent and its deficiencies, particularly its concentration on physician disclosure of information rather than on patient understanding, which led to the development of shared decision making as a way to enhance informed consent. As a vague and imprecise rubric, shared decision making encompasses several different approaches. Narrower approaches presuppose an individualistic account of autonomy, while broader approaches view autonomy as relational and hold that clinician-patient relationships grounded in good communication can assist decision making and foster autonomous choices. Shared decision making faces conceptual, normative, and practical challenges, but, with its goal of respecting, protecting, and promoting patients' autonomous choices, it represents an important cultural change in medicine.