Patient education as empowerment and self-rebiasing
Patient education as empowerment and self-rebiasing
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DOI：
10.1007/s11019-016-9702-9
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发表时间：
2016-12-01
影响因子：
2.1
通讯作者：
Elger, Bernice S.
中科院分区：
文献类型：
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作者：
Jotterand, Fabrice;Amodio, Antonio;Elger, Bernice S.
医患关系的信托性质要求临床医生以患者的最佳利益行事。患者由于健康状况和缺乏医学知识而易受伤害，这使他们依赖临床医生的专业知识。然而，有能力的患者可能会拒绝医生的建议，或者拒绝有益的医疗干预，或者拒绝基于与感知的医疗适应症不匹配的个人观点的程序。在某些情况下，病人的拒绝可能危及他们的健康或生命，但也损害了临床医生的道德责任，以促进病人的最佳利益。换句话说，卫生专业人员必须处理那些行为和医疗保健决定似乎对他们的健康起反作用，甚至恶化的患者，因为缺乏知识，不良习惯或偏见，而不是患者的自由自愿选择。道德困境集中在病人的自主权（权利）和临床医生的作用，以促进病人的福祉（责任）的限制周围的问题。在本文中，我们认为：（1）操纵策略的使用，尽管被认为是有益的，但违背了病人教育的目的，因此应该被拒绝;和（2）适当的战略是通过患者教育赋予患者权力，提高他们的自主性，鼓励他们成为全面的医疗保健合作伙伴，而不是临床干预的对象或价值观或态度需要塑造的实体，通过教育改变。首先，我们提供了一个病人教育的概念和它的起源简要的历史概述的工作定义。其次，我们研究的性质，病人和医生的关系，以划定其边界，理解教育在临床环境中的作用至关重要。第三，我们认为，患者教育应促进自我再偏，提高自主性，并赋予患者决定自己的治疗目标。最后，我们制定了一个道德框架的病人教育。
The fiduciary nature of the patient-physician relationship requires clinicians to act in the best interest of their patients. Patients are vulnerable due to their health status and lack of medical knowledge, which makes them dependent on the clinicians' expertise. Competent patients, however, may reject the recommendations of their physician, either refusing beneficial medical interventions or procedures based on their personal views that do not match the perceived medical indication. In some instances, the patients' refusal may jeopardize their health or life but also compromise the clinician's moral responsibility to promote the patient's best interests. In other words, health professionals have to deal with patients whose behavior and healthcare decisions seem counterproductive for their health, or even deteriorate it, because of lack of knowledge, bad habits or bias without being the patients' free voluntary choice. The moral dilemma centers on issues surrounding the limits of the patient's autonomy (rights) and the clinician's role to promote the well-being of the patient (duties). In this paper we argue that (1) the use of manipulative strategies, albeit considered beneficent, defeats the purpose of patient education and therefore should be rejected; and (2) the appropriate strategy is to empower patients through patient education which enhances their autonomy and encourages them to become full healthcare partners as opposed to objects of clinical intervention or entities whose values or attitudes need to be shaped and changed through education. First, we provide a working definition of the concept of patient education and a brief historical overview of its origin. Second, we examine the nature of the patient-physician relationship in order to delineate its boundaries, essential for understanding the role of education in the clinical context. Third, we argue that patient education should promote self-rebiasing, enhance autonomy, and empower patients to determine their therapeutic goals. Finally, we develop a moral framework for patient education.