Patient's and Family's Participation in Medical Decision Making and Effective Competence among Nurses and Physicians

在日本，作为医学伦理学基础的主导原则正从家长制向尊重病人自主权过渡。随着医疗卫生事业的发展，伦理学问题日益复杂化和争议性，对护士的日常工作产生了很大的影响，采用结构式自我描述问卷对住院患者、家属、护士、数据分析显示，包括患者家属在内的患者的观点与医疗保健之间存在差异，（b）向专业人员（护士和医生）提供关于病人及其家属参与决策的信息。大约三分之一的护士和医生经历过家属要求不告知病人诊断和预后的情况。大多数病人认为在某种程度上参与了他们的医疗决策过程。三分之一的有能力的病人、一半的家属和四分之三的护士和医生最常见的决策过程是，是在与医生和家人协商后做出自己决定的愿望。然而，偏好的决策过程中有能力的病人和他们的家庭是不同的病人，他们的家人，和医疗保健专业人士认为，家庭有一个至关重要的作用，即使病人有能力作出自己的决定。参与这项研究的护士显然认为，他们遇到了与病人自主权有关的伦理困境。

In Japan the reigning principle underlying medical ethics is in transition from paternalism to respect for patient autonomy. Ethical issues have become more complicated and controversial with the development of medicine and health care, and this has great impact on the daily work of nurses.A structured self descriptive questionnaire was administered to inpatients, their families, nurses, and medical doctors in two general hospitals with over 500 beds in Japan.Data analysis revealed differences between the perspectives of patients including their families and health care professionals (nurses and medical doctors) regarding the participation of patients and their families in decision making. Approximately one-third of nurses and medical doctors experienced a family request not to inform a patient of a diagnosis and prognosis.Most of patients thought to be involved in their medical decision making processes to some degree.The most common decision making process desired by one-third of competent patients, half of their families, and three-quarters of the nurses and medical doctors, was the desire to make their own decisions after consultation with the physician and the family. However, preferences regarding the decision making process for competent patients were diverse among patients and their families.Patients, their families, and health care professionals believed that families have a crucial role to place in health care decision making even when a patient is competent to make their own decisions. Nurses involved in the study clearly believed that they encountered ethical dilemmas associated with patient autonomy.