基於儒家家庭本位思想的知情同意原則的思考

2013 ◽  
Vol 11 (1) ◽  
pp. 33-44
Author(s):  
Xiangjin KONG ◽  
Mingjie ZHAO
Keyword(s):  
Decision Making ◽  
Filial Piety ◽  
Moral Virtue ◽  
Family Members ◽  
Confucian Ethics ◽  
Medical Decision ◽  
Individual Autonomy ◽  
The Family ◽  
Family Decision ◽  
Opinion Polls

LANGUAGE NOTE | Document text in Chinese; abstract also in English.在具有家庭主義特徵的中國社會文化語境下，儒家家庭本位思想對病人知情同意權的影響是客觀實在。以自由主義和個人主義為理論基礎的個人自主知情同意原則要想在中國本土的醫療實踐中發揮應有作用，突顯家庭在知情同意過程中的主導地位是重要前提。在中國的醫療實踐中，知情同意的模式必須融入中國儒家家庭本位思想，才能更好地發揮其作用。Opinion polls released recently show that the majority of people in China today think that informed consent in medical practice is necessary, with more than half favoring family decision making over individual, autonomous patient decision making. Based on these opinion polls, this essay argues that the liberalism and liberal individualism that emphasize individual autonomy do not square with the Confucian tradition.The essay submits that the “family decision” model is designed to embody Confucian family ethics and maximize the benefit of family involvement in medical decision making. The family model includes both the patient and his or her close family members in the decision making process. The Confucian ethics of humanness (ren) – the highest moral virtue – and filial piety (xiao) – the foundation of all moral virtue – support family as the most appropriate authority for medical decisions. Further, the essay explores how the family as a unit is better positioned to work with the physician at critical moments to protect the interests of the patient. This means that the family, not the patient, is in authority, and that in some cases, it is acceptable for family members to hide “medical information” from the patient with the cooperation of the physician. The essay concludes that the family is, and should be treated as, a significant moral participant in medical decision making.DOWNLOAD HISTORY | This article has been downloaded 99 times in Digital Commons before migrating into this platform.

scholarly journals 當代中國家庭醫療決策的倫理策略——一個有關家庭醫療決策的案例研究

2017 ◽  
Vol 15 (2) ◽  
pp. 21-41
Author(s):  
Guobin CHENG
Keyword(s):  
Decision Making ◽  
Family Involvement ◽  
Filial Piety ◽  
Medical Information ◽  
Family Members ◽  
Confucian Ethics ◽  
Medical Decision ◽  
Medical Decisions ◽  
The Family ◽  
Family Decision

LANGUAGE NOTE | Document text in Chinese; abstract also in English.在當代中國家庭醫療決策過程存在以下幾個特點：第一，病人的自主權並未完全消失，但其實現程度和方式受到了諸多限制；第二，對病人的行為能力和權利限度的判斷上存在家長主義和後果論的特徵，在一定程度上構成了對病人權利的剝奪；第三，病人的最大利益和個人意願仍然是決策依據的重要方面，但對這兩者的解讀體現出了偏重客觀利益和共用價值觀的特點，又受到家庭具體權力結構的影響。在家人做出最終決策的形式背後隱藏著諸多豐富的細節，家庭醫療決策是一個傳統與現代、家庭與個人價值觀共同作用的複雜過程，用任何一個單一的理論模型都很難說清它的本來面貌。This essay points out that informed consent in China today is often replaced by the “family decision” model, which is designed to embody Confucian family ethics and maximize the benefit of family involvement in medical decision making. The author, a physician, uses a specific case he encountered when treating an elderly woman with late-stage colon cancer. Because the patient did not know the whole truth of her condition, most of the medical decisions regarding her treatment were made by her children. Ideally speaking, a “family decision” means that both the patient and his/her close family members will be involved in the decision-making process. Yet, the author’s experiences show that in most cases, decision-making responsibilities shift from the patient to the family, especially when the patient is an elderly parent. Theoretically speaking, the Confucian ethics of humanness (ren) and filial piety (xiao) support family as the most appropriate authority for medical decisions. However, in reality, the author finds that this could be problematic when family members hide medical information from the patient—sometimes with cooperation from the physician. The essay recommends that more respect and autonomy should be given to the patient if the “family decision” policy is truly implementedDOWNLOAD HISTORY | This article has been downloaded 202 times in Digital Commons before migrating into this platform.

scholarly journals 論醫療中的家庭決策

2010 ◽  
Vol 8 (2) ◽  
pp. 33-45
Author(s):  
Yu CAI
Keyword(s):  
Decision Making ◽  
Family Member ◽  
Decision Model ◽  
Filial Piety ◽  
Family Members ◽  
Medical Decision ◽  
The Family ◽  
Family Decision ◽  
Close Family ◽  
Family Decisions

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文首先通過引入“家庭決策”揚棄“家屬決策”之概念而統一了家庭、患者和家屬之意願，消弭了長久以來醫療決策領域存在的患者決策和家屬決策之矛盾與紛爭。其後，文章從中國儒家文化中的“仁愛”、“孝悌”與“家庭觀”之視角立論了家庭決策的妥當性與可行性，並在西方倫理的自由主義和主體性思想中找到了家庭決策之落腳點。This paper begins with a definition of “family decisions.” I emphasize that family decisions are made jointly by all close family members on a voluntary basis. This decision-making mechanism is designed to embody the spirit of Confucian family ethics and maximize the benefit of family involvement in medical decision making.Introducing this concept allows us to abandon the outdated concept of “family member decisions” that seems to exclude the patient from the process of decision making. Family decision models should reflect the unity of the family, and should include both the patient and his or her close family members in the proper way in the decision making process. This unity will help to eliminate contradictions or disputes on whether medical decisions should be made by the patient alone or by the patient’s family members only. This paper expounds on the appropriateness and feasibility of the family decision model from the perspectives of benevolence (ren), filial piety (xiao), and family values cherished in the Chinese Confucian culture. First, Confucianism regards benevolence as the highest ethical and moral virtue, with filial piety as the foundation. According to the Confucian concept of filial piety, the rudimentary moral standard for individuals is that they must love their family members. As family decisions involving medical care need to take into account the long-term interests and common development of all family members, those decisions should be more in line with the spirit of reciprocal affection among family members advocated in the concepts of Confucian benevolence and filial piety. At the same time, family members are more likely to reach a compromise among themselves, based on mutual love, that maximizes the interests of the family for every member. Second, in accordance with the Confucian concept of the family, the life and behavior of individuals do not entirely belong to them, but rather to their family. Indeed, individual happiness is greatly dependent on the well-being of the family. Hence, the Confucian concept of the family underpins the family decision model and makes it appropriate in a clinical context. Influenced by the Confucian concept of the family, family decisions are easier to reach in China.This paper also explores the basis for family decisions in Western ethics, and suggests that the family decision model can also be defended from a liberal ethical perspective. In the process of family decision-making, every family member must limit their own behavior so as not to interfere with the freedom of other family members, thereby allowing every member the maximum freedom that they can enjoy in familial life. This reflects the ethical meaning of liberalism in a more comprehensive and in-depth way. Further, when making family decisions, all family members participate in the consultation as moral agents, and the status of each member as a moral agent is fully respected and exhibited. Finally, a family often serves as a moral community, and there are thus few obstacles to joint decision making arising from differing views on values. At the same time, even if family members hold different moral standards, they can still fully understand the needs of other family members in the process of familial decision making through effective mutual communication, so that a consensus is easier to reach through reciprocal compromise.DOWNLOAD HISTORY | This article has been downloaded 122 times in Digital Commons before migrating into this platform.

scholarly journals Development and validation of the Family Decision-Making Self-Efficacy Scale

2009 ◽  
Vol 7 (3) ◽  
pp. 315-321 ◽  
Author(s):  
Marie T. Nolan ◽  
Mark T. Hughes ◽  
Joan Kub ◽  
Peter B. Terry ◽  
Alan Astrow ◽  
...  
Keyword(s):  
Decision Making ◽  
Self Efficacy ◽  
Family Members ◽  
Terminally Ill ◽  
Loved One ◽  
The Family ◽  
Family Decision ◽  
Patient Scenario ◽  
Family Decision Making ◽  
Test Retest Reliability

AbstractObjective:Several studies have reported high levels of distress in family members who have made health care decisions for loved ones at the end of life. A method is needed to assess the readiness of family members to take on this important role. Therefore, the purpose of this study was to develop and validate a scale to measure family member confidence in making decisions with (conscious patient scenario) and for (unconscious patient scenario) a terminally ill loved one.Methods:On the basis of a survey of family members of patients with amyotrophic lateral sclerosis (ALS) enriched by in-depth interviews guided by Self-Efficacy Theory, we developed six themes within family decision making self-efficacy. We then created items reflecting these themes that were refined by a panel of end-of-life research experts. With 30 family members of patients in an outpatient ALS and a pancreatic cancer clinic, we tested the tool for internal consistency using Cronbach's alpha and for consistency from one administration to another using the test–retest reliability assessment in a subset of 10 family members. Items with item to total scale score correlations of less than .40 were eliminated.Results:A 26-item scale with two 13-item scenarios resulted, measuring family self-efficacy in decision making for a conscious or unconscious patient with a Cronbach's alphas of .91 and .95, respectively. Test–retest reliability was r = .96, p = .002 in the conscious senario and r = .92, p = .009 in the unconscious scenario.Significance of results:The Family Decision-Making Self-Efficacy Scale is valid, reliable, and easily completed in the clinic setting. It may be used in research and clinical care to assess the confidence of family members in their ability to make decisions with or for a terminally ill loved one.

scholarly journals 重審生命倫理學視域下身體話語的地位——以臨終決策為線索

2015 ◽  
Vol 13 (1) ◽  
pp. 83-94
Author(s):  
Jue WANG
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Personal Identity ◽  
Ethical Issues ◽  
Family Members ◽  
The Body ◽  
Confucian Ethics ◽  
Individual Autonomy ◽  
End Of Life Decision ◽  
Life Decision

LANGUAGE NOTE | Document text in Chinese; abstract also in English.對於生命終極的關懷，臨終決策是現代生命倫理學不可忽視的一個重大話題。本文試圖從身體的角度論證當代生命倫理學話語由於失落了身體而陷入一場深刻的危機。具體而言，本文將通過對臨終決策困境的分析展示危機的根源，論證身體經驗及相關倫理關係是生命倫理學不可或缺的基礎。作者認為，只有作為身體倫理，生命倫理學才能充分實現它的學術追問和學科理念。身心二元論只是一個虛構，身體性存在才是人格同一性的真正基礎。因此，建設生命倫理學不只是擁抱某些抽象的自主原則，或是某些精緻的道德主體的體系，更關鍵的問題是要回答“我們希望成為何等樣的人，希望將來生活在怎樣的世界中”。How is the body articulated in language and discourse during end-of-life decision making? How do individuals and their family members represent and define the relationships between person, body, and self? Recently, studies have been conducted on the decision-making process in the field of end-of-life care. Most researchers focus on patients’ determination (vis-à-vis physicians’ beneficence), which gives rise to a plethora of issues, such as patients’ self-identity, self-continuity, relationships, freedom of choice,and rights.In this paper, end-of-life decision making is considered from the perspective of the relationship between the body and one’s personal identity. It is argued that the current bioethical discourse on individual autonomy and patients’ rights is inadequate to address the ethical issues relating to end-of-life decision making. Instead of purely theoretically conceptualizing the sovereignty of the patient over his or her body, the author explores the issue in relation to the phenomenology of lived-body experience as described by the American bioethicist Margret P. Battin. The rights available to the patient are not the only significant issue during end-of-life decision-making; aspects of the patient’s physicality are also relevant. Discourse on representations of the body and embodied action/autonomy aids our understanding of end-of-life choices. Finally, these body-related issues are linked with the Confucian understanding of what a person is. According to Confucian ethics, personal identity should not be viewed as an abstract “thing”; instead, it is defined by a person’s relationships with others, especially family members, in his/her most vulnerable moments.DOWNLOAD HISTORY | This article has been downloaded 138 times in Digital Commons before migrating into this platform.

Rethinking individual autonomy in medical decision-making for young adults reliant on caregiver support: A case report and analysis

2021 ◽  
pp. 147775092110698
Author(s):  
Alexia Zagouras ◽  
Elise Ellick ◽  
Mark Aulisio
Keyword(s):  
Decision Making ◽  
Young Adults ◽  
Medical Decision Making ◽  
Life Experience ◽  
Pregnant Patient ◽  
Medical Decision ◽  
Individual Autonomy ◽  
Caregiver Support ◽  
Neurological Condition ◽  
Decision Making Capacity

There is a gap in the clinical bioethics literature concerning the approach to assessment of medical decision-making capacity of adolescents or young adults who demonstrate diminished maturity due to longstanding reliance on caregiver support, despite having reached the age of majority. This paper attempts to address this question via the examination of a particular case involving assessment of the decision-making capacity of a young adult pregnant patient who also had a physically disabling neurological condition. Drawing on concepts from adolescent bioethics and feminist critiques of bioethical theory, we argue that limited life experience, secondary to a disabling neurological condition, can result in a lack of adult-like capacity even in a patient who is legally an adult. In such cases, it may be that autonomy, to the extent that it is to be relevant and meaningful, must be viewed through a relational lens. Furthermore, clinicians may avoid unjustifiably paternalistic practices by working with the patient help her gain a better appreciation of the consequences of her decision, thereby calling forward her capacity rather than resorting to being directive in counseling. We conclude that lessons from this case can be used to approach ethically complex instances of medical decision-making in adult patients with normal cognition but diminished experiential maturity.

Family Members' Perceptions of Adolescents' Influence in Family Decision Making

1989 ◽  
Vol 15 (4) ◽  
pp. 482 ◽  
Author(s):  
Ellen R. Foxman ◽  
Patriya S. Tansuhaj ◽  
Karin M. Ekstrom
Keyword(s):  
Decision Making ◽  
Family Members ◽  
Family Decision ◽  
Family Decision Making

Confucian Perspectives on Psychiatric Ethics

2014 ◽  
Author(s):  
Ruiping Fan ◽  
Zhengrong Guo ◽  
Michael Wong
Keyword(s):  
Mainland China ◽  
Real Life ◽  
Confucian Ethics ◽  
Individual Autonomy ◽  
Clinical Settings ◽  
Involuntary Hospitalization ◽  
Way Of Life ◽  
Family Obligations ◽  
The Family ◽  
Family Based

This chapter examines Confucian perspectives on psychiatric ethics by focusing on a family-based and family-oriented way of life. It first provides a background on Confucianism and Confucian familism, with emphasis on central concerns in the Confucian virtuous way of life including the integrity, continuity, and prosperity of the family. It then compares Confucian ethics with Western bioethics in terms of moral responsibility and individual autonomy in the context of family obligations and patient needs. It also discusses the Mental Health Act in China, which became effective in May 2013, and its restrictions on involuntary hospitalization within the context of Confucian ethics. The chapter considers two cases, one from mainland China and another from Australia, to illustrate Confucian psychiatric ethics at work in real life and highlight various issues that arise in contemporary clinical settings.

Treatment decision-making for older adults with cancer: A qualitative study

2020 ◽  
pp. 096973302094575
Author(s):  
Ni Gong ◽  
Qianqian Du ◽  
Hongyu Lou ◽  
Yiheng Zhang ◽  
Hengying Fang ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Cancer Patients ◽  
Family Members ◽  
Treatment Decision ◽  
Chinese Society ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
The Family ◽  
Older Cancer Patients

Background: Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients’ treatment decisions are made by family members. Objective: This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice. Method: A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis. Ethical considerations: The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time. Results: Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members. Conclusion: This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family.

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