scholarly journals 家庭作為弱勢人群的首重保障: 儒家倫理與醫療倫理

2013 ◽  
Vol 11 (2) ◽  
pp. 7-30
Author(s):  
Ping Cheung LO
Keyword(s):  
Decision Making ◽  
Chinese Culture ◽  
Public Hospitals ◽  
Medical Decision ◽  
Personal Integrity ◽  
Human Vulnerability ◽  
International Bioethics ◽  
Hospital Patients ◽  
Life Sustaining Treatment ◽  
Individual Self

LANGUAGE NOTE | Document text in Chinese; abstract also in English.晚近國際生命倫理學的個人主義色彩仍然甚濃，本文以如何保護醫療弱勢人群（病人）為例，指出國際生命倫理委員會2009年報告書這方面的弊病。文中一方面解釋了儒家倫理學的“家庭共決” 模式，為何應當作為保護醫療弱勢人群的首重保障，另方面也梳理出其它價值體系的相關觀點，發現某些西方學者也有類似看法，只是未為重視。筆者最後以香港公立醫院對終止維持生命治療及預設醫療指示的道德指引為例，說明儒家的家庭共決模式實際如何運作。Individualism is still very much alive in “international” bioethics. Using two documents from the International Bioethics Committee as examples (Proposed Outline for a Report on Respect for Human Vulnerability and Personal Integrity, 2009; Report of the IBC on the Principle of Respect for Human Vulnerability and Personal Integrity, 2011), and focusing on hospital patients as a vulnerable group, this essay points out the pitfalls of individualistic bioethics. Confucianism advocates family co-determination rather than individual self-determination, and this model of decision making can serve as the first bulwark in protecting vulnerable patients. This model of medical decision making is not unique to Chinese culture, but is actually advocated by a small number of Western scholars. This essay also illustrates how family co-determination in medical decisions works using the example of two recent policies introduced in Hong Kong public hospitals, viz., forgoing life-sustaining treatment for the terminally ill and the use of advance directives.DOWNLOAD HISTORY | This article has been downloaded 342 times in Digital Commons before migrating into this platform.

Hope-Colored Glasses: Perceptions of Prognosis Among Pediatric Oncology Patients and Their Parents

2021 ◽  
pp. OP.20.00762
Author(s):  
Deena R. Levine ◽  
Andrea Cuviello ◽  
Catherine Nelson ◽  
Zhaohua Lu ◽  
Belinda N. Mandrell ◽  
...  
Keyword(s):  
Decision Making ◽  
Pediatric Oncology ◽  
Medical Decision ◽  
Cancer Type ◽  
Oncology Patients ◽  
Hospital Patients ◽  
Original Survey ◽  
Survey Responses ◽  
Very High ◽  
High Chance

PURPOSE: Cancer patients' belief about prognosis can heavily influence medical decision making and goals of care. It is known that parents of children with cancer tend to be optimistic regarding their child's prognosis; however, little is known about pediatric patients' prognostic beliefs, how physicians' prognostic communication is perceived, and how these perceptions are compared with actual prognoses. PATIENTS AND METHODS: An original survey was administered to 100 pediatric oncology patients, age 10-18 years, and their parents from 2013 to 2015, at St Jude Children's Research Hospital. Patients were eligible for inclusion if they had an oncologic diagnosis, were between 1 month and 1 year from diagnosis, and were English speaking. Survey responses regarding perceived prognosis were compared with actual prognoses as determined from the medical record review and published literature. Analysis included descriptive statistics and association tests. RESULTS: Nearly half of participants (patients = 48.9%, parents = 50.5%) displayed prognostic optimism as compared with the determined objective estimate of curative potential. The majority of both patients (78%) and parents (85%) reported belief in a very high chance of cure, although fewer reported that their physician communicated a very high chance for cure (patients = 57%, parents = 70%), and only 43% were determined to have a very high probability of cure. Significant differences were noted in prognostic optimism by cancer type ( P < .0001); patients with solid tumor were more often optimistic (n = 25, 83.3% optimistic; n = 5, 16.7% accurate), and patients with lymphoma were most often accurate (n = 2, 8.7% optimistic; n = 21, 91.3% accurate). CONCLUSION: Pediatric oncology patients and parents tend to be optimistic about their chance of cure, as compared to both perceived prognostic communication from physicians and objective estimated prognosis. Understanding the nature of prognostic optimism among patients with cancer and caregivers may empower clinicians to guide realistic decision making while supporting hope.

A new kind of paternalism in surrogate decision-making? The case of Barnsley Hospitals NHS Foundation Trust v MSP

2020 ◽  
pp. medethics-2020-106797
Author(s):  
Scott Y H Kim ◽  
Alexander Ruck Keene
Keyword(s):  
Decision Making ◽  
Best Interests ◽  
Medical Decision ◽  
Negative Consequences ◽  
Substituted Judgment ◽  
Mental Capacity Act 2005 ◽  
Values And Beliefs ◽  
Life Sustaining Treatment ◽  
Surrogate Decision ◽  
Mental Capacity Act

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the patient and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment in Barnsley Hospitals NHS Foundation Trust v MSP [2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient.

Influence of personal preferences for life-sustaining treatment on medical decision making among pediatric intensivists*

2012 ◽  
Vol 40 (8) ◽  
pp. 2464-2469 ◽  
Author(s):  
Jennifer S. Needle ◽  
Richard A. Mularski ◽  
Thuan Nguyen ◽  
Erik K. Fromme
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Life Sustaining Treatment

Are pictures the voice of numbers in a medical decision making task?

2009 ◽  
Author(s):  
Joshua Kelades ◽  
Peter J. McLeod ◽  
Rick Mehta
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
The Voice

The information bias in medical decision making

2007 ◽  
Author(s):  
Gabriella Pravettoni ◽  
Claudio Lucchiari ◽  
Salvatore Nuccio Leotta ◽  
Gianluca Vago
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Information Bias

Moral medical decision-making: Colliding sacred values in response to COVID-19 pandemic.

2020 ◽  
Vol 12 (S1) ◽  
pp. S128-S130
Author(s):  
Neil Shortland ◽  
Presley McGarry ◽  
Juan Merizalde
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Sacred Values
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