scholarly journals 病人訪談: 一個知情同意的故事

2002 ◽  
Vol 4 (2) ◽  
pp. 119-124
Author(s):  
Shuqing WU
Keyword(s):  
Informed Consent ◽  
Medical Knowledge ◽  
Medical Professionals ◽  
Her Family ◽  
Digital Commons ◽  
The Family ◽  
The Will ◽  
The Individual ◽  
The Cost ◽  
Economic Capacity

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本故事提出了如下一些知情同意方面的問題：面對沒有文化、且毫無醫學知識的病人，如何履行知情同意？在病情緊急情況下應否免除知情同意或待病情穩定後再向病人或家屬補充說明？如果是後者，這種事後的同意有何意義？在醫院追逐利潤並與病人利益發生衝突的情況下，費用成為病人關注的重要問題，病人如何有效的表示自己的意見？在病人本人沒有經濟能力、又無醫療保險的條件下，一切依賴家屬，病人如何維護自己的權益？病人本人的意願有何意義？如何面對既不能否定家屬的同意又有可能出現家屬違背病人本人意願行事可能的困境？The story reported in this article raises some questions on informed consent. To patients with no education and no medical knowledge, how do medical professionals perform informed consent? In the situation of emergence, should medical professionals be excused from the obligation of informed consent? Or should the patient and his or her family be informed after the illness is cured? If this is so, what is the meaning of informed consent? With the conflict between the interests and the patient and the hospital, the cost is a very importance issue. How does the patient express his or her opinions effectively? Patients who have no economic capacity and no medical insurance depend on their families for medical care. How can their rights and interests are protected? What medical professionals should do if the decision of the family is against the will and interests of the individual patient?DOWNLOAD HISTORY | This article has been downloaded 38 times in Digital Commons before migrating into this platform.

scholarly journals 儒家“個人”的道德身份與道德責任

2013 ◽  
Vol 11 (2) ◽  
pp. 37-40
Author(s):  
Yu CAI
Keyword(s):  
Current Practice ◽  
Moral Identity ◽  
Historical Narrative ◽  
Medical Decisions ◽  
Her Family ◽  
Legal Provisions ◽  
Informed Consent Form ◽  
Digital Commons ◽  
The Family ◽  
Family Decisions

LANGUAGE NOTE | Document text in Chinese; abstract in English only.This article reviews Professor Lo Ping Cheung’s paper, “The Family as the Primary Protector of the Vulnerable: Confucian versus Medical Ethics.” The paper describes human behavior by way of historical narrative, thus offering a historical perspective on philosophical research. His notion of “family co-determination” instead of “parent-determination” also brings a developmental attitude to philosophical research. At the same time, we discuss the moral identity and moral responsibility of the Confucian “individual.” The moral identity of the Confucian “individual” includes both specific cultural identities and a specific social identity. Confucian individuals are the successors, developers and creators of Confucian culture, and also the practitioners and successors of family virtues. These are their moral responsibilities. This article also makes recommendations on forming and expressing family decisions in practice. First, family decisions should be taken by those members of the family who have the capacity to make a decision. However, taking the view of the family as the ethical unit, a family decision should be made on the family’s specific circumstances, with no need for administrative or legal provisions. Second, in accordance with current practice, a representative of the family who has the capacity to make medical decisions should sign an informed consent form. When the views of the patient and his or her family are not consistent, the general principle is that the doctor should follow the patient’s decision. Yet there might be some cases in which the doctor should not follow the decision of the patient; for example, if the patient makes a decision that endangers his or her life due to a lack of knowledge, emotional state or other reasons. In this case, the other family members will put forward their different views based on their responsibility to the patient, and the doctor may comply with the latter.DOWNLOAD HISTORY | This article has been downloaded 301 times in Digital Commons before migrating into this platform.

scholarly journals 病人自主性與家庭本位主義之間的張力

2002 ◽  
Vol 4 (2) ◽  
pp. 70-84
Author(s):  
Jin-cheng LEI ◽  
Zhi-qing XIE
Keyword(s):  
Informed Consent ◽  
Basic Unit ◽  
Individual Autonomy ◽  
Cultural Tradition ◽  
The West ◽  
Cultural Contexts ◽  
Patient’S Autonomy ◽  
The Family ◽  
The Difference ◽  
The Individual

LANGUAGE NOTE | Document text in Chinese; abstract also in English.在中國幾千年小農經濟和傳統文化背景下，個人利益、個人權利一直被置於家庭之下，個人自主性被包含在家庭自主性之內，表現為一種家庭本位主義。源自西方歷史、文化的知情同意移植到中國後，受傳統文化概念的影響，中國人對知情同意的認知、理解以及實踐方式均不同於西方人。這種不同集中表現在人們對家屬同意權的認可。以個人本位主義為背景的病人自主性與中國文化中的家庭本位主義之間存在張力。對知情同意在不同文化環境中不同踐行方式，應以文化寬容主義的態度對待之。不同文化背景下的倫理觀念，不僅存在差異性，而且也存在可通約性和相容性。由於種種原因，家庭同意並不能等同於病人本人的意願。隨著全球化進程的加速和人們相互交往的密切，類似知情同意這樣一些原本屬於個人的自然權利，將會愈來愈多地為各國人民接受。我們應當在某些條件具備時，盡可能地將家屬同意限制在合理的範圍，讓病人更好地表達自己的意願。Family has a long history. With China's small-scale peasant economy and traditional cultural background for centuries, family has been the most basic unit of polity, economy, and socio-cultural life. Interests and rights of the individual are always placed below those of family; individual autonomy is often included in family autonomy. All this can be called familism. There are deeper and determining economic reasons for familism. The economy of the family is controlled by the head of the family or clan so that the individual usually has no independent economic measures to support his or her autonomous rights.Informed consent originated in the Western culture. The theoretical premise of informed consent is respect for the patient's autonomy. The patient's autonomy is closely related with individualism in the West. After informed consent is spread from the West to China, due to the influence of traditional Chinese culture, the Chinese perception, understanding, and practice of are different from those of the West. The difference mainly lies in Chinese familism. To focus on the autonomy of the family reflects the influence of traditional familism upon informed consent. As a result, there exits a tension between the patient's autonomy based on individualism and familism in Chinese culture.Informed consent is not a culture issue, but it is closely related with cultural tradition. It is impossible to get away with cultural norms in the practice of informed consent. To different practicing methods of informed consent in different cultural contexts, the spirit of cultural tolerance is needed. In China, with the principle of cultural tolerance as a practical guidance, we should establish a set of procedure and ways of practicing informed consent with Chinese characteristics. Fundamentally, informed consent is to balance the unbalanced power between doctors and patients. According to the principle of cultural tolerance, the difference in the practice of informed consent at different cultural contexts should be tolerated so long as the basic purpose of informed consent is not violated. There exists a variety of cultural ideas among contemporary Chinese. The individual patient and his or her family are essential part of informed consent, with both having their rationality. Thus, we shouldn't reject absolutely some methods. From the angle of historical development, it is worthwhile noticing the transformation from family determination to individual autonomy. National and cultural differences are integrating in the age of globalization. Since laws, ethics, and customs in different countries and cultures are mutually exchanging, we should promote to make the practice of informed consent to become similar.DOWNLOAD HISTORY | This article has been downloaded 35 times in Digital Commons before migrating into this platform.

scholarly journals 是情結還是希望？

2013 ◽  
Vol 11 (2) ◽  
pp. 103-107
Author(s):  
Xiaolin WANG
Keyword(s):  
Social Harmony ◽  
Chinese Han ◽  
Sacred Place ◽  
Cultural Phenomenon ◽  
Digital Commons ◽  
The Family ◽  
The Individual ◽  
Individual Self ◽  
Chinese Han People ◽  
Secular Life

LANGUAGE NOTE | Document text in Chinese; abstract in English only.This article proposes a different view from that offered by Professor Ni in “Regulating the Family and Gongfu.” Professor Ni argues that the family forms the base from which a person’s life can go beyond the individual self, obtain sacredness within the secular, and become immortal, in addition to providing the basis for social harmony. This article agrees that the notion that family serves not only as a refuge in the secular life of Chinese Han people, but also as a sacred place in their soul, is a cultural phenomenon. At the same time, however, this article argues that adopting the family as the basis for rejuvenating our tradition is merely an unrealistic assumption.DOWNLOAD HISTORY | This article has been downloaded 72 times in Digital Commons before migrating into this platform.

scholarly journals 家庭共同決策模式在手術知情同意中的應用

2013 ◽  
Vol 11 (2) ◽  
pp. 141-145
Author(s):  
Mingxu WANG ◽  
Le MA ◽  
Hui YUEN
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Family Functioning ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Fundamental Interest ◽  
Digital Commons ◽  
The Family

LANGUAGE NOTE | Document text in Chinese; abstract in English only.H. Tristram Engelhardt indicates that the ontological or metaphysical account of the family is superior to the libertarian-liberal account of the family with respect to significant issues in bioethics. By appealing to the development of the concept of informed consent and relevant medical laws and institutions, illustrated by examples from China, this essay supports Engelhardt’s view and emphasizes the cultural and ethical importance of the family functioning as a whole in the process of proper medical decision making and the protection of the fundamental interest of the patient.DOWNLOAD HISTORY | This article has been downloaded 94 times in Digital Commons before migrating into this platform.

scholarly journals Sources of stress in the practice of psychiatry: perspective from the Arab world

2019 ◽  
Vol 16 (03) ◽  
pp. 58-59
Author(s):  
Rudwan Abdul-Al
Keyword(s):  
Home Country ◽  
Arab World ◽  
Obsessive Compulsive ◽  
Complex Situation ◽  
Her Family ◽  
Compulsive Disorder ◽  
The Family ◽  
And Migration ◽  
The Cost

The main challenges faced by psychiatrists in the Arab world are stigma, shortage of resources, role of the family and effects of conflicts and migration. Psychiatrists practising in this region have to adapt to these challenges and use creative methods to provide a good service to their patients.A woman in her mid-20s presented to a private psychiatric out-patient clinic with a longstanding obsessive–compulsive disorder of contamination. She had fled her home country with her family because of an ongoing armed conflict. They were under temporary ‘visitor’ visas and the possibility of their stay not being renewed created immense anxiety. The patient was prone to bouts of anger on a regular basis, causing her to shout at her mother and brother. Her mother was concerned that the neighbours might complain, which might get the family into trouble with the police. The family were eager to know if the patient's condition was likely to improve with medication. They also asked if she could be admitted to an in-patient unit for treatment. Unfortunately, the psychiatric in-patient unit was not suitable for her needs and she could not go back to her home country because of safety concerns. The cost of treatment at a private clinic was expensive for the family. She was not eligible for state-funded healthcare.The psychiatrist had to manage a complex situation created by stigma, effects of war and migration, lack of appropriate resources and the role of family. He maintained a trusting relationship with the patient and made sure no information was given to her family without her consent. Regular contact with the family was maintained to increase awareness about the nature of the patient's symptoms and to support the family in coping with the difficulties mentioned above.

scholarly journals 知情同意的權利主體: 儒家倫理視角下的考察

2008 ◽  
Vol 6 (1) ◽  
pp. 17-28
Author(s):  
Tongwei YANG ◽  
Zhangqi FENG
Keyword(s):  
Informed Consent ◽  
Family Relationship ◽  
Family Values ◽  
Reciprocal Relationship ◽  
Confucian Ethics ◽  
Individual Autonomy ◽  
Digital Commons ◽  
The Family ◽  
Physician Relationship ◽  
The Right

LANGUAGE NOTE | Document text in Chinese; abstract also in English.“ 知情同意”這個在西方文化背景中產生的倫理和法律術語在中國仍然是一個比較新的概念。尤其是對於知情同意的權利主體這一基本問題，在立法實踐和臨床實務中仍存在認識模糊和不一致之處。本文基於儒家家庭倫理的基本精神——尊重個人意願與家庭關懷的統一，提出了關於知情同意權利主體的立法建議。在儒家倫理中，主張“和而不同”、“互以對方為重”，體現了尊重個人意願的思想。在儒家倫理中還主張“父慈子孝”、“兄友弟恭”、“夫婦和順”，體現了家庭關懷。可見，在儒家倫理視野下，知情同意權利並非由家屬包辦，也非僅僅屬於患者而和家庭無關，而是在患者做主前提下的家庭參與，是患者做主與家庭關懷的統一。所以，對於有同意能力的患者而言，其本人所作的同意表示才具有法律效力；只有在某些特殊的情形下患者家屬才可以代為簽署知情同意書或者代行知情同意權利。Informed consent has been a core principle endorsed by modern Western medical ethics. It involves patient-physician relationship as well as family relationship. It has been a focus of debates since it was introduced to the Chinese world whether informed consent is agreeable to the cultural ethos of China, and if not, whether it can be applied transculturally. This paper first discusses three principles in the policy of informed consent: 1. the principle of individual autonomy; 2. the principle of non-maleficence; and 3. the principle of effectiveness. Then the paper explores the issue informed consent within the framework of the Confucian concept of family and family values, indicating that in Confucian ethics, the idea of“ harmony in diversity” acknowledges the importance of individuality whereas the notion of reciprocal relationship emphasizes the interconnectedness of everyone in family and society at large. We should always look for a balanced point between the right of the patient and the duty of the physician, and between the interest of an individual person and the interest of the family as a unit.DOWNLOAD HISTORY | This article has been downloaded 183 times in Digital Commons before migrating into this platform.

scholarly journals 中國文化是否構成了對知情同意的挑戰？

2009 ◽  
Vol 7 (1) ◽  
pp. 117-134
Author(s):  
Wei ZHU
Keyword(s):  
Informed Consent ◽  
Chinese Culture ◽  
Ethical Judgment ◽  
Decisive Role ◽  
Digital Commons ◽  
The Family ◽  
Wide Perspective ◽  
Controversial Topic ◽  
The Analects ◽  
Family Consent

LANGUAGE NOTE | Document text in Chinese; abstract also in English.知情同意原則自引進中國以來，遭遇到能否與中國文化相適應的質疑。這樣的質疑，基於以下兩個事實判斷：一是，在現實的臨床和研究的同意過程中，往往是家庭共同參與或代替病人或研究參與者決策，而不是由他們本人單獨作決定；二是，從文化傳統來看，中國文化似乎不具備知情同意的理論基礎。由此，一些學者認為中國文化對知情同意形成了挑戰。本文認為，這兩個事實判斷不足以證明中國文化對知情同意構成了挑戰。這不僅因為這樣的事實不是全部的、或真正的事實，而且還因為事實判斷不能代替倫理判斷。倫理的判斷需要更為廣泛的視角。當我們試圖以一些事實說明家庭同意是合理的，那麼我們須要考察，家庭同意是否保護了病人和受試者的利益和權利？當我們斷言說中國文化缺乏自主性的特質時，除了事實的說明外，還須要對自主性的內涵及其意義作出分析，從而能夠判斷這樣的結論是否具有普遍性。自主性之所以是重要的，並成為知情同意的理論基礎，是因為借此病人和受試者可按照自己的利益、意願來行動、決定和選擇，從而達到保護他們的目的。從這個意義上說，沒有必要去深究家庭同意是否撼動了知情同意的基礎，或重新構建知情同意的理論基礎。知情同意的文化敏感性更應該著眼於操作層面。Since its introduction into China as a bioethical principle, informed consent has been a controversial topic. Many doubt its adoptability in the Chinese context. They claim that in China, it is often the family and not the patient that makes the decision about patient care in real clinical practice or medical research. In addition, Chinese culture appears incompatible with the principle of informed consent. As a result, many scholars conclude that Chinese culture constitutes a challenge to the application of informed consent in China.This essay contends that such an argument does not hold water, or at least, is not well justified. First, such a claim obviously fails to tell everything about the situation in China. In addition, a factual judgment cannot take the place of an ethical one, while an ethical judgment should be made taking a wide perspective. When we seek to determine the justifiability of family consent with certain facts, we need to consider also whether it is conducive to the protection of the rights and benefits of the patient. When people assert that autonomy is not part of Chinese culture, they should not rely on just a factual presentation. Rather, they should go a step further, to work at the meaning and significance of autonomy, so that they can determine whether such a claim is universally true. In fact, Confucian Chinese culture features rich intellectual and moral resources that support individual independence, creativity, and freedom. For example, in the Confucian classics, including the Analects, we can easily find sayings of Confucian sages that emphasize a free, independent, and strong will, which underlies informed consent.Autonomy, which is the theoretical basis of informed consent, is important because it plays a decisive role in helping to safeguard the rights and benefits of patients. It should be quite clear that it is irrelevant to try to determine whether family consent damages the theory of informed consent, or to try to reconstruct the theoretical framework for informed consent. This essay contends that the key issue to be addressed is to improve the necessary operational measures for implementing informed consent.DOWNLOAD HISTORY | This article has been downloaded 112 times in Digital Commons before migrating into this platform.

scholarly journals 履行知情同意原則在中國傳統倫理下的困境

2008 ◽  
Vol 6 (1) ◽  
pp. 29-49
Author(s):  
Yan LI
Keyword(s):  
Informed Consent ◽  
Medical Information ◽  
Sense Of Self ◽  
Well Being ◽  
Individual Autonomy ◽  
Traditional Values ◽  
Moral Framework ◽  
Digital Commons ◽  
The Family ◽  
Communal Responsibility

LANGUAGE NOTE | Document text in Chinese; abstract also in English.知情同意是尊重人的自主原則在診療環節的重要實踐，也是當代生命倫理學的重要組成之一，但在中國的履行卻體現出與其在西方社會建立起來的原有狀態中不同的特色。本文試圖探討形成這樣的特色與中國傳統倫理因素——例如“儒家、道家”——之間的關係，挖掘其可能的思想、制度、倫理淵源。在文章的最後，還對中國傳統倫理在當代正在發生變革的現狀及其對履行知情同意原則的積極作用進行了簡單的闡釋。The informed consent has been practiced as a clinical and ethical principle for many years in China. With traditional emphasis on the family as a whole and a hierarchical social structure there is a strong ethic of indebtedness and obligations for one family member to others. Within this moral framework there is a special need for evoking a sense of self-restraint and communal responsibility towards the well-being of a family instead of an individual. As a result, the implementation of the informed consent in China sometimes takes a different direction. This paper intends to explore how traditional values systems, namely Confucianism, Daoism, Buddhism inf luence the way of the informed consent is interpreted and practiced. The paper has offered several specific medical cases to show the diff iculties in excising the principle of informed consent due to an absence of individual autonomy needed for a general requirement of competency and a lack of public medical information. Finally, I shall discuss the possibility of“ modernizing” traditional ethics.DOWNLOAD HISTORY | This article has been downloaded 146 times in Digital Commons before migrating into this platform.

scholarly journals A clínica da psicose: um estudo de caso

2021 ◽  
Vol 9 (2) ◽  
pp. 503
Author(s):  
Silvia Herszkowicz ◽  
Araceli Albino
Keyword(s):  
Family Relationship ◽  
Social Contact ◽  
Professional Issues ◽  
Therapeutic Group ◽  
Her Family ◽  
Arduous Task ◽  
The Family ◽  
The Individual ◽  
The Relationship

Este é um estudo de caso realizado em 2018, com o objetivo de descrever a proposta de atendimento de uma paciente com estrutura psíquica psicótica. O casoé oriundo da proposta de atenção psicanalítica em uma clínica social, no modo individual e grupal, por um período superior a oito anos. Os encontros grupais e as sessões individuais ocorriam semanalmente. No modo grupal, com a participação de quatro analistas, havia além uma tríade social: pacientes, mamãe e papai. No modo individual, a relação se dava analista-analisando. De um começo pouco participativo no grupo e nas sessões individuais, a paciente (Rebeca – nome fictício), evoluiu melhorando sua sociabilização, sua relação familiar, e até mesmo as questões profissionais.A clínica da psicose é uma árdua tarefa, mas Rebeca conseguiu se posicionar e se descolar da família. Atualmente, está trabalhando, tem mantido um bom contato social com os demais membros do grupo terapêutico (Grupo Vida) e com seus colegas de trabalho. Essa clínica é cativante porque, de alguma forma, o vínculo com os pacientes permanece; é uma análise interminável, que exige coragem e determinação do analista.Aponta-se a importância da viabilidade da clínica da psicose, na proposta psicanalítica, via transferência ativa.This is a case study carried out in 2018. It aims to describe the proposal for the care of a patient with a psychotic psychic structure. The case comes from the proposal of psychoanalytic care in a social clinic, in the individual and group mode, for a period of more than eight years. Group meetings and individual sessions took place weekly. In group mode, with the participation of four analysts, there was also a social triad: patients, mom and dad. In the individual mode, the relationship took place as an analyst-analyzed. From a little participatory beginning in the group and in the individual sessions, the patient (Rebeca - fictitious name), evolved improving her socialization, her family relationship, and even her professional issues. The psychosis clinic is an arduous task, but Rebeca managed to position herself and detach herself from the family. Currently, she is working, has maintained good social contact with the other members of the therapeutic group (Grupo Vida) and with her co-workers. This clinic is captivating because, in some way, the bond with patients remains; it is an endless analysis, which requires courage and determination from the analyst. The importance of the viability of the psychosis clinic is pointed out, in the psychoanalytic proposal, via active transference.

Psycho-Social Aspects of Breast Cancer

1989 ◽  
Vol 20 (2) ◽  
pp. 23-27 ◽  
Author(s):  
Michael A. Ingram
Keyword(s):  
Breast Cancer ◽  
Financial Education ◽  
Rehabilitation Counselors ◽  
Her Family ◽  
Psychological Constructs ◽  
The Family ◽  
High Incidence ◽  
Vocational Goals ◽  
Definition Of ◽  
The Individual

Because of the high Incidence, and the possible resulting vocational disability it is very likely that rehabilitation counselors, particularly those employed in medical settings and the state, federal system, will work with women who have breast cancer and are eligible for services. Cancer of the breast may have significant impact on the emotional and psychological constructs of the individual, as it affects not only the patient, but her family as well and may interfere with, and disrupt the organization of the family, social, financial, education, vocational goals, and indeed the very definition of the family unit. Suggestions are made for some counseling techniques which may be used in dealing with these problems.

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