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 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 家庭與社會公義

2018 ◽  
Vol 16 (2) ◽  
pp. 45-48
Author(s):  
Lawrence YUNG
Keyword(s):  
Social Justice ◽  
Legal Status ◽  
Individual Autonomy ◽  
Same Sex ◽  
Sexual Freedom ◽  
Same Sex Marriage ◽  
Digital Commons ◽  
The Family ◽  
Gender Neutrality ◽  
Heterosexual Marriage

LANGUAGE NOTE | Document text in Chinese; abstract in English only.Mark Cherry’s article identifies claims regarding individual autonomy, gender neutrality, and rights to sexual freedom as taking a commanding place within the secular liberal recasting of the family to grant same-sex marriage the same legal status as heterosexual marriage. Cherry refers to Plato’s proposal of abolishing family in Republic (Book V) as a precursor to reforming the family to engineer currently favored versions of social justice. This paper adds to the discussion on family and social justice with an explication of this proposal of abolishing family and a comparison with the Confucian ideal of Great Unity.DOWNLOAD HISTORY | This article has been downloaded 122 times in Digital Commons before migrating into this platform.

scholarly journals 知情同意臨床實踐實證研究——第一人稱視角的考察

2017 ◽  
Vol 15 (2) ◽  
pp. 9-20
Author(s):  
Hua CHEN ◽  
Yonghui MA
Keyword(s):  
Informed Consent ◽  
Individual Autonomy ◽  
Medical Treatments ◽  
Legal Implications ◽  
Patient’S Autonomy ◽  
Digital Commons ◽  
Consent Document ◽  
Informed Consent Document ◽  
China Today ◽  
Medical Policy

LANGUAGE NOTE | Document text in Chinese; abstract also in English.知情同意作為一項權利，患者成為闡述其體驗的首要主體。實證調查表明，患者對於其權利認知還存在不足，多數偏好於患者與家庭共用模式；在實踐中，知情與同意在主體層面存在分離現象。對於病情的告知傾向於任選模式，但家庭是不可或缺的告知物件，對於診療、護理等相關資訊，傾向於患者模式；在同意方面，家屬成為獲取同意的主體。經濟因素成為患方“不同意”的首要原因。對於不同維度的調查表明，基於女性相對脆弱性特點，他們對於家庭的依賴性更強，其維權意識更強；在年齡層面，青少年對於權利的認知更理性，具有現代契約精神。在地域層面，縣級以上城市居民對於權利認知度更高；職業往往與教育程度相關，表明農民的個體依賴性更強；政府機關以及事業單位人員個體主體性更強。為此，需要加強患者權利教育，提升主體意識；對醫務人員加強職業道德教育，履行告知義務，強化醫患信任；深化醫療衛生體制改革，為知情同意的踐行提供空間與時間。An informed consent document is vital for all surgical procedures and medical treatments. Proper documentation and counseling of patients is important for informed consent. Opinion polls conducted in this essay show that the majority of people in China today have accepted informed consent as a legally binding medical policy, yet they do not fully understand the ethical and legal connotations involved, particularly the idea of the patient’s autonomy. As a result, the patient’s own experience as a first-person narrative is often ignored and his/her subjectivity is blurred when his/her family’s subjectivity intervenes. According to the essay, the problem appears when liberalism—which emphasizes individual autonomy and rights—does not square with the Confucian tradition that emphasizes family as a coherent unit. The essay also points out that there is a huge difference in patients’ perceptions of “individual rights,” due to their different levels of education. The author argues that informed consent could be better practiced if both doctors and patients were “well informed” and understood the moral and legal implications of informed consent.DOWNLOAD HISTORY | This article has been downloaded 97 times in Digital Commons before migrating into this platform.

Family Canon: The Politics of Family during the Last Civic-Military Dictatorship in Argentina, 1976–83

2021 ◽  
pp. 1-23
Author(s):  
Patricia Juárez-Dappe
Keyword(s):  
Building Block ◽  
Focal Point ◽  
Well Being ◽  
Traditional Values ◽  
Basic Building Block ◽  
Military Dictatorship ◽  
Military Junta ◽  
Authoritarian State ◽  
The Family ◽  
Double Function

Abstract On 24 March 1976 a military junta deposed President María Estela Martínez de Perón and assumed power in Argentina. From the first days of the takeover, the authorities worked vigorously to restore what they defined as legitimate Argentine values. This article shows how the family became a focal point of the government's efforts because of its double function as an agent of and a target for renovation. A microcosm of the Argentine nation, the family was considered the basic building block of society, a guarantor of the civic well-being of the nation and, as such, an important ally of the authoritarian state in the fight to restore Argentina's ‘traditional’ values. The analysis focuses on the civic-military regime's efforts to fashion a family canon, which would become the only legitimate version of the Argentine family, and the broad repertoire of strategies used to impose it on the Argentine population.

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 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 臨床知情同意在中國的一些實踐及反思

2013 ◽  
Vol 11 (1) ◽  
pp. 21-32
Author(s):  
Wenqing ZHAO
Keyword(s):  
Clinical Practice ◽  
Informed Consent ◽  
Individual Autonomy ◽  
Clinical Practices ◽  
Empirical Reality ◽  
Medical Practitioners ◽  
Republic Of China ◽  
Institutional Settings ◽  
Digital Commons ◽  
History Of

LANGUAGE NOTE | Document text in Chinese; abstract also in English.“患者利益至上”知情同意是當代西方生命倫理學的一個核心概念，在規範臨床醫療實踐中的應用十分廣泛，相關的法規和指引更是層出不窮。隨著自由主義理論和權利觀念在全世界範圍內的流行，中國也開始注意到知情同意原則在臨床實踐中的重要意義，並逐步引入西方的相關規範。然而，大部分規範的制定缺乏對知情同意倫理基礎的考察，對臨床知情同意在中國的實踐也沒有足夠的關注。本文分析作為知情同意的道德基礎，並通過對一線醫務工作人員的訪談，了解臨床知情在中國實踐情況及限制，希望能為相關規範的制定提供一些思路。Informed consent is considered to be one of the most important conceptual developments in contemporary bioethics, and is strongly implicated in the regulation of clinical practices in the West. Over the past decade, the growing prevalence of both liberal arguments supporting individual autonomy and rights-based debates focusing on equality has brought the concept of informed consent into the purview of Chinese legislation pertaining to healthcare and clinical practice. However, most of the laws and regulations are made by Chinese authorities in ignorance of the concept’s ethical groundings. In addition, lawmakers have not taken into account the empirical reality and specific situations of clinical practice in contemporary China. This essay contends that the history of informed consent legislation in China since 1994, exemplified by the recently adopted Article 55 of the Tort Law of the People’s Republic of China, reveals conflicting understandings of the ethical foundation of the notion of informed consent. The essay also presents extensive interviews conducted by the author with four frontline medical practitioners in first-tier cities that demonstrate how their experiences with informed consent are largely shaped by current institutional settings and influenced by traditional Confucian ethical norms, (e.g., an emphasis on interdependence among family members, which requires the doctor to consult with the family rather than the patient). The essay concludes that we must take into serious consideration the Chinese ethical tradition and its unique application in practice when cross-fertilizing the concept of informed consent.DOWNLOAD HISTORY | This article has been downloaded 116 times in Digital Commons before migrating into this platform.

scholarly journals 家庭成員共同決定——儒家家庭本位思想在臨床決定中的體現

2013 ◽  
Vol 11 (1) ◽  
pp. 9-20
Author(s):  
Hanhui XU
Keyword(s):  
Decision Making ◽  
Family Involvement ◽  
Family Relationships ◽  
Medical Decision Making ◽  
Well Being ◽  
Family Values ◽  
Medical Decision ◽  
Medical Issues ◽  
Digital Commons ◽  
The Family

LANGUAGE NOTE | Document text in Chinese; abstract also in English.儒家家庭本位思想對於中國傳統社會有著極其深刻的影響，而這種影響直到今天仍然發揮著巨大的作用，並由此形成了中國特有的社會結構和家庭觀念。在中國家庭中，家庭成員之間的關係更加密切，遇到重大事情，往往會由家庭成員共同做出決定。由於這種特殊的文化氛圍，在臨床決定的時候，應該用家庭共同決定代替個人自主決定，這種模式既能保障個人權利，維護個人利益，同時也是尊重家庭決定，營造和諧的家庭關係。Family involvement in medical decision making is a common practice in China due to the influence of Confucianism, which emphasizes the family as an organic unit. Instead of speaking of the individual’s right to choose and make a decision, the Confucian model for “informed consent” calls for “family co-decision making” or “co-determination.” The essay argues that China has long-standing moral traditions such as Confucianism, with its inherent ethical views toward family values that are still pertinent to a person’s daily life in general and bio-medical issues in particular.The author points out that those who acknowledge the role of the family in medical decision making feel much more satisfied. Sometimes both medical and non-medical burdens related to family roles and relationships are taken into consideration, but a patient who has good family relationships would rather family members be actively involved in the decision making. In addition, as young people are becoming increasingly individualistic under the influence of Western culture, family medical co-decision making can promote the Confucian values of family, family responsibility, and the well-being of individuals.DOWNLOAD HISTORY | This article has been downloaded 1791 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 Family Members' Perceptions of Their Psychological Responses One Year Following Pediatric Intensive Care Unit (PICU) Hospitalization: Qualitative Findings From the Caring Intensively Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Janet E. Rennick ◽  
Alyssa M. Knox ◽  
Stephanie C. Treherne ◽  
Karen Dryden-Palmer ◽  
Robyn Stremler ◽  
...  
Keyword(s):  
Family Dynamics ◽  
Sense Of Self ◽  
Family Members ◽  
Behavioral Responses ◽  
Well Being ◽  
New Normal ◽  
The Family ◽  
Health And Illness ◽  
One Year

Introduction: PICU hospitalization can have a profound impact on child survivors and their families. There is limited research on children's long-term recovery within the context of the family following critical illness. This study aimed to explore children's and parents' perceptions of long-term psychological and behavioral responses within the context of the family one year following PICU hospitalization.Materials and Methods: Caring Intensively is a mixed methods multi-site prospective cohort study that aims to examine children's psychological and behavioral responses over a 3-year period following PICU hospitalization. In this study, part of the qualitative arm of Caring Intensively, an interpretive descriptive design was used to explore children's recovery one year post-discharge. Purposive sampling was used to select 17 families, including 16 mothers, 6 fathers, and 9 children. Semi-structured, audio-recorded interviews were conducted. Data were analyzed iteratively using the constant comparison method.Results: Families described efforts to readapt to routine life and find a new normal following PICU hospitalization. Finding a New Normal consisted of four major themes: (1) Processing PICU Reminders and Memories, (2) Changing Perceptions of Health and Illness, (3) We Are Not the Same, and (4) Altered Relationships. Participants described significant emotional and behavioral changes during the year following discharge. The psychological impact of individual family members' experiences led to changes in their sense of self, which affected family dynamics. PICU memories and reminders impacted participants' perceptions of childhood health and illness and resulted in increased vigilance. Parents and siblings demonstrated increased concern for the child survivor's health, and the experience of long absences and new or altered caregiving roles resulted in changes in relationships and family dynamics.Conclusion: PICU hospitalization impacted the psychological well-being of all family members as they sought to re-establish a sense of normalcy one year following discharge. Parent and child experiences and responses were closely interconnected. Findings highlight the importance of increased follow-up care aimed at supporting the family's psychological recovery.

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