scholarly journals 中國文化是否構成了對知情同意的挑戰?

Author(s):  
Wei ZHU

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.

Author(s):  
Shuqing WU

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.


Author(s):  
Mingxu WANG ◽  
Le MA ◽  
Hui YUEN

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.


Author(s):  
Tongwei YANG ◽  
Zhangqi FENG

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.


Author(s):  
Yan LI

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.


2017 ◽  
Vol 5 (1) ◽  
pp. 498
Author(s):  
Maria Stănescu

The article is about the role of the family in the education and formation of children and, especially, in the life and development of autistic children. It describes the problems their family is facing and the need for counseling to parents with autistic children. The reaction to finding the diagnosis of autism varies from one family to another and may encounter a large variety: from disbelief, anger, guilt, helplessness, devastation, surprise, or even rejection of the child, to understanding and relief when finally the parents have an explanation for their child behaviors. Early intervention is important in psychological sustaining of the parent, as parent involvement in the recovery of the child with autism has a determinant role in his development and in ensuring a high quality of life of the child and the life of the hole family. The response to a child's autism diagnosis varies from one family to another. The family goes through a variety of disbelief, anger, guilt, helplessness, devastation, surprise, or even rejection of the child, to understanding and relief. Early intervention is very important in the psychological support of the parent. Because any change disturbs the family equilibrium. A diagnosis of autism changes not only the life of the diagnosed child, but also the life of family members. All the resources are focused on the need of the child. Although each parent is different, after diagnosing the child with autism, all parents are overwhelmed by confusion, shock and denial. Parents' feelings can be influenced by how their children's situation affects different aspects of life - it has an impact on service, on social life and all their personal life. If we look at the family as a system and when a disturbing factor appears, all parts of the system are affected. The involvement of parents in the recovery of the child with autism has a decisive role in its development and in ensuring a high quality of child's life and family life.


Author(s):  
Eleticia Isabel Pinargote Macías ◽  
Francisco Ashley Gavilanes Vaca ◽  
Víctor Hugo Cedeño Gavilánez

The resilience of parents can play a decisive role as a resource that favors the inclusion and development of students with disabilities, representing a decisive contribution in school-family co-responsibility. This work showed a conceptual analysis related to resilience from a family dimension and especially the role played by parents. The research was carried out in the context of the Technical University of Manabí, a representative sample of students with disabilities and their families was selected, two instruments were applied to obtain the data: Family Functioning Scale [1] and the Mother Resilience Scale [2]. The attention to the young person with a disability was analyzed, and it is particularized in the related to the family of these. The results are shown in tables that allow the final results to be identified.


Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Xichenhui Qiu ◽  
Janet W SIT ◽  
Haixia Feng

Introduction: Among the estimated 22.5 million stroke survivors in China, 78% of them require home care. Previous research has indicated that culture can have a significant impact on caregivers’ perceptions of the caregiving role. There is a dearth of research on stroke caregivers’ perceptions within the Chinese culture. Objective: To explore how Chinese culture influences the perceptions of the caregiving role among stroke caregivers. Methods: In this qualitative descriptive study, 14 stroke caregivers were recruited from a 1800-bed regional hospital in China. Caregivers were on average 58 years old (range 46-74), 78% female, 50% spouse-caregivers and 50% children-caregivers. Caregivers spent on average 14 hours per day (range 5-24) providing care. All were 1st time caregivers who had provided stroke caregiving < 12 months. Individual, semi-structured interviews were conducted. Qualitative content analysis was performed. Strategies to achieve trustworthiness include triangulation of the data in the analysis process, member checking and peer debriefing. Results: Three themes emerged from the interviews. (1) Caregiving is a natural expected part of life. All caregivers accepted caregiving for the sick family member as an expected part of life. This perception is deeply rooted in Chinese culture. (2) Caregiving is a culturally prescribed obligation. Spouse caregivers believe that it is their moral obligation to take care of their sick life partner. Female caregivers emphasized their position and role in the family to take up caregiving for sick relative. (3) Caregiving is an expression of reciprocal love within the immediate family. Tangible caregiving and support during adversity are viewed as expression of reciprocal love among family members. Particularly, the children-caregivers believed in the virtue of filial piety and perceived stroke caregiving as a means of repaying their parents. Conclusions: Our findings highlight an underlying acceptance and devotion of undertaking stroke caregiving within the Chinese culture. Researchers and clinicians that plan to develop an intervention to support Chinese stroke caregivers need to consider integrating these findings.


Author(s):  
Yongsong GUO

LANGUAGE NOTE | Document text in Chinese; abstract also in English.對於沒有臨床救治希望的病人,要不要繼續治療?誰有最終的決定權?這既是臨床醫療問題,又是一個涉及社會倫理法規的問題。對於這樣的病人,不放棄治療可能意味著要消耗更多的醫療資源但又無法挽救病人,但是如果放棄治療,可能會遇到更多的來自社會傳統的、倫理法規的問題。筆者認為,在社會多元化發展的今天,面對臨床無效治療,應在尊重病人或病人家屬有最終決定權的前提下,以一定道德、法規為依據,按照一定的醫療程式和法律手續進行處理,可能是更為符合人道和社會公眾利益的理性選擇。There has not been a clear medical definition of futility. The concept of futile treatment involves not only medical, but also social, ethical, and legal components. This paper argues that in today's pluralistic moral circumstances, the patient and/or the family should have the final right to decision regarding futile treatment.Some are opposed to renouncing futile treatment, whatever futility is defined. For them, first, abandoning treatment is in conflict with the physician's basic duty of offering treatment. Second, giving up treatment also gives up the chance of making medical progress by attempting to treat the patient. Third, the patient would thereby lose the opportunity of prolonging the life. And finally, it would change the good image of the physician (as taking care of the patient). On the other hand, those who support renouncing futile treatment offer different reasons. First, giving up futile treatment will turn out to be respecting the value of the patient's life. Second, It would help people recognize the natural limit of contemporary medical development. Third, it would facilitate a reasonable pattern of distributing scarce medical resources. And finally, it could reduce the suffering of the patient. As a result, we face a social situation of moral pluralism: people disagree with each other regarding renouncing futile treatment.A difficult practical issue is who has the right to decide renouncing futile treatment. This paper argues that, giving individuals hold conflicting views of life, valoue and morality, the patient should have the final decision power regarding his/her own treatment. If the patient is incompetent, then the family should have the deciding right. In this respect we should overcome the longstanding medical paternalism. In addition, society should establish a prcocedure to regulate and facilitate the decision-mading of renouncing futile treatment.DOWNLOAD HISTORY | This article has been downloaded 16 times in Digital Commons before migrating into this platform.


Author(s):  
Si XIAO

LANGUAGE NOTE | Document text in Chinese; abstract in English only.In this response essay, Xiaosi, the author of [Philosophy of Family], made five points in response to Ni Peimin’s article, “The Way of the Family and the Gongfu of Regulating the Family.”1. Gongfu is indeed a philosophically significant concept that uniquely reflects the features of the Chinese Philosophical tradition. Ni’s recent works that advocate this concept provide a valuable contribution to philosophy.2. In his additional notes on Gongfu, Xiaosi points out that a sense of “enduring” or “lasting” and a sense of spending time in an accumulative fashion are two indispensible elements for an appropriate understanding of Gongfu.3. Greek philosophy does not seem to be included in this concept, which is unfortunate.4. Gongfu and familization may well be connected, each facilitating understanding of the other.5. Xiaosi also made two criticisms against Ni Peimin’s article.DOWNLOAD HISTORY | This article has been downloaded 27 times in Digital Commons before migrating into this platform.


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