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maximize the benefit of family involvement in medical decision making.Introducing this concept allows us to abandon the outdated concept of “family member decisions” that seems to exclude the patient from the process of decision making.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.

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 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 Validation of the German version of the Family Reported Outcome Measure (FROM-16) to assess the impact of disease on the partner or family member

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Susanne A. Elsner ◽  
Sam S. Salek ◽  
Andrew Y. Finlay ◽  
Anna Hagemeier ◽  
Catherine J. Bottomley ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Family Member ◽  
Internal Consistency ◽  
Outcome Measure ◽  
Test Validity ◽  
Family Members ◽  
German Version ◽  
The Family ◽  
The Difference ◽  
The Impact

Abstract Background The Family Reported Outcome Measure (FROM-16) assesses the impact of a patient’s chronic illness on the quality of life (QoL) of the patient’s partner or family members. The aim of the study was to translate, explore the structure of and validate the FROM-16. Methods The questionnaire was translated from English into German (forward, backward, four independent translators). Six interviews with family members were conducted to confirm the questionnaire for linguistic, conceptual, semantic and experiential equivalence and its practicability. The final German translation was tested for internal consistency, reproducibility and test validity. Criterion validity was tested by correlating the scores of the FROM-16 and the Global Health Scale (GHS). Principal component analysis, factor analysis, and confirmatory factor analysis was used to assess the questionnaire’s structure and its domains. Reliability and reproducibility were tested computing the intraclass correlation coefficient (ICC) using one sample t-test for testing the hypothesis that the difference between the scores was not different from zero. Results Overall, 83 family members (61% female, median age: 61 years) completed the questionnaire at two different times (mean interval: 22 days). Internal consistency was good for the FROM-16 scores (Cronbach’s α for total score = 0.86). In those with stable GHS, the ICC for the total score was 0.87 and the difference was not different from zero (p = 0.262) indicating reproducible results. A bi-factor model with a general factor including all items, and two sub-factors comprising the items from the original 2-factor construct had the best fit. Conclusions The German FROM-16 has good reliability, test validity and practicability. It can be considered as an appropriate and generic tool to measure QoL of a patient’s partner or family member. Due to the presence of several cross-loadings we do not recommend the reporting of the scores of the two domains proposed for the original version of FROM-16 when using the German version. Thus, in reporting the results emphasis should be put on the total score. Trial registration: Retrospectively registered: DRKS00021070.

Redefining the Circumstances in which Family Hardship Should Mitigate Sentence Severity

2019 ◽  
Author(s):  
Mirko Bagaric
Keyword(s):  
Family Members ◽  
Case Law ◽  
Financial Hardship ◽  
The Family ◽  
Family Connections ◽  
Criminal Penalties ◽  
Close Family

The hardship stemming from prison goes well beyond the pain experienced by offenders. The family and dependants of prisoners often experience significant inconvenience and hardship. Family members of prisoners have not engaged in wrongdoing and hence arguably their suffering should be a mitigating consideration in sentencing. However, this approach potentially unfairly advantages offenders with close family connections and undermines the capacity of courts to satisfy a number of important sentencing objectives, including the imposition of proportionate penalties. The courts and legislatures have not been able to find a coherent manner in which to reconcile this tension. There is conflicting case law regarding the circumstances in which family hardship can mitigate the severity of criminal penalties. This article examines these competing positions and proposes that family hardship should mitigate penalty severity only when incarcerating the offender would cause severe financial hardship to his or her dependants.

It's about Family: The Death of a Close Family Friend

2009 ◽  
Vol 90 (2) ◽  
pp. 227-230 ◽  
Author(s):  
Joan Beder
Keyword(s):  
Family Structure ◽  
Family Member ◽  
Family Relationships ◽  
Extended Family ◽  
Entire System ◽  
The Family ◽  
Counseling Interventions ◽  
Definition Of ◽  
Close Family

When an individual dies, the role of the family member(s) is clearly prescribed by society: support, presence, caring, and remembrance. Traditionally, the definition of “family” has broadened to create the “extended family” or “expanded family” with members defined by deep bonds, relationships, and friendships. Currently, close friends who become the extended/expanded family, can be as central as kin to family structure and stability. Therefore, when one member of an extended family dies, the death resonates throughout the entire system affecting not only the lives of the immediate family members, but also those in the expanded circle of family relationships. This article describes the relationships in one extended family and discusses the struggles and counseling interventions used when one member of an extended family suddenly dies.

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

scholarly journals Durable Relationship and Family Members “by Analogy” in the European Union

2018 ◽  
Vol 10 (4) ◽  
pp. 175
Author(s):  
Tanel Feldman ◽  
Marco Mazzeschi
Keyword(s):  
Member State ◽  
Family Member ◽  
Family Members ◽  
The European Union ◽  
Member States ◽  
Registered Partnership ◽  
The Family ◽  
Definition Of ◽  
Union Citizen ◽  
The Eu

Rights of residence derived from a durable relationship with an EU citizen, are left to a relatively wide discretion of the Member States. Pursuant to Article 2.2 (b) Directive 2004/38/EC (“Directive”), “the partner with whom the Union citizen has contracted a registered partnership, on the basis of the legislation of a Member State, if the legislation of the host Member State treats registered partnerships as equivalent to marriage and in accordance with the conditions laid down in the relevant legislation of the host Member State” qualifies as family member. Provided that they have a durable relationship (duly attested) with an EU citizen, pursuant to Article 3.2(b), unregistered partners are as well beneficiaries of the Directive. The durable relationship was expressly excluded from the scope of Article 2(2)(b): “Unlike the amended proposal, it does not cover de facto durable relationships” (EU Commission, Document 52003SC1293). Article 3 (2)(a) covers “other family members” (no restrictions as to the degree of relatedness) if material support is provided by the EU citizen or by his partner or where serious health grounds strictly require the personal care of the family member by the Union citizen. Pursuant to Article 3.2, “other family members” and unregistered partners can attest a durable relationship, must be facilitated entry and residence, in accordance to the host Member State’s national legislation. In the light of Preamble 6 Directive, the situation of the persons who are not included in the definition of family members, must be considered “in order to maintain the unity of the family in a broader sense”. The questions discussed in this paper are the following: (i) are Member States genuinely considering the concept of durable relationship in view of maintaining the unity of the family in a broader sense? and (ii) how to overcome legal uncertainty and which criteria, both at EU and at international level, can be taken into account in order to assess whether a durable relationship is genuine and should be granted the rights set forth by the Directive?

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