醫病共享決策與臨床倫理

Shared Decision Making and Clinical Ethics

李思潔(Shih-Chieh Lee) ； 周昱辰(Yu-Chen Chou) ； 蔡甫昌(Daniel Fu-Chang Tsai)

《台灣醫學》 26卷1期 (2022/01) Pp. 84-89

https://doi.org/10.6320/FJM.202201_26(1).0011

摘要

近幾十年來病人自主的重要性越來越被重視，而醫病共享決策常被作為提升病人自主的一個方式。然而醫病共享決策並非等同於病人自主，而是重視共享資訊且按照病人的意願做決定。本文提出較符合自主原則的醫病共享決策進行模式、探討醫病共享決策在不同醫病關係中進行的模式，也闡述父權模式和醫病共享决策非衝突及對立的狀態。本文也針對我國及許多亞洲國家在臨床上重視的關係自主（relational autonomy）及有別於「以病人或家庭為中心」的家庭醫病共享決策的倫理原則。

關鍵字

醫病共享決策 ； 病人自主 ； 醫病關係 ； 關係自主

並列摘要

As the importance of patient autonomy rises in the past decades, shared decision making (SDM) has been widely used as a route to enhance patient autonomy. Yet SDM is not equal to patient autonomy, it is for sharing information and accomplishing the consent process according to patient's preferences. In this paper, we explored how SDM applies in different doctor-patient relationships and proposed models most aligned with autonomy. We also explored ethics of relational autonomy and shared family-decision which are common and essential issues in Taiwan and many Asian countries.

並列關鍵字

shared decision making ； patient autonomy ； physician-patient relationship ； relational autonomy

參考文獻

Liao HH, Liang HW, Chen HC, et al. Shared decision making in Taiwan. Z Evid Fortbild Qual Gesundhwes 2017;123-4:95-8.

Ho A. Family and informed consent in multicultural setting. Am J Bioeth 2006;6:26-8, discussion W27-28.

Capron AM. Informed consent in catastrophic disease research and treatment. Univ PA Law Rev 1974; 123:340-438.

Sandman L, Munthe C. Shared decision-making and patient autonomy. Theor Med Bioeth 2009;30:289-310.

Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA 1992;267: 2221-6.