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Abstract 摘要

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 implemented

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。

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