恶性肿瘤最佳治疗决策的实证调查与伦理探讨

An Empirical Investigation and Ethical Discussion on the Optimal Decision-making for Cancer Treatment

中国的恶性肿瘤治疗决策中往往会有家属的参与,对家属参与决策的道德辩护常常诉诸于后果论,假设家属的参与有利于实现患者的最佳利益,然而这一假设是否成立?笔者通过对北京市两所三甲医院的11组患者、家属和医生进行访谈,分别了解三方参与决策的方式、程度及考虑因素等。本文在三方观点对比分析基础上,结合最佳利益的伦理概念探讨恶性肿瘤的最佳治疗决策。结论是提高患者的自主性有利于形成最佳治疗方案,并实现其最佳利益,医生和家属应该鼓励患者积极参与决策。

The family members always engage a lot in cancer treatment decision-making in China, the moral justifications for the participation of family members mostly resort to consequentialism which suppose that the participation of family members will help to achieve the best interests of patients. However, is such a hypothesis true？ The author explored the way and degree of their participation, the relevant factors they considered and how did they balance these factors in decision-making through interviewing 11 groups of patients, their family members and doctors from two hospitals of Beijing. Based on the comparative analysis of the views of three parties and the ethical concepts of best interests of patients, the paper studied the optimal decision-making for cancer treatment. The conclusion is that improving autonomy of patients will be beneficial to form the best treatment options and achieve the best interests of patients, so doctors and family members should encourage patients to participate in decision-making actively.