临床伦理咨询中共同协商决策的伦理问题研究

Study on Ethical Issues of Shared Participated Decision-making in Clinical Ethics Consultation

临床伦理咨询又称临床伦理支持服务,是应对关乎患者疗护的临床伦理问题的一种机制。共同协商决策是临床伦理咨询的核心步骤,直接关系到咨询的质量和效果。在该步骤中,咨询委员应该扮演何种角色?“患者支持者”角色符合患者利益至上的诊疗道德要求,但可能因偏袒患者价值诉求或患者利益而出现道德错误。以商谈伦理为理论基石的“伦理调节者”角色更尊重各方价值观与参与性,有利于各方达成维护患者最佳利益的道德共识。在此基础上,咨询委员应采取伦理调节型模式,组织、引导、协调各方共同协商决策,谨防误入权威主导型和纯粹利导型两个极端模式。

Clinical ethics consultation,also known as clinical ethics support services,is a mechanism to deal with ethical issues related to patient healthcare in clinical practice.Shared participated decision-making is a core step of clinical ethics consultation,which is directly related to the quality and effectiveness of ethics consultation.What role should ethical consultants or ethical committees play in this step?The"patient advocator"role is in line with the moral requirements of putting patients'interests first,but may result in unethical action due to only favor values or benefits of patients.The role of"ethical facilitator",based on the theory of discourse ethics,is more respectful of the values and participation of all agents related to patient's healthcare,which is helpful to reach a moral consensus of all agents to safeguard the best interests of patients.Thus,ethical consultants or ethics committees should adopt an ethics facilitation model to organize,guide,and coordinate the agents to communicate,discourse and make decisions together,and meanwhile,be against of the two extreme models of authoritarian approach and pure facilitation approach.