临床代理决策中的利益冲突及其消解

The Conflicts of Interest and Its Settlements in the Surrogate Decision-making

对于限制/无行为能力患者的医疗决策采取代理决策模式,该模式奠基于社会习俗与习惯法。通常情况下,亲属能够更加准确地评判患者的个人价值取向和医疗决定偏好。但是,基于利益判断的主观性,代理决策中的道德冲突难以避免,其合理性辩护基于代理身份的合法性、“善意”与“患者利益”的标签、制度缺失,对于其批评在于代理者德性基础上的一致性不足。按照解决问题的逻辑进程,规避代理决策中利益冲突的方式有寻求共识的可能、临床伦理咨询与司法介入,其中伦理咨询与司法介入需要依托国家制度设计。

For limited-capacity or disabled patients,the model of agent decision-making is adopted,which is based on social customs and customary law.Generally,relatives can judge patients'personal value and medical decision preference more accurately.However,based on the subjectivity of interest judgment,the moral conflict in agency decision-making is inevitable,and its rationality defense is based on the legitimacy of agency identity,the label of"good faith"and"patient interest"and the lack of system.Its criticism lies in the lack of consistency on the basis of agent virtue.According to the logical process of solving the problem,the way to avoid the conflicts of interest in clinical surrogate decision-making is likely to seek consensus,clinical ethical consultation and judicial intervention,in which ethical consultation and judicial intervention need to rely on the design of national system.