从中西文化差异审视知情同意

中西文化差异的核心是价值观的差异,西方文化强调个人主义,中国文化强调家庭主义.知情同意作为生命伦理学的重要原则,是西方个人主义文化的产物.移植到家庭本位的中国文化语境中,因价值观、行为方式和社会制度方面的差异,知情同意遇到了患者知情同意而家属知情不同意、家属知情同意而患者知情不同意的困境.对此,医方应做好协调沟通工作,一般情况应首先尊重患者意见.     

论医学伦理学的自主性原则

医学伦理学的自主性原则是对个人的自主和自由的尊重,其核心是对人权的尊重,包含有知情同意、保密、隐私等具体规则。自主性原则是根源于西方强调个性自由和选择的自由主义道德传统,我国古代哲人也提出过相近乃至相同的看法。     

论医学伦理学的自主性原则

医学伦理学的自主性原则是对个人的自主和自由的尊重,其核心是对人权的尊重,包含有知情同意、保密、隐私等具体规则.自主性原则是根源于西方强调个性自由和选择的自由主义道德传统,我国古代哲人也提出过相近乃至相同的看法.     

论知情同意的中国本土化--中国文化视野中的知情同意走向

知情同意原产于西方,移植到中国后被"家文化"、"功利论"、"简单化"等中华传统文化彻底改造过以后,浓缩成了手术前一味要求病人家属或单位领导签字的行为模式,远离了知情同意的主旨,但曾一度非理性地普遍流行.现在,又出现了一种照搬欧美知情同意的倾向,在一线医务人员中引发了诸多困惑和不满.在实施知情同意时,离开中华文化语境,或者在本土化中化掉其本质的做法,都是不可行的.正确的取向只能是立足于中国当代医学实践,以正在形成中的中国现代文化去整合西方知情同意的本质、理念和规范,构建成一套适合中国国情的知情同意机制.     

知情同意在中国不适用吗——“文化差异论”的认知错误

知情同意是在当代生命伦理学中最有影响的概念,在大多数西方国家它已成为医疗实践和涉及人体的医学科学研究的一个基本的伦理要求。不少西方和中国学者认为,由于中西文化显著而根本的差异,知情同意不适宜于中国。指出了“文化差异论”的三个认知错误,即,文化差异论是建立在对中国文化和医学道德、西方文化以及知情同意的一系列误解之上的。基于文化的差异而拒绝知情同意在中国的适用性和必要性,显然不能成立。     

精准医学对传统知情同意原则的挑战

知情同意包括信息的告知、对信息的理解以及同意的自主性等几个重要环节。知情同意原则的这几个环节在精准医学情境中面临新的挑战。在精准医学中,由于风险和收益存在未知数,风险告知成为难题,告知范围具有不确定性,无法做到信息的充分告知;由于患者或受试者对信息的理解难度增加并影响传统知情同意模式的有效实施;同时,个人自主与群体自主之间面临冲突。在精准医学时代,应当对传统的知情同意原则进行补充,构建出新的知情同意原则的实践模式,以使其更好地发挥作用。     

从权利意识的视角看实践患者知情同意的文化障碍

实现知情同意权是对患者自主权利的尊重,但患者知情同意权的实现遇到诸多的文化障碍,从权利意识的视角看,主要来自于中国的一元社会结构、儒家文化和法律文化传统对个人权利诉求的影响,只有培养和提高患者权利意识,增强主体性和自主性,消除文化障碍,才能真正落实知情同意权。     

知情同意原则的中国化:一种生命伦理学视角的转换

知情同意原则的中国化是我国生命伦理学中的一个理论难点.有学者主张可以在知情同意原则的实践上实现个人自决与家庭决策的并立共存,也有学者认为应当运用多元道德理论来对知情同意原则进行论证.然而,知情同意原则中国化的更为可行的方式是认识到“自主”理论下的知情同意原则的限度,并重新确立医学“行善”原则的核心地位.通过这种理论视角的转变,知情同意原则的中国化就不再是一个难解的问题.     

受试者知情同意决策与家庭的相关度研究

在中国大陆,至少有以下四个方面的因素影响着受试者知情同意的决策,包括研究者的告知和研究者的导向、人体研究不同分期或类型的差别、受试者个体特质的状况、受试者家庭及类家庭成员(朋友、同伴等)的观念.这些因素与家庭的相关度不尽相同,家庭在不同领域、不同类型、不同层级的人体研究中参与决策表现出不同范围和深度.论证了在受试者知情同意决策过程中,需要受试者家庭或类家庭成员的参与,以实现保护受试者的目的.     

论知情同意的家庭主义模式

知情同意是生命伦理学的基本原则.中国语境下,知情同意的临床实践具有区别于西方个体模式的特点,即家庭主义模式.这种模式的产生植根于病人的脆弱性与依赖性、自主的内在联系,并受到儒家文化的深刻影响,其本质是一种家庭自主.在临床实践中,家庭主义模式有利有弊,我们应当发挥其优势,克服其弊端.     

Age Expectations of Behavioural Autonomy in Hong Kong,Australian and American Youth: The Influence of Family Variables and Adolescents' Values

Tenth and 11th grade students from Hong Kong (N = 141), Australia (N = 155), and the United States (N = 155) completed questionnaires about the age at which they expected to achieve behavioural autonomy and about their family environments and values. In general, Hong Kong youth had later expectations for autonomy; described their families as less accepting-engaged and less structured; placed less value on individualism, outward success, and individual competence, and more value on tradition, prosocial, and well socialised outcomes. However, in all three cultures, age expectations for behavioural autonomy showed similar patterns of association with family environments and values as revealed by parallelism of regression planes. Expectations for later autonomy were associated with perceptions of parental monitoring, a demanding family environment, low levels of autocratic parenting, and with youths' de-emphasis of individualism, individual competence and outward success. In regression analyses the family environment and values scores reduced by 62% the influence attributed to culture.     

HIV/AIDS reduces the relevance of the principle of individual medical confidentiality among the Bantu people of Southern Africa

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons living with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient.     

Do I need ethnic culture to be free? A critique of Will Kymlicka’s liberal nationalism

Abstract

As part of a vigorous debate about the politics of multiculturalism, Will Kymlicka has sought to find grounds within liberal political theory to defend rights for cultural groups. Kymlicka argues that the individual’s ability to choose the good life necessarily takes place in a cultural context such that access to one’s ethnic or national culture constitutes a condition of autonomy. Thus, in liberal societies where the culture of minority ethnic groups or nations is under threat, these groups should enjoy certain special rights so as to uphold the autonomy of their individual members. However, Kymlicka’s ‘liberal nationalist’ argument relies on a problematic isomorphism between culture and identity. Very simply, I shall argue that an individual’s culture is not necessarily given by their membership of an ethnic group or nation, thus breaking the link between individual autonomy and rights for ethnic groups or nations.     

From solidarity to autonomy: towards a redefinition of the parameters of the notion of autonomy

Starting from examples of concrete situations in France, I show that autonomy and solidarity can coexist only if the parameters of autonomy are redefined. I show on the one hand that in situations where autonomy is encouraged, solidarity nevertheless remains at the foundation of their practices. On the other hand, in situations largely infused with family solidarity, the individual autonomy may be put in danger. Yet, based on my ethnographic observations regarding clinical encounters and medical secrecy, I show that while solidarity may endanger individual autonomy, it does not necessarily endanger autonomy itself. The social practices observable in France reflect the reality of an autonomy that goes beyond the individual, a reality that involves a collective subject and includes solidarity. The opposition between these two values can then be resolved if the content of the notion of autonomy is understood to be dependent on its cultural context of application and on its social use.     

Individual and Family Decisions About Organ Donation

abstract This paper examines, from a philosophical point of view, the ethics of the role of the family and the deceased in decisions about organ retrieval. The paper asks: Who, out of the individual and the family, should have the ultimate power to donate or withhold organs? On the side of respecting the wishes of the deceased individual, the paper considers and rejects arguments by analogy with bequest and from posthumous bodily integrity. It develops an argument for posthumous autonomy based on the liberal idea of self‐development and argues that this establishes a right of veto over donation. It claims, however, that whether the family's power to veto would conflict with posthumous autonomy rights depends on how it comes about. On the side of respecting the family's wishes, the paper first considers an argument from family distress. This supports a contingent, non‐rights‐based reason for the family's power that is trumped by the deceased's rights. It then outlines and criticises an argument based on family autonomy. The conclusion is that the individual has the right to veto the family's wish to donate and that, while the family has no right to veto the individual's wishes to donate, it can legitimately acquire this power and has done so in practice.     

Perceived Intrafamilial Connectedness and Autonomy in Families With and Without an Anxious Family Member: A Multiple Informant Approach

Perceived intrafamilial “emotional connectedness” and “autonomy” were investigated within families with and without an anxious family member using a multiple informant approach. The sample consisted of 32 mothers with a current anxiety disorder and 56 controls, their partners, and their anxious and nonanxious teenage children. No differences were found with respect to the perceived family relationships of family members with versus without anxious mothers. However, compared with nonanxious adolescents, anxious adolescents perceived less autonomy in relation to both parents. Mothers of anxious adolescents also perceived their children to be less autonomous toward them and their partners, than mothers of nonanxious adolescents. In contrast with “autonomy,” “emotional connectedness” was not reported to be different between families with and without an anxious adolescent. Agreement among family members and the importance of perceived individual autonomy in the development of anxiety are discussed.     

Why American conservatives and individuals from traditionalist cultures may share a preference for group uniformity

American culture is known for its emphasis on freedom‐promoting values such as self‐determination and autonomy. Yet, a large segment of American society endorses a conservative ideology that seems to go against these values. In this article, we empirically show that conservatives’ weaker endorsement of autonomy values predicts a preference to be an amorphous entity in a tight, uniform group (Study 1A). We do so by implementing a novel measure of sociocultural tightness that is not based on self‐report items. We subsequently show that cultural (East–West) differences in this preference can be explained through a similar mechanism (Study 1B). Hence, we show that some cognitive processes of American conservatives are similar to those of individuals coming from more collectivist, non‐Western societies.     

Individual autonomy in work teams: The role of team autonomy,self-efficacy,and social support

Task autonomy is long recognized as a means to improve functioning of individuals and teams. Taking a multilevel approach, we unravelled the constructs of team and individual autonomy and studied the interplay between team autonomy, self-efficacy, and social support in determining individual autonomy of team members. Hierarchical regression results of a survey among 733 members of 76 health care teams showed that individual autonomy was related not only to the level of team autonomy, but also to self-efficacy and social support. Moreover, results suggested that social support moderates the extent to which team autonomy is incorporated into the individual tasks of team members. In highly autonomous teams, individuals experiencing moderate support from co-workers and supervisors reported higher individual autonomy than members experiencing either low or very high support.