Reconsidering autonomy: Asian Americans' use of relational autonomy in organ donation decisions.

IF 3 1区 哲学 Q1 ETHICS
Gerard P Alolod, Diana C Litsas, Laura A Siminoff
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引用次数: 0

Abstract

Background: As cultural contexts have gained increasing relevance in medical decision-making, the current mainstream definition of autonomy is insufficient. A viable alternative framework, relational autonomy posits that agents' actions are influenced by and embedded in society and culture rather than occurring in isolation. To test the concept's applicability, we examine whether Asian Americans in the study's sample operationalize relational autonomy as a decisional approach in hypothetical scenarios about organ donation, a practice for which there is considerably lower enthusiasm compared to other racial groups in the US.

Methods: A national sample of Asian American adults were recruited from a Qualtrics research panel. Participants completed a Think-Aloud interview containing scenarios in which they decide whether or not to: (1) become a registered donor at the motor vehicle department; (2) authorize organ donation for a close relative who unexpectedly died. The interview first elicited candid reactions to the scenarios, followed by probing participants' rationale of their initial responses. Participants' final decision to each scenario (whether or not to register; whether or not consent to surrogate authorization), as well as participants' decisional approaches (individualistic vs. relational) were coded using the constant comparison method.

Results: The sample (n = 40) mirrored the largest proportions of Asian Americans in the US; the plurality identified as Chinese (35%), Filipino (27.5%) and Indian (25%). In response to the organ donor registration prompt, a majority of respondents (57.5%) expressed they would employ the mainstream decisional approach of individualistic autonomy, and 42.5% would make the decision with a relational approach. In contrast, when responding to the surrogate authorization prompt, the majority (77.5%) described a relational approach when making the decision, to preserve familial harmony and honor their cultural heritage.

Conclusions: Use of individualistic and relational autonomy frameworks are situational for some individuals. Participants acknowledged the impact of personal, cultural, and societal elements on their decisional approach. The concept of relational autonomy has utility through its versatility in complex decision-making events and by accounting for multiple stakeholders without privileging the autonomy of a single decision-maker over others.

Clinical trial number: Not applicable.

重新考虑自主权:亚裔美国人在器官捐赠决策中使用关系自主权。
背景:由于文化背景与医疗决策的相关性越来越大,目前主流的自主性定义是不够的。关系自治是一个可行的替代框架,它假定行动者的行为受到社会和文化的影响并根植于社会和文化之中,而不是孤立地发生。为了测试这一概念的适用性,我们研究了研究样本中的亚裔美国人是否将关系自主作为一种假设的器官捐赠决策方法,与美国其他种族相比,这种做法的热情要低得多。方法:从Qualtrics研究小组中招募全国亚裔美国成年人样本。参与者完成了一项“大声思考”访谈,其中包含了他们决定是否在以下情况下作出决定:(1)成为汽车部门的登记捐赠人;(二)对意外死亡的近亲属授权捐赠器官的。这个采访首先引起了参与者对这些场景的坦诚反应,然后探究他们最初反应的理由。参赛者对每个方案的最终决定(是否报名;是否同意代理授权),以及参与者的决策方法(个人主义与关系)使用恒定比较方法进行编码。结果:样本(n = 40)反映了美国亚裔美国人的最大比例;多数被认定为中国人(35%)、菲律宾人(27.5%)和印度人(25%)。对于器官捐献登记提示,大多数受访者(57.5%)表示将采用个人自主的主流决策方式,42.5%表示将采用关系决策方式。相比之下,在回应代孕授权提示时,大多数人(77.5%)表示在做出决定时考虑到关系,以保持家庭和谐并尊重他们的文化遗产。结论:对某些个体而言,个人主义和关系自主框架的使用是情境性的。参与者承认个人、文化和社会因素对他们决策方法的影响。关系自治的概念具有实用性,因为它在复杂的决策事件中具有多功能性,并且考虑到多个利益相关者,而不会使单个决策者的自主权高于其他决策者。临床试验号:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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