Argument for Consensual Paternalism in Shared Decision-Making: Rediscovering Autonomy in Western Bioethics.

IF 1.7 2区 哲学 Q2 ETHICS
Bioethics Pub Date : 2025-06-25 DOI:10.1111/bioe.70003
Sarosh Saleem
{"title":"Argument for Consensual Paternalism in Shared Decision-Making: Rediscovering Autonomy in Western Bioethics.","authors":"Sarosh Saleem","doi":"10.1111/bioe.70003","DOIUrl":null,"url":null,"abstract":"<p><p>Western bioethics has evolved from discussions centered around paternalism and individual autonomy to the concept of Shared Decision-Making (SDM). This approach to decision-making aims to uphold patients' autonomy while prioritizing open communication and collaboration. When it comes to making decisions for infants or children, both parents and pediatricians share the responsibility. Parents' personal experiences, values, and beliefs play a central role in the concept of SDM. However, there is still ongoing debate regarding whether physicians should convey their own values, preferences, and recommendations. In Pakistan, clinical decision-making is predominantly the domain of physicians. Physicians are regarded as figures of respect and authority, and seeking a physician's opinion is common. In a patrilineal and family-oriented society, medical paternalism is accepted and valued by patients and their families. Autonomy is viewed through a different lens in this cultural setting. This paper presents a narrative analysis of the contrasting approaches to clinical decision-making in these two cultural contexts. It raises thought-provoking questions about how clinicians navigate decision-making dynamics, particularly when faced with different expectations from patients and families. The juxtaposition of these approaches prompts reflection on the potential impact of cultural and societal norms on ethical considerations in healthcare. The paper criticizes the moral hegemony of autonomy and argues for rethinking the separation of autonomy and paternalism in Western bioethics, offering Consensual Paternalism, which represents shared yet unconventional decision-making.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bioethics","FirstCategoryId":"98","ListUrlMain":"https://doi.org/10.1111/bioe.70003","RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ETHICS","Score":null,"Total":0}
引用次数: 0

Abstract

Western bioethics has evolved from discussions centered around paternalism and individual autonomy to the concept of Shared Decision-Making (SDM). This approach to decision-making aims to uphold patients' autonomy while prioritizing open communication and collaboration. When it comes to making decisions for infants or children, both parents and pediatricians share the responsibility. Parents' personal experiences, values, and beliefs play a central role in the concept of SDM. However, there is still ongoing debate regarding whether physicians should convey their own values, preferences, and recommendations. In Pakistan, clinical decision-making is predominantly the domain of physicians. Physicians are regarded as figures of respect and authority, and seeking a physician's opinion is common. In a patrilineal and family-oriented society, medical paternalism is accepted and valued by patients and their families. Autonomy is viewed through a different lens in this cultural setting. This paper presents a narrative analysis of the contrasting approaches to clinical decision-making in these two cultural contexts. It raises thought-provoking questions about how clinicians navigate decision-making dynamics, particularly when faced with different expectations from patients and families. The juxtaposition of these approaches prompts reflection on the potential impact of cultural and societal norms on ethical considerations in healthcare. The paper criticizes the moral hegemony of autonomy and argues for rethinking the separation of autonomy and paternalism in Western bioethics, offering Consensual Paternalism, which represents shared yet unconventional decision-making.

共同决策中的共识式家长制之论证:重新发现西方生命伦理学中的自主性。
西方的生命伦理学已经从以家长主义和个人自治为中心的讨论演变为共同决策(SDM)的概念。这种决策方法旨在维护患者的自主权,同时优先考虑开放的沟通和协作。当涉及到为婴儿或儿童做决定时,父母和儿科医生都有责任。父母的个人经历、价值观和信仰在SDM的概念中起着核心作用。然而,关于医生是否应该传达他们自己的价值观、偏好和建议,仍然存在争论。在巴基斯坦,临床决策主要是医生的领域。医生被视为受人尊敬和权威的人物,寻求医生的意见是很常见的。在父系和以家庭为导向的社会中,医疗家长式作风被患者及其家属所接受和重视。在这种文化背景下,人们从不同的角度看待自治。本文对这两种文化背景下临床决策的对比方法进行了叙述分析。它提出了一个发人深省的问题,即临床医生如何驾驭决策动态,特别是当面对来自患者和家属的不同期望时。这些方法的并置促使人们反思文化和社会规范对医疗保健伦理考虑的潜在影响。本文批判了自主性的道德霸权,主张重新思考西方生命伦理学中自主性与家长制的分离,提出了代表共同但非常规决策的共识家长制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Bioethics
Bioethics 医学-医学:伦理
CiteScore
4.20
自引率
9.10%
发文量
127
审稿时长
6-12 weeks
期刊介绍: As medical technology continues to develop, the subject of bioethics has an ever increasing practical relevance for all those working in philosophy, medicine, law, sociology, public policy, education and related fields. Bioethics provides a forum for well-argued articles on the ethical questions raised by current issues such as: international collaborative clinical research in developing countries; public health; infectious disease; AIDS; managed care; genomics and stem cell research. These questions are considered in relation to concrete ethical, legal and policy problems, or in terms of the fundamental concepts, principles and theories used in discussions of such problems. Bioethics also features regular Background Briefings on important current debates in the field. These feature articles provide excellent material for bioethics scholars, teachers and students alike.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信