{"title":"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。","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":"{\"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}","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}
Argument for Consensual Paternalism in Shared Decision-Making: Rediscovering Autonomy in Western Bioethics.
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.
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.