Transcript 論文寫作的心理社會與倫理議題

臨床醫療倫理
Ethics in Clinical Practice
Ming-Been Lee, M.D.
Departments of Psychiatry and Social Medicine
College of Medicine
National Taiwan University
醫學的真諦
醫學是關係的科學
◎病
人為中心
◎家庭為單位
◎社區為基礎
醫學以人文為基礎
 傳統:人的尊嚴、利益與價值
 現代:人與萬物
和諧共生
優質的醫療

聖
專業技術
專業倫理
專業溝通
Terminology
Morality
 Ethics
 Law
 Bioethics

Medical
Ethics
Objectives of Medical Ethics Education: To Teach
1. Humanistic and ethical aspects of medical career;
2. Personal moral and professional moral
commitments;
3. Foundation of philosophical, social, and
legal knowledge;
4. Medical reasoning;
5. Interactional skills to apply insight, knowledge and
reasoning to clinical care.
醫學倫理理論、原則與規則
理論
原則
行善
效益論
(Utilitarianism)
(beneficence)
不傷害
(nonmalefice
nce)
規則
1.關懷，保護病人的權利
2.預防及排除可能的傷害
3.幫助他人，造福人群
1.不能傷 害病人
2.不能侵害病人的權利或
幸福
3.平衡利害得失，使痛苦
減至最低
醫學倫理理論、原則與規則
理論
原則
公正
(justice)
義務論
(Deontological
Theory)
規則
1.分配正義
2. 福利正義
3. 法律正義
1.誠實
( respect for 2.守密
autonomy)
3.知情同意
4.尊重隱私
尊重自主
Medical Ethics: Principles
1.
Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
Medical Ethics: Rules
 Informed
Consent
 Confidentiality
 Truth
telling
 Veracity
 Privacy:
Limited
Parties Involved in Clinical Ethics

Staff-patients
Staff-family
 Staff-staff
 Staff-society
 Third parties

Health Care Ethics
Team.

Model of Staff-Patient relationship: a

Good manners

Keep secret: third parties, legal, using computers
 Informed decision making
 Patient’s right and responsibility
 Justice: Resource allocation, Minimal justice
 High-tech medicine
 Special issues: AIDS/ICU/organ transplantation
Clinical Ethics: Three
Obligations to Patients
Give
the best care that we can
Be
honest
Be
trustworthy
Principle of Autonomy
 Rational individuals should be permitted to be
self-determined.

Patient’s autonomy VS rights and needs of
others .
Respect for Autonomy
Patient’s body integrity.
 Patient’s control over touching, manipulation,

invasion, medication, or other intervention.

Patient’s right to authorize beneficient act.
Informed Consent

Show
respect for self-determination.
Function as a corrective process to
paternalism.
 Provide opportunity and encouragement to
become more active in decision making.


A PROCESS rather than a Document.
Consent Process

Provision of information
 Comprehension
 Voluntariness
Consent
Active authorization rather than passive
consent
Required Discussion
1. Define problems
2. Exact nature of proposed treatment
3. Alternatives
4. Prognosis with and without treatment
5. Risks and benefits of treatment and
alternatives
6. Serious risks even if unlikely
7. Any question patient may have
General Process of Case Analysis

1. The Case: Review of fact.
 2. Identification of ethical problems.
 3. Determine reasonable alternatives.
 4. Consider the option in relation to
ethical Principles and Context.

5. Propose a resolution.

6. Consider your position critically.

7. Action required: Do the RIGHT thing.
Interactional Skills
Education
Support
常用的溝通技巧
關係的建立
非言語溝通技巧
言語溝通技巧
Establishment of Rapport
1. Listening by 3rd ear
2. Sensitivity
3. Empathy
□ Concern
□ Respect
□ Acceptance
□ Warmth
□ Genuineness
□ Understanding
4. Confidence
非言語溝通技巧
●
動作
●
●
●
空間
語助詞
觸摸
Major types of kinesic
nonverbal communication
Gestures
Facial
Expressions
Gaze
Supportive Technique
Abreaction
1.
2. Clarification
3. Praise
4. Reassurance
5. Suggestion
醫療 態 度

能：專業技能、溝通合作

心：同理心
1. 尊重
4. 體諒
2. 關懷
5. 坦誠
3. 接納
6. 溫馨
後SARS : 從關懷出發
Safety
Appreciation
Reflection
Support
苦
海
慈
航
I
Q
EQ
CQ
MQ