臨床醫療倫理 Ethics in Clinical Practice

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

專業技術 專業倫理專業溝通優質的醫療聖聖

Terminology • Morality • Ethics • Law • Bioethics • Medical Ethics

Objectivesof 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

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 • Model of Staff-Patient relationship: a Team. • 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 respectfor 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 questionpatient 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

關係的建立 非言語溝通技巧言語溝通技巧常用的溝通技巧

Establishment of Rapport 1. Listening by 3rd ear 2. Sensitivity 3. Empathy □ Concern □ Respect □ Acceptance □ Genuineness □ Warmth □ 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 Gaze Facial Expressions

Supportive Technique 1. Abreaction 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

臨床醫療倫理 Ethics in Clinical Practice