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首页> 美国卫生研究院文献>Journal of Medical Ethics >Tell me whats wrong with me: a discourse analysis approach to the concept of patient autonomy.
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Tell me whats wrong with me: a discourse analysis approach to the concept of patient autonomy.

机译：告诉我我有什么毛病：一种针对患者自主权概念的话语分析方法。

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BACKGROUND: Patient autonomy has gradually replaced physician paternalism as an ethical ideal. However, in a medical context, the principle of individual autonomy has different meanings. More knowledge is needed about what is and should be an appropriate understanding of the concept of patient autonomy in clinical practice. AIM: To challenge the traditional concept of patient autonomy by applying a discourse analysis to the issue. METHOD: A qualitative case study approach with material from one consultation. The discourse is interpreted according to pragmatic and text-linguistic principles and provides the basis of a theoretical discussion of different concepts of patient autonomy. RESULTS: The consultation transcript illustrates how the patient's wishes can be respected in real life. The patient, her husband and the doctor are all involved in the discourse dynamics, governed by the subject matter, namely her mental illness. CONCLUSION: We suggest a dynamic and dialogue-based conception of autonomy as adequate for clinical purposes. These perspectives, based on mutual understanding, take communication between patient and doctor as their starting point. According to this approach, autonomy requires a genuine dialogue, an interpersonal mode of being which we choose to call "authentic interaction".
机译：背景：患者的自主权已逐渐取代医师的家长式作风成为一种道德理想。但是，在医学上，个人自治原则具有不同的含义。在临床实践中，需要更多的知识来了解患者自主权的概念，并且应该适当理解这些知识。目的：通过对问题进行话语分析来挑战传统的患者自治概念。方法：定性案例研究方法，包含一次咨询的资料。话语是根据务实和文本语言原则进行解释的，并提供了有关患者自主性不同概念的理论讨论的基础。结果：咨询笔录说明了如何在现实生活中尊重患者的意愿。患者，她的丈夫和医生都参与了由主题即精神疾病决定的话语动态。结论：我们建议以动态和基于对话的自主概念来满足临床目的。这些观点基于相互理解，以患者和医生之间的沟通为出发点。按照这种方法，自治需要真正的对话，即我们选择称为“真实互动”的人际关系模式。

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