肿瘤治疗中的医患互相拒绝和临床抉择  

The Mutual Rejection between Doctors and Patients in Cancer Treatment and Clinical Decision-making

作　　者：邓窈窕[1] 姜愚[1,2] DENG Yaotiao;JIANG Yu(Department of Head and Neck Oncology,West China Hospital/West China School of Medicine,Sichuan University,Chengdu 610041,China;Department of Medical Oncology,West China Hospital/West China School of Medicine,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院头颈肿瘤科/四川大学华西临床医学院,四川成都610041 [2]四川大学华西医院肿瘤内科/四川大学华西临床医学院,四川成都610041

出　　处：《医学与哲学》2024年第24期1-7,共7页Medicine and Philosophy

摘　　要：在复杂的临床场景中,患者与医生的选择分歧甚至相互拒绝,可能源于医学知识背景、生命质量诉求、经济状况以及个人价值观的差异。基于医学伦理学的五大原则(将患者利益置于首位、自主、不伤害、公正、友善)及伦理推理的四个维度(医疗适应证、患者意愿、生命质量、情境特征),通过多例肿瘤诊疗案例分析,系统探讨了医患互相拒绝背后的伦理逻辑和可考虑的决策路径。强调在复杂医患冲突中,把握伦理原则的主次与平衡、社会资源、医疗政策及伦理咨询委员会的重要作用,并呼吁建立更完善的伦理支持体系,助力医生在解决冲突时实现科学与伦理的双重目标。In complex clinical scenarios,disagreements and even mutual rejection between patients and doctors may arise due to differences in medical knowledge background,quality of life demands,economic status,and personal values.Based on the five principles of medical ethics(patient benefit as priority,autonomy,non-maleficence,fairness,and beneficence)and the four dimensions of ethical reasoning(medical indications,patient preferences,quality of life,and situational characteristics),this article systematically explores the ethical logic behind the mutual refusal between doctors and patients and the possible decisionmaking paths through the analysis of multiple actual cases in tumour diagnosis and treatment.This article emphasizes the importance of understanding the priority and balance of ethical principles,social resources,medical policies,and ethics advisory committees in complex doctor-patient conflicts,and calls for the establishment of a more comprehensive ethical support system to help doctors achieve the dual goals of science and ethics in conflict resolution.

关 键 词：医患关系 医学伦理学 伦理冲突 临床决策 

分 类 号：R-05[医药卫生]