醫(yī)務(wù)社會(huì)工作中“案主自決”的兩難困境與倫理抉擇

[中圖分類號(hào)]R-052 [文獻(xiàn)標(biāo)志碼]A [文章編號(hào)]1001-8565（2025）06-0781-09

DOI：10.12026/j.issn.1001-8565.2025.06.15

Thedilemmasand ethicalchoicesof“clientself-determination”inmedical social work

ZHONG Liuqing

（School ofHumanities and Management，Guangdong Medical University，Dongguan 5238O8，China）

Abstract： Medical social work requires workers to carry out professonal help with values and concepts， and client self-determination is an important principle.However，when intervening in the specific situation of patients with severe illness，social workers often fall into dilemmas of“whether the client continues to receive treatment”，“whether the client should be informed of their condition”，and“whether to intervene when the decision-making causes harm to the client's self-interests.”This paper conducted ethical judgments and ethical decision-making analysis regarding pediatric leukemia patients. It also analyzed the pros and cons of client selfdeterminationand limitedself-determination from the ethical level of deontology and teleology，as well as appropriate approaches to informed consent.Based on this analysis，suitable action strategies were selected，and final decisions were made.Finally，reflecting on the judgment and choices made throughout the ethical dilemma，it was believed that effective self-determination in professional helping relationships needs to avoid paternalism，be familiar with local culture，develop discretionary rights，as well asengage in individual transcendence and return to virtue theory considerations.

Keywords： medical social worker;client self-determination；informed consent；ethical judgment；ethical choice

1 問題提出

隨著重癥醫(yī)學(xué)的發(fā)展和醫(yī)學(xué)技術(shù)的進(jìn)步，重癥監(jiān)護(hù)室（intensivecareunit，ICU）的救治能力和患者生存率逐漸提高，ICU患者的生命質(zhì)量也越發(fā)受到關(guān)注。（剩余15100字）