On The Role Of Family In Medical Decision Making

With the rise of human rights movement and advancement of medical technology, more and more attention has been paid to patients’ decision-making right. The mode of giving the final decision right to patients has generally replaced the mode based on medical patriarchy. However, we are confronted with the theoretical and practical problems: the so-called patient’s autonomy is the patient’s self-determination or the joint decision of family members; we should adhere to bioethics value of modern western liberalism and individualism or insist on traditional Confucian bioethics value based on mutual compliance and mutual consultation among doctor, patient and family member. That is to say, should family play a role in medical decision-making? If so, what role should family play and how to play?First, this paper explores the function and role of family from the perspective of cultural sociology, among which the structure and function of Confucian social family have been analyzed emphatically. Then, combining with clinical practice, this paper analyses the uniqueness and complexness of medical decision-making. At last, this paper suggests giving full play of the function of family, that is, patient, patent’s family and doctor consult with each other and make a joint decision.By means of theoretical and empirical study of western patient’s autonomy, the author finds that in Chinese social and cultural environments, with regard to decision-making right, patients, by no means, enjoy as complete independence from others’intervention as western individual liberalism does. Under Chinese medical environments, patients’life and health will never receive thorough and comprehensive protection via single dependence on their own decision. Family is a small social community on the basis of marriage relationship, kinship relationship and adoptive relationship, which is an independent economic unit taking growth and reproduction of individual as its basic functions. In the perspective of bioethics, family has obligation of caring growth and health, sharing the medical expense and bearing the medical consequences together. As a small social community on the basis of marriage, kinship dnd adoption, family constitutes an independent economic unit whose basic functions mainly consist in people’s growth and reproduction. From the perspective of bioethics, it is specific care for individual growth and health and common responsibility for medical expense and consequences that materializes a family’s function. Therefore, family participant in medical decision-making does have its ethics basis.From the point of view of ontology, patient is not an isolated individual, but a member of family with duty and obligation for the family. Therefore, patient’s autonomy is constrained by family’s decision and should combine with the participant of family members in order to mediate the conflict between concept of human rights and cultural traits. From the perspective of virtue theory, family is the substance of virtue. Getting illness is not just an individual problem, but the situation the family faces. Patient can get economic and spiritual support from family while family proactively gives sincere care and considerate comfort. In the perspective of consequentiality, the best way to face illness is participant together of the whole family. Family participant is not the deprival of patient’s autonomy; on the contrary, family intervene intervention makes family bear the burden of decision-making, which is unbearable for patient. Therefore, under Chinese cultural background, patient’s autonomy should be understood newly through the relationship between patient and family. The patient’s autonomy lacking effective participant is not complete. Patient need make the decision and choice for the whole family. Besides doctor and patient, the participant of patient’s family is also essential in medical decision.In the end, combining with medical decision-making practice, this paper puts forward the medical decision-making mode based on co-participant of doctor, patient and patient’s family:First, remedial medical act whose medical expense has little influence over family can be decided by patient himself\herself on the basis of his\her own will. Second, the medical act with great influences of medical expense over family should be approved by patient and family. Third, non-remedial medical act should be based on the family’s opinion. Fourth, family decision can be irrational. When family decision may endanger patient’s health and life, doctor is obliged to interfere it, that is, exercise the special right of interference to make the choice which is good for patient.