공유의사결정의 선행 개념으로서의 자율성

Abstract

Today, as patients’ participation in decision-making is becoming more important in the medical field, the concept of “sharing decision-making” is drawing attention. This is based on the “principle of respect for autonomy,” one of the “Principle of Biomedical Ethics” advocated by Tom L. Beauchamp and James F. Childress. However, compared to emphasizing patient autonomy in shared decision-making, discussion on the relationship between shared decision-making and the concept of autonomy is insufficient. It is necessary to explain the discussion that can integrate each concept being done individually. Shared decision-making is an approach that helps doctor and patient share the best possible evidence when faced with medical decision-making challenges, and allows patients to consider options to achieve informed preferences. Despite the increasing awareness of patients’ rights today, there are still difficulties in realizing shared decision-making in reality. Among them, this paper focuses on the intervention of families that are practically guaranteed and working in the medical decision-making process in Korea. Family intervention and leading decisions in the process of ‘sharing decision-making’ fundamentally act as a factor that violates patient autonomy. In the decision-making process for patients at the end of their lives, the concept of “autonomy” should not be derived from the existing abstract and absolute self and used to speak of macroscopic life values, but should be evaluated as autonomous by going through the process of moral reflection. Based on this concept of autonomy, it will be the basis for preparing a more sophisticated ‘sharing decision-making’ model along with concerns about problems derived from various relationships that actually appear in the sharing decision-making process.