医务社会工作中“案主自决”的两难困境与伦理抉择

[中图分类号]R-052 [文献标志码]A [文章编号]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 问题提出

随着重症医学的发展和医学技术的进步，重症监护室（intensivecareunit，ICU）的救治能力和患者生存率逐渐提高，ICU患者的生命质量也越发受到关注。（剩余15100字）