關係自主之概念分析

Relational Autonomy : A Concept Analysis

關係自主（relational autonomy）近年來逐漸受到國外學者所重視，此名詞經常在醫學倫理中用來理解個人在做決策時受到人際關係或社會脈絡等影響的複雜過程，以及個人在這些關係處境中所發展出的自主決策能力。目前國內針對此概念的相關探討甚少，因此本文乃以Walker & Avant（2011）提出之概念分析步驟，統整文獻後，歸納關係自主的定義性特徵為（1）決策情境中，個人與關係他人彼此承擔人際間連帶的責任、相互信任、關懷與合作；（2）個人的決策在與關係他人及社會文化互動中達到穩定，為動態平衡（dynamic balance）過程；（3）個人在決策過程中其意願或決定可保有自主性並被尊重。其前置因子是（1）行使自主權的能力；（2）面對需要做決定的情境；（3）個人存在於社會中，與社會緊密相依；決策過程受到關係他人（個人、重要他人或專業人士）與社會文化背景影響。後果則是在考量了關係他人的建議與自己的想法後，個人做出符合價值觀的選擇，以及良好的決策品質：對決策過程滿意、對所做決定不後悔。期望此概念分析有助於醫護人員對關係自主的了解及臨床實務與相關研究應用的參考。

Relational autonomy is an emerging concept in the field of medical ethics to understand an individual’s decision-making process which is influential with the interpersonal relationships and social context, and how to develop autonomous decision-making ability when being immersed in social networking environment. Currently the research focuses on relational autonomy is limited. This article analyzes the concept of relational autonomy based on the procedures of Walker & Avant (2011). We describe the defining characteristics of relational autonomy as (1) individuals and others within interpersonal relationships take the responsibility, trust and care for each other in the decision-making situation, (2) individuals’decision-making could achieve stable through the interaction with others or their social cultural context, which is a process of dynamic balance, (3) individuals can maintain autonomy and their willingness or decisions could be respected in the decision-making process. Antecedents include that individuals have the ability to exercise autonomy, facing a decision-making situation, and existing in society with close relation. Consequences of relational autonomy include that individual makes a decision based on personal values and achieve high quality of decision-making after considering inner voices and others’suggestions: satisfaction with the decision, and no regret in the decision. This paper may provide health professionals with understanding of the concept of relational autonomy and use as a reference for clinical practice and future research.