ABSTRACT:The movement toward family-centered care in medicine has brought more attention to the importance of patients’ families in clinical practice. However, an issue central to the movement—why families matter—remains underexplored in both the family-centered care and the wider biomedical ethics literature. Given the possibility—and reality—of conflicts between patient and family interests, the need to think about how far providers should go in attending to a family’s welfare and wishes, and the focus that family-centered care has placed on further inclusion of families into care, a clearer understanding of providers’ responsibilities for family members is needed. In this paper, I argue for a framework in which providers have non-instrumental responsibilities for their patients’ family members but their responsibilities for their patients remain primary. To reach this conclusion, I first identify both role- and relationship-based reasons for thinking providers have non-instrumental responsibilities for family members. I then explain why clinicians should still largely prioritize the wishes and interests of their patients over those of their families and provide a reasoning structure for use in situations where wishes and interests conflict.

中文翻译：

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为什么医疗应该以家庭为中心？：了解患者家庭成员的道德责任。

摘要：医学上以家庭为中心的护理运动已使人们更加关注患者家庭在临床实践中的重要性。但是，在以家庭为中心的护理和更广泛的生物医学伦理学文献中，该运动的核心问题（为什么家庭重要）仍未得到充分探讨。考虑到患者和家庭利益之间存在冲突的可能性和现实情况，有必要考虑提供者在照顾家庭的福利和愿望方面应该走的距离，以及以家庭为中心的护理的重点是将家庭进一步纳入在护理方面，需要更清楚地了解提供者对家庭成员的责任。在本文中，我主张建立一个框架，在该框架中，提供者对其患者的家庭成员负有非仪器责任，但对患者的责任仍然是主要责任。为了得出这个结论，我首先确定了基于角色和基于关系的原因，认为提供者对家庭成员负有非工具性责任。然后，我将解释为什么临床医生仍应在很大程度上优先考虑患者的愿望和利益，而不是其家庭的利益，并提供一个推理结构，以在愿望和利益冲突的情况下使用。