一位護理師照護一名末期病人。家屬希望對病人隱瞞診斷結果。護理師應遵循哪項倫理原則來回應？
A nurse is caring for a client who is terminally ill. The client's family wants to withhold the diagnosis from the client. Which ethical principle should guide the nurse's response?
- AJustice正義
- BBeneficence行善
- CNonmaleficence不傷害
- DAutonomy✓ 正解自主
自主原則（Autonomy）是指病人有權利知道自己的診斷、預後及治療選擇，並根據這些資訊做出自主決策。隱瞞診斷（即所謂的「善意的謊言」）雖然在家屬看來是出於保護（行善），但在倫理上直接侵犯了病人的知情權與自主權。在 NCLEX 考試中，當病人具備決策能力時，其自主權通常高於家屬的願望。護理師應協助溝通，解釋病人知情的重要性，而非盲目從家屬。行善原則（Beneficence）與不傷害原則（Nonmaleficence）雖然也重要，但在此情境下，剝奪病人處理遺願或做最後決策的機會，被視為對自主權的嚴重損害。
The principle of autonomy supports a competent client's right to self-determination and to be fully informed about their health status. Withholding a terminal diagnosis violates the client's right to know, which takes precedence over family wishes to protect them. Although beneficence aims to do good, it does not justify depriving a capable patient of the opportunity to make end-of-life decisions.
美國臨床實務深受《病人自決法》（PSDA）影響，強調病人本位，家屬影響力相對較小；台灣文化中，「家庭集體決策」傾向明顯，護理師常需在「法律要求的病人自主」與「文化要求的家庭和諧」之間做困難的溝通協調。