日本老龄认知症护理的伦理困境

Ethical Dilemma of Nursing for Ageing Cognitive Disorder in Japan

人口老龄化已成为人类社会面临的共同挑战。日本在实现老龄高质量生活方面提供了值得借鉴的经验,以自立支援为核心,拥有伦理的意识,关注生命伦理的日本护理伦理具有鲜明特点。随着老龄化社会的进程不断深入,老龄者不再被视为被动弱者,而是尊重其独立人的主体性尊严。特别值得探究的是,老龄认知症的护理领域面临着诸多的伦理问题,其一,自我决定与代理判断的顺序相异,呈现出老龄认知症个体与家庭的伦理难题;其二,个体尊严与资源分配的价值对立,呈现出老龄认知症个体与机构之间的伦理困境;其三,伦理与法律的兼顾难题,呈现出老龄认知症晚期护理的伦理思考。通过对诸多伦理困境的分析发现,老龄认知症护理遭遇伦理困境时有三种解决路径:直观路径、协商式路径和伦理分析路径。简言之,探明伦理困境之所在,使用伦理四原则、决疑论、关怀伦理等可以探索解决方案。此外,对于伦理价值的判断不仅应遵循伦理原则,还需从医学与法律视角思考及开放式对话,应以老龄认知症个体为核心,同时在家庭、社会组织、制度体系中取其平衡。最终,在老龄认知症护理领域应形成伦理共识,而这将有赖于长期的伦理实践。

The ageing of the population has become a common challenge shared by human society.Japan’s experience in achieving a high quality of life in aging population is worthy of learning.It takes self-support as the core and has sense of ethical consciousness,the Japanese nursing ethics,which pays attention to bioethics,has distinct characteristics.With the deepening process of an ageing society,the elderly are no longer regarded as passive and weak,but should be respected for their independent subjective dignity.It is particularly worth exploring that,there are many ethical problems in the nursing field of Aging cognitive disorder.First,there is difference between the order of self-determination and agency judgment,showing the ethical problems of the individual and family of ageing cognitive disorder.Second,there is opposition between individual dignity and the value of resource distribution,presenting the ethical dilemma between the individual and the institution of cognitive aging.Third,there is difficulty in balancing ethics and law,reflecting the ethical thinking of the late-stage nursing of cognitive aging disorder.Through the analysis of many ethical dilemmas,it is found that there are three ways to solve the ethical dilemmas in the care of ageing cognitive disorder:intuitive path;consultative path and ethical analysis path.In brief,finding out where the ethical dilemma lies,the four principles of ethics,the theory of doubt and the ethics of care can be used to explore solutions.In addition,the judgment of ethical value should not only follow the ethical principles,but also thinks from the perspective of medicine,law and opens dialogue,takes the individual of ageing cognitive disorder as the core,and take its balance among the family,social organization and system.Finally,there should be an ethical consensus in the nursing field of ageing cognitive disorder,which will depend on long-term ethical practice.