老龄人临终关怀服务中的伦理冲突

Ethical Conflicts in Elderly Hospice Care

在我国传统文化视域和现行伦理、法律框架下,老年人临终关怀会遇到一系列的伦理冲突和难题:医疗保护中隐瞒病情与知情同意中告知原则的伦理冲突;中国传统孝道观念与尊重病人自主抉择权利的伦理冲突;临终关怀中的死亡商讨与传统死亡观的伦理冲突;选择临床积极治疗或临终关怀服务的伦理决策冲突;临终关怀的服务理念与传统医德观的伦理冲突。提出解决的对策为:应根据病人的心理状态和实际需要适当告知病情;关注病人意愿,尊重病人的自主权;推广有关生死关怀等相关的教育课程;开展死亡观教育和伦理引导,构建和普及科学的死亡观;医务人员要转变医疗观念,重视对临终老人的身心照护。

Under traditional Chinese culture, according to the current ethical and legal system, the elderly hospice care will encounter a series of ethical conflicts and dilemmas： ethical conflicts between hiding conditions in medical protection and the informing principle in conformed insent ; the ethical conflicts between the traditional Chinese filial piety idea and respecting autonomy of the patients; the ethical conflicts between the discussion of death and traditional thanatopsis ; the ethical conflicts in selection clinnical treatment or the hospice care ; the ethical conflicts between service philosophy in hospice care and the traditional view of medical ethics and so forth. The countermeasures were： properly inform the illness according to the patient＇s psychological state and the actual needs; focus on patients＇willingness and respecting their autonomy; improve hospice care and related education; carry out the concept of death education and ethical guidance, build and popularize scientific thanatopsis; medical personnel need to change the concept of health, pay attention to the physical and mental care in elderly.