代人战争:"最佳利益价值观"层次结构和生命结束冲突与代人决策者
1University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA, 19102, USA. fiester@upenn.edu.
概括
由于价值观的差异,医疗保健提供者和ICU的代理决策者之间的冲突仍然存在. 了解这些"最佳利益价值"与"延续生命价值"是解决终身护理争端的关键.
科学领域:
- 医学伦理 医学伦理
- 关键护理医学 关键护理医学
- 医疗保健社会学 医疗保健社会学
背景情况:
- 医疗保健提供者 (HCP) 和代理决策者 (SDM) 之间的终身护理冲突在ICU中持续存在.
- 近年来,这些冲突升级为口头和身体暴力.
- 之前的研究强调了这些争端的频率,从ICU入院的32-78%不等.
研究的目的:
- 探索 ICU 内生命末期护理中持续和不断升级的冲突的根本原因.
- 根据不同的价值体系,提出一个理解这些冲突的框架.
- 为这些争端提供导航和解决建议.
主要方法:
- 在终身护理决策中对价值体系的概念分析.
- 基于有关HCP-SDM冲突的现有文献的论证.
- 基于美国价值观的伦理分析多元主义.
主要成果:
- 对于ICU冲突的一个核心解释在于医疗人员和SDM不可比拟的价值体系.
- 医疗保健工作者通常根据"最佳利益价值观" (BIV) 运作,这与家庭的"延续生命价值观" (LCV) 发生冲突.
- 这种价值观冲突是许多ICU争端的根本驱动力.
结论:
- 在多元社会中,对LCV家族强加BIV系统是无效的,并且在伦理上存在问题.
- 医疗机构必须与LCV利益相关者进行建设性接触,以解决终身护理冲突.
- 解决价值体系差异的根本原因对于解决ICU中的"代用战争"至关重要.
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