导航痴呆和妄想:在提前指令中平衡身份和利益
1Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
概括
预先指示 (AD) 对痴呆症患者 (PLWD) 具有道德权威,即使是痴呆症患者. 他们的关键利益,反映价值观,应该引导关心当前的经验利益.
科学领域:
- 生物伦理学生物伦理学
- 神经科学是一个神经科学.
- 老年学是一门学科.
背景情况:
- 对痴呆症患者 (PLWD) 的预先指示 (AD) 的道德权威进行了辩论,重点是真实性和照顾者的角色.
- 德雷瑟的批评使用帕菲特的身份理论和玛戈的案例,认为痴呆症创造了一个新的自我,其经验利益取代了先前的关键利益.
研究的目的:
- 探讨对PLWD的AD的道德权威,特别是当妄想使决策复杂化时.
- 在复杂的护理场景中,争辩一个有能力的自我关键利益的优先权,如ADs所述,超过当前的经验利益.
主要方法:
- 个人身份理论的哲学分析 (帕菲特,德沃金).
- 案例研究的调整:将妄想引入到一个PLWD场景 (Margo).
- 关于批判性和体验性兴趣与生活质量 (QoL) 之间的相互作用的论证.
主要成果:
- 妄想症可以迅速减少PLWD的体验兴趣和QOL.
- 由于疾病轨迹的不确定性,应优先考虑主管自我的关键利益,以ADs来表达.
- ADs拥有道德权威,受到自我所有权的支持.
结论:
- 提前指示保留了痴呆症患者的道德权威,即使是 Delirium 等急性疾病.
- 医疗保健专业人员必须促进ADS的理解和共享决策,以维护自主性和尊严.
- 伦理性痴呆护理需要通过强有力的AD实施来优先考虑患者的价值观和偏好.
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