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加强三脚架:通过能力评估,代理决策和研究先进指令来维护自主权
Adam Omelianchuk1, Daniel Hurst2
1Center for Medical Ethics & Health Policy, https://ror.org/02pttbw34Baylor College of Medicine, United States.
研究预先指示 (RADs) 帮助阿尔茨海默病患者说明未来的研究愿望. 维护自主性需要RAD,能力评估和替代性决策,以实现伦理临床研究.
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.
- 临床研究伦理学
背景情况:
- 对阿尔茨海默病 (AD) 的临床研究面临道德挑战,因为影响知情同意的认知障碍.
- 提前研究指令 (RAD) 是通过记录未来的研究偏好来保护残疾人的自主权.
- 现有的文献经常支持RADs,但它们的有效性在复杂的伦理场景中受到争议.
研究的目的:
- 分析在AD临床研究中维护患者自主权所需的基本组成部分.
- 提出一个框架,将RAD与其他道德保障相结合.
- 确保涉及认知障碍患者的临床研究的伦理行为.
主要方法:
- 临床研究中的伦理原则的概念分析.
- 检查能力评估,代理决策和RADs的作用.
- 关于AD研究中的自主性和知情同意的生物伦理学术文献综述.
主要成果:
- 在AD研究中的患者自主性依赖于相互连接的元素的"三脚架":能力评估,代理决策和RAD本身.
- 能力评估决定了RADs的激活和撤销.
- 代理决策者对于解释患者的最佳利益和使用替代判断标准解决冲突至关重要.
结论:
- 研究预先指令本身对于认知障碍个体的伦理研究是不够的.
- 有效实施需要强有力的能力评估,以确定决策能力.
- 积极的代孕参与对于导航复杂的研究场景和调整过去的愿望与现在的福祉是不可或缺的,从而促进伦理研究.
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