Starzomski Rosalie
School of Nursing, University of British Columbia, Vancouver.
Can J Cardiol. 1995 Jan;11(Suppl. A):4A-7A.
The discussions around health and health care suggest that many of the diseases prevalent in our society today are a direct result of lifestyle choices made by citizens. As these discussions continue, there is mounting evidence relating personal habits and lifestyle to major causes of mortality and morbidity. This evidence, coupled with the technological advances in health care and the resource allocation issues around health care delivery, is leading to a plethora of ethical concerns, questions and challenges. There has been little movement in society to begin to address these issues, although there is growing recognition that to solve these dilemmas a collaborative partnership of providers and consumers is required. In this paper, selected ethical issues associated with lifestyle and behaviour change are explored, with emphasis on the dilemmas that may occur as a result of differences in values. Various conceptual approaches to the issue of 'voluntariness' and several models for examining whether or not health risks are voluntary will be reviewed briefly. The use of interdisciplinary ethical decision making, and ongoing consumer and health care provider collaboration and dialogue, are emphasized as a means of beginning to solve these dilemmas.
围绕健康与医疗保健展开的讨论表明，当今社会许多普遍存在的疾病是公民所做生活方式选择的直接结果。随着这些讨论的持续，越来越多的证据表明个人习惯和生活方式与主要的死亡和发病原因相关。这些证据，再加上医疗保健方面的技术进步以及医疗保健服务中的资源分配问题，引发了大量的伦理问题、疑问和挑战。尽管人们越来越认识到要解决这些困境需要提供者和消费者建立合作关系，但社会在着手解决这些问题方面进展甚微。本文探讨了与生活方式和行为改变相关的一些伦理问题，重点关注因价值观差异可能产生的困境。将简要回顾关于“自愿性”问题的各种概念方法以及几种用于审视健康风险是否为自愿的模型。强调采用跨学科的伦理决策以及持续的消费者与医疗保健提供者的合作与对话，以此作为开始解决这些困境的一种方式。
