Rosin A J, van Dijk Y
Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
J Med Ethics. 2005 Jun;31(6):355-9. doi: 10.1136/jme.2004.008532.
Routine management of geriatric problems often raises ethical problems, particularly regarding autonomy of the old person. The carers or children may be unaware of the sensitivity of role reversal in dealing with the financial affairs; the need for a residential carer may compromise the old person's privacy. Attending a day centre confers much benefit, but one must understand the old person's resistance to change in the proposal of a new daily regimen. Similarly his or her autonomy must be the priority in planning for admittance to an old age home, and not the assumption that the family knows best. A common dilemma is the assessment of an old person's competency in decision making, either about management of his affairs, or regarding consent to treatment, or participation in research. Because cognitive capacity is not always identical with competency, meaningful tools have recently been developed in which the emphasis is on the specific situation to be investigated.
老年问题的常规管理常常引发伦理问题，尤其是在老年人的自主权方面。护理人员或子女可能没有意识到在处理财务事务时角色逆转的敏感性；对住家护理人员的需求可能会损害老年人的隐私。参加日间护理中心有诸多益处，但必须理解老年人对新日常安排提议的抵触情绪。同样，在规划入住养老院时，其自主权必须是首要考虑因素，而不是假定家庭最了解情况。一个常见的困境是评估老年人在决策方面的能力，无论是关于其事务的管理、治疗同意还是参与研究。由于认知能力并不总是等同于决策能力，最近已经开发出了有意义的工具，这些工具强调要针对具体情况进行调查。
