Liégeois A, Van Audenhove C
Faculty of Theology, Catholic University of Leuven, Belgium, Sint-Michielsstraat 6, B-3000 Leuven, Belgium.
J Med Ethics. 2005 Aug;31(8):452-6. doi: 10.1136/jme.2003.006999.
Ethical dilemmas in community mental health care is the focus of this article. The dilemmas are derived from a discussion of the results of a qualitative research project that took place in five countries of the European Union. The different stakeholders are confronted with the following dilemmas: community care versus hospital care (clients); a life with care versus a life without care (informal carers); stimulation of the client toward greater responsibility versus protection against such responsibility (professionals); budgetary control versus financial incentives (policy makers), and respect for the client versus particular private needs (neighbourhood residents). These dilemmas are interpreted against the background of a value based ethical model. This model offers an integral approach to the dilemmas and can be used to determine policy. The dilemmas are discussed here as the result of conflicting values-namely autonomy and privacy, support and safety, justice and participation, and trust and solidarity.
社区精神卫生保健中的伦理困境是本文的焦点。这些困境源自对一项在欧盟五个国家开展的定性研究项目结果的讨论。不同利益相关者面临以下困境：社区照料与医院照料（服务对象）；接受照料的生活与无照料的生活（非正式照料者）；促使服务对象承担更多责任与防止其承担此类责任（专业人员）；预算控制与经济激励（政策制定者）；以及尊重服务对象与满足特定个人需求（社区居民）。这些困境是在基于价值观的伦理模型背景下进行解读的。该模型为这些困境提供了一种综合方法，可用于制定政策。本文将这些困境作为相互冲突的价值观的结果进行讨论，即自主性与隐私、支持与安全、公正与参与、信任与团结。
