阿尔茨海默病诊断与治疗中的伦理问题。
Ethical issues in diagnosing and treating Alzheimer disease.
作者信息
Howe Edmund G
机构信息
Dr. Howe is the Professor of Psychiatry and Director, Programs in Ethics, at the Uniformed Services University of the Health Sciences, in Bethesda, Maryland.
出版信息
Psychiatry (Edgmont). 2006 May;3(5):43-53.
Many unique ethical issues arise when diagnosing and treating Alzheimer disease (AD). This article discusses several core ethical dilemmas that arise for psychiatrists during different stages of AD, focusing particularly on areas of consensus and controversy. Issues addressed include screening, genetic testing, and discussions of advance directives during early stages; telling soft and even outright lies during middle and late stages; and withholding life-preserving interventions during the last stage of AD when death is imminent. While there is overwhelming ethical consensus that psychiatrists should be fully honest and respect patient autonomy as much as possible during the early stages of disease, there is more controversy regarding the extent to which psychiatrists should do this during the later stages of disease. Possible, optimal approaches to resolving these ethical issues are presented.
在诊断和治疗阿尔茨海默病（AD）时会出现许多独特的伦理问题。本文讨论了精神科医生在AD不同阶段面临的几个核心伦理困境，特别关注共识和争议领域。涉及的问题包括疾病早期的筛查、基因检测以及生前预嘱的讨论；疾病中期和晚期的善意隐瞒甚至直接说谎；以及在AD晚期临近死亡时停止维持生命的干预措施。虽然在疾病早期精神科医生应尽可能完全诚实并尊重患者自主权这一点上存在压倒性的伦理共识，但在疾病后期精神科医生应在多大程度上做到这一点存在更多争议。本文还提出了解决这些伦理问题的可能的、最佳方法。
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