Fry S T
University of Maryland School of Nursing, Baltimore 21201.
Nutrition. 1990 Jul-Aug;6(4):329-32.
Although a number of ethical issues have been identified with TPN use, the most pressing issues are equitable access to the technology; potential injustices toward other members of society because of the cost of the technology; quality of life issues, including prolongation of life; and decision making for TPN use. Empirical data on the factors that influence access to the technology and on the current utilization of TPN in elderly populations are needed to assess the issue of equitable access to the technology. In addition, the effects of the technology's cost on access need to be evaluated carefully. The decision-making process in the use of TPN and the relation of quality-of-life judgments to such decisions need further study and evaluation. In addition, factors that influence the decision to withdraw TPN also need to be identified and studied. Adequate ethical assessment of any technology relies in part, on empirical studies in the field, the sophistication of the ethical literature, and the careful delineation of the conceptual and methodologic issues associated with a particular technology's use. To the extent that these aspects can be addressed in the use of TPN, there is reason to believe that an adequate ethical assessment of the technology will be made, but such an assessment is not yet available.
尽管在全胃肠外营养（TPN）的使用方面已发现一些伦理问题，但最紧迫的问题是该技术的公平可及性；因该技术成本而可能对社会其他成员造成的不公平；生活质量问题，包括生命延长；以及关于TPN使用的决策。需要有关影响该技术可及性的因素以及老年人群中TPN当前使用情况的实证数据，以评估该技术的公平可及性问题。此外，需要仔细评估该技术成本对可及性的影响。TPN使用中的决策过程以及生活质量判断与此类决策的关系需要进一步研究和评估。此外，还需要确定和研究影响停止使用TPN决策的因素。对任何技术进行充分的伦理评估部分依赖于该领域的实证研究、伦理文献的成熟度以及对与特定技术使用相关的概念和方法问题的仔细界定。就TPN的使用能够解决这些方面而言，有理由相信将对该技术进行充分的伦理评估，但目前尚未有这样的评估。
