MacKenzie C Ronald, de Melo-Martin Inmaculada
Department of Rheumatology and Medicine Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA,
Curr Rev Musculoskelet Med. 2015 Jun;8(2):128-33. doi: 10.1007/s12178-015-9271-1.
Chronic diseases compromise the life of the sufferer, encumber their families, and exert intractable burdens on the health-care system. With the aging of the population, such conditions have become the primary determinants of morbidity and mortality and the leading cause of disability in our society. Despite the serious challenges they impose, the ethical discourse engendered by them has lagged behind that of acute care medicine. Of particular relevance are the challenges to individual autonomy, as the dilemmas arising in the chronic care setting have not only medical but personal and societal dimensions, may require the input of multiple participants, and resolve over longer periods of time. As such, the conventional model of autonomy is often inadequate to address problems in the chronic care setting. This paper deals with this dilemma through an examination of a clinical scenario. A framework for the exploration of ethical problems in the chronic care setting is thus presented.
慢性病损害患者的生活，给其家庭带来负担，并给医疗保健系统造成棘手的难题。随着人口老龄化，这些疾病已成为发病率和死亡率的主要决定因素，也是我们社会中残疾的主要原因。尽管它们带来了严峻挑战，但由此引发的伦理讨论却落后于急性护理医学。尤其相关的是对个人自主权的挑战，因为慢性病护理环境中出现的困境不仅涉及医学层面，还包括个人和社会层面，可能需要多个参与者的投入，且需要更长时间才能解决。因此，传统的自主权模式往往不足以解决慢性病护理环境中的问题。本文通过审视一个临床案例来探讨这一困境。由此提出了一个在慢性病护理环境中探索伦理问题的框架。
