Yang Y Tony, Kels Charles G
From the Department of Health Administration and Policy, George Mason University, Fairfax, VA (YTY); the Division of Legislative Counsel, American Medical Association, Washington, DC (CGK); and the Judge Advocate General's Corps, US Air Force Reserve, Washington (CGK).
J Am Board Fam Med. 2017 Mar-Apr;30(2):258-263. doi: 10.3122/jabfm.2017.02.160219.
Cognitive impairment afflicts an estimated 16 million people in the United States. Wandering is a concerning behavior associated with cognitive impairment, as it may threaten patient safety. The risks posed by wandering place severe burdens on both professional and informal caregivers, as well as law enforcement institutions throughout the United States. As such, location trackers that could reduce this burden have become increasingly prevalent. As with many assistive technologies, the substantial promise of location trackers is counterbalanced by potential pitfalls with respect to loss of privacy and autonomy. This article reviews the ethical issues raised by electronic monitoring of cognitively impaired persons, with the goal of transcending a narrow focus on decisional capacity in favor of a patient-centered framework that is applicable and adjustable at different stages of cognitive decline. Balancing the ethical principles of beneficence and respect in treating cognitively impaired persons goes beyond the necessary step of evaluating decision-making capacity to include partnering with families, caretakers, and cognitively impaired individuals who wander in a collaborative coalition of care. An approach emphasizing the individual needs of patients and caretakers is best suited to finding solutions that implement tracking technologies in ways that both protect and empower the cognitively impaired.
据估计，美国有1600万人患有认知障碍。徘徊是一种与认知障碍相关的令人担忧的行为，因为它可能威胁患者安全。徘徊带来的风险给美国各地的专业和非专业护理人员以及执法机构都带来了沉重负担。因此，能够减轻这种负担的定位追踪器越来越普遍。与许多辅助技术一样，定位追踪器的巨大前景被隐私和自主权丧失方面的潜在问题所抵消。本文回顾了对认知障碍者进行电子监测所引发的伦理问题，目的是超越对决策能力的狭隘关注，转而采用以患者为中心的框架，该框架在认知衰退的不同阶段都适用且可调整。在治疗认知障碍者时平衡行善和尊重的伦理原则，不仅需要评估决策能力这一必要步骤，还包括与家庭、护理人员以及徘徊的认知障碍个体合作，形成一个协作的护理联盟。强调患者和护理人员个体需求的方法最适合找到以既能保护又能增强认知障碍者能力的方式应用追踪技术的解决方案。
