Boddington Paula, Featherstone Katie
Bioethics. 2018 May;32(4):251-260. doi: 10.1111/bioe.12446.
Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of continence care for people living with dementia can be seen as the 'canary in the coal mine' for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio-economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in-depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity.
大小便失禁护理是护理过程中的一个关键环节，它能让我们了解急症医院病房中痴呆症患者的整体护理情况。目前，英国各地都在关注老年人的医院护理质量，但人们对他们在医院环境中受到的不当治疗、忽视、虐待和歧视仍感到担忧。因此，在医院里，痴呆症患者的护理既是一个福利问题，也是一个人权问题。对痴呆症患者进行大小便失禁护理的挑战可被视为急症环境中尊严丧失的“煤矿中的金丝雀”。本文借鉴了在英格兰和威尔士五家医院开展的一项人种志研究，这些医院的选择代表了一系列医院类型、地理位置和社会经济区域。在收治大量痴呆症患者的急症医院进行了为期154天的观察性实地调查。本文通过提供深入的人种志分析，探讨将患者视为人来对待的方式是如何被协商、实现或受到威胁的，从而开始填补理论与数据之间的空白。我们研究了痴呆症诊断和大小便失禁对患者自主性的双重冲击如何威胁到患者的人格。对这个患者群体的急性威胁可能会加剧将患者视为人来对待的风险。我们的研究结果表明，在这样的环境中，个人尊严以及道德人格的社会建构既受到威胁，也得到维护。我们展示了实证人种志数据如何为道德人格和尊严的理论阐释提供支持并增添细节。
