Department of Internal Medicine, Erasmus MC University Medical Center, PO box 2040 3000 CA, Rotterdam, the Netherlands.
Department of Medical Ethics and Philosophy of Medicine, Erasmus MC University Medical Center, PO box 2040 3000 CA, Rotterdam, the Netherlands.
Arch Gerontol Geriatr. 2020 Sep-Oct;90:104160. doi: 10.1016/j.archger.2020.104160. Epub 2020 Jun 23.
With an ageing population physicians are more and more faced with complex medical and moral situations. Medical professional guidelines are often of limited use in these cases. To assist the decision making process, several ethical frameworks have been proposed. Ethical frameworks are analytical tools that are designed to assist physicians and other involved healthcare workers in complex moral decision-making situations. Most frameworks are step-by-step plans that can be followed chronologically during moral case deliberations. Some of these step-by-step plans provide specific moral guidance as to what would constitute a morally acceptable conclusion, while others do not.
In this narrative review we will present and discuss the ethical frameworks used for medically complex situations in older people that have been proposed in literature.
Three electronic databases (embase.com. Medline Ovid and PsychINFO Ovid) were searched from inception to January 24, 2020, with the help of expert librarians.
Twenty-three studies were included in the review, containing seventeen different frameworks. Twenty studies described step-by-step-frameworks, with the number of steps varying from three to twelve. In four studies suggestions were made as how to balance conflicting moral values.
Ethical frameworks are meant to assist healthcare professionals who are faced with morally complex decisions in older patients. In our view, these frameworks should contain a step-by-step plan, moral values and an approach to balancing moral values.
随着人口老龄化，医生越来越多地面临复杂的医疗和道德问题。在这些情况下，医学专业指南往往用处有限。为了协助决策过程，已经提出了几种伦理框架。伦理框架是分析工具，旨在协助医生和其他相关医疗保健工作者在复杂的道德决策情况下做出决策。大多数框架是按时间顺序遵循的逐步计划。这些逐步计划中的一些为构成可接受的道德结论提供了具体的道德指导，而另一些则没有。
在这篇叙述性评论中，我们将介绍和讨论文献中提出的用于老年人复杂医疗情况的伦理框架。
在专家图书馆员的帮助下，从创建到 2020 年 1 月 24 日，我们在三个电子数据库（embase.com、Medline Ovid 和 PsychINFO Ovid）中进行了搜索。
该综述共纳入 23 项研究，包含 17 种不同的框架。20 项研究描述了逐步框架，步骤数从 3 到 12 不等。在 4 项研究中，提出了如何平衡相互冲突的道德价值观的建议。
伦理框架旨在协助面临老年患者复杂道德决策的医疗保健专业人员。在我们看来，这些框架应该包含一个逐步计划、道德价值观以及平衡道德价值观的方法。
