Glasser G, Zweibel N R, Cassel C K
Department of Medicine, University of Chicago, IL 60637.
J Am Geriatr Soc. 1988 Feb;36(2):150-6. doi: 10.1111/j.1532-5415.1988.tb01786.x.
As the complexity, prevalence and visibility of ethical dilemmas in medical care of the elderly have grown, hospitals and nursing homes have attempted to develop mechanisms for responding to these difficult ethical issues. While it is known that many hospitals rely on education and advice provided by an ethics committee, little data exist on the responses of nursing homes, despite the unique nature of ethical issues in a long-term care setting. The present paper reports findings from a national survey of administrators of 4504 nursing homes in which mechanisms for handling ethical dimensions in patient care were investigated. Results from 29% of respondents reveal that few nursing homes have established ethics committees (2% of the sample) and that committee formation appears positively associated with facility size and religious affiliation. Committees that have been formed engage in policy review (81%), advisory case review (67%) and education (45%). Few committees include patients or their representatives as members, and few have the authority to make binding decisions (26%). While the most effective response to ethical issues in medical decision-making is being debated, standing committees provide one means to contribute to the quality of decision-making by patients, their family members and their physicians. However, broader inclusion of patient perspectives and education of members regarding ethical analysis are necessary precursors to effective functioning of ethics committees in long-term care.
随着老年医疗护理中伦理困境的复杂性、普遍性和显著程度不断增加，医院和养老院已尝试建立应对这些棘手伦理问题的机制。尽管已知许多医院依赖伦理委员会提供的教育和建议，但关于养老院的应对情况，尽管长期护理环境中伦理问题具有独特性质，却几乎没有相关数据。本文报告了一项对4504家养老院管理人员进行的全国性调查结果，该调查对患者护理中处理伦理层面问题的机制进行了研究。29%的受访者结果显示，很少有养老院设立了伦理委员会（占样本的2%），且委员会的组建似乎与机构规模和宗教归属呈正相关。已组建的委员会开展政策审查（81%）、咨询案例审查（67%）和教育工作（45%）。很少有委员会将患者或其代表纳入成员，且很少有委员会有权做出具有约束力的决定（26%）。虽然对于医疗决策中伦理问题的最有效应对方式仍存在争议，但常设委员会是提高患者、其家属和医生决策质量的一种方式。然而，更广泛地纳入患者观点以及对成员进行伦理分析教育，是长期护理中伦理委员会有效运作的必要前提。
