Lowey Susan E
Susan E. Lowey, PhD, RN, CHPN, CNE, FPCN , is associate professor and advisement coordinator, Department of Nursing, SUNY College at Brockport, New York.
J Hosp Palliat Nurs. 2021 Jun 1;23(3):200-206. doi: 10.1097/NJH.0000000000000737.
Decisions surrounding withholding and withdrawing medical interventions are common within the palliative and hospice care community. The unexpected effects of the recent pandemic ignited conversations about scarcity of resources and withholding medical interventions, based on age, among providers with limited expertise in palliative care. Using a case study and literature review, the aim of this article was to examine the best ethical considerations for resource allocation decision making that minimizes the effects of ageism. Public health ethics differs from clinical ethics by giving priority to promoting the greatest good over the protection of individual autonomy. This divide in ethics sheds light on the dangers associated with ageism. Age is often a component within clinical instruments that guide clinicians with allocation decisions. Basing decisions solely on age without evaluating health and functional status is dangerous and further propagates the discriminatory practices that fuel ageism. Previous research identified using ethical principles to guide resource allocation decisions but that may not be enough to protect the rights of older adults. A new model to guide these decisions should include advance directives and goals of care, medical indicators instead of demographics, functionality, transparent medical team, and impact of social determinants of health.
在姑息治疗和临终关怀社区中，围绕停止和撤销医疗干预措施的决策很常见。近期疫情的意外影响引发了关于资源稀缺以及在姑息治疗专业知识有限的医护人员中基于年龄停止医疗干预措施的讨论。本文通过案例研究和文献综述，旨在探讨资源分配决策中最佳的伦理考量，以尽量减少年龄歧视的影响。公共卫生伦理与临床伦理不同，它优先考虑促进最大利益而非保护个人自主权。这种伦理分歧揭示了与年龄歧视相关的危险。年龄常常是指导临床医生进行分配决策的临床工具中的一个因素。仅基于年龄而不评估健康和功能状况做出决策是危险的，并且会进一步助长导致年龄歧视的歧视性做法。先前的研究提出使用伦理原则来指导资源分配决策，但这可能不足以保护老年人的权利。指导这些决策的新模式应包括预先指示和护理目标、医疗指标而非人口统计学特征、功能状况、透明的医疗团队以及健康的社会决定因素的影响。
