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关于无效性的道德直觉,作为心理健康护理目标评估的提示。

Moral Intuitions About Futility as Prompts for Evaluating Goals in Mental Health Care.

机构信息

Clinical ethicist in the Clinical Ethics Unit at the University Hospital Basel, the University Psychiatric Clinics Basel, the University Geriatric Medicine Felix Platter, and the University Children's Hospital Basel in Switzerland.

Head of the Clinical Ethics Unit at the University Hospital Basel, the University Psychiatric Clinics Basel, the University Geriatric Medicine Felix Platter, and the University Children's Hospital Basel in Switzerland.

出版信息

AMA J Ethics. 2023 Sep 1;25(9):E690-702. doi: 10.1001/amajethics.2023.690.

Abstract

Mental health professionals' moral intuitions about futility should prompt reevaluation of goals of care and care plans. Mostly, it will suffice to improve the care plan and/or slightly adjust the goal of care (eg, lower expectations), which is standard practice. Sometimes, however, all care plans that seek to reduce core symptoms (ie, that pursue a curative goal) are most likely futile and thus should not be imposed. Here, it may be in the patient's best interest to change the goal of care toward palliation (ie, harm reduction, relief of suffering, and best possible quality of life). Thus, futility can function as a moral counterweight to the duty to treat, helping mental health professionals find the right balance between over- and undertreatment.

摘要

心理健康专业人员对无效性的道德直觉应该促使重新评估护理目标和护理计划。通常,只需改进护理计划和/或稍微调整护理目标(例如,降低期望)即可,这是标准做法。但是,有时,所有旨在减轻核心症状(即追求治疗目标)的护理计划都可能无效,因此不应强加。在这种情况下,改变护理目标以达到缓解(即减少伤害、减轻痛苦和尽可能提高生活质量)可能符合患者的最佳利益。因此,无效性可以作为治疗义务的道德制衡,帮助心理健康专业人员在过度治疗和治疗不足之间找到适当的平衡。

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