Dogan Vildan, Taneska Marija, Novotni Gabriela, Iloski Svetlana, Novotni Antoni, Dimitrova Vesna, Milutinović Miloš, Novotni Ljubisha, Weber Anne, Joksimoski Boban, Chorbev Ivan, Hasani Shpresa, Ivanovska Andrea, Grimmer Timo, Fischer Julia
Clinic for Psychiatry and Psychotherapy, Center for Cognitive Disorders, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia.
Front Psychiatry. 2024 Oct 1;15:1421582. doi: 10.3389/fpsyt.2024.1421582. eCollection 2024.
Existing literature on moral conflicts that healthcare professionals encounter in dementia care has explored, amongst others, issues related to autonomy, decision-making capacity, privacy, and more. Notably, conflicts related to healthcare professionals who support informal dementia caregiving and who are confronted with family members being overburdened with their care responsibly remains an underexplored topic in the current literature, particularly in the context of Low-and Middle-Income Countries. The present paper introduces such an encounter, presenting an ethical case analysis of a conflict that occurred during a larger research project conducted in North Macedonia.
Due to the absence of formal care services that could have relieved an overburdened family caregiver, healthcare professionals felt compelled to reach out to the uninvolved adult daughters, requesting them to participate in their parents' care. Wondering about whether their reaching out to the daughters might count as an attempt of pressure and undue interference, professionals conflicted over the appropriateness of their action. This paper follows up on their concern, ethically assessing the professionals' action. To answer the question on whether the healthcare professionals acted appropriately or not, and to what extent, theories of filial duties are applied, embedding their action in the larger context of dementia care in North Macedonia.
It is argued that the lack of formal care services in North Macedonia is of utmost relevance to the conflict. Thus, the conclusion is that the ethical inappropriateness of the case is to be located not so much with the action of the healthcare professionals but with the state because of its failure to provide professional care services that allow healthcare professionals to take ethically sound actions to counteract overarching burdens that family members face when providing informal dementia care.
关于医疗保健专业人员在痴呆症护理中遇到的道德冲突的现有文献，除其他外，探讨了与自主权、决策能力、隐私等相关的问题。值得注意的是，在当前文献中，与支持非正式痴呆症护理的医疗保健专业人员以及面临照顾责任过重的家庭成员相关的冲突仍是一个未充分探讨的话题，特别是在低收入和中等收入国家的背景下。本文介绍了这样一次遭遇，对在北马其顿进行的一个更大的研究项目中发生的冲突进行了伦理案例分析。
由于缺乏可以减轻负担过重的家庭照顾者压力的正规护理服务，医疗保健专业人员感到不得不联系未参与的成年女儿，请求她们参与对其父母的照顾。专业人员对他们联系女儿的行为是否可能被视为一种压力和不当干涉感到疑惑，对自己行为的适当性存在冲突。本文跟进了他们的担忧，从伦理角度评估了专业人员的行为。为了回答医疗保健专业人员的行为是否适当以及在何种程度上适当的问题，本文应用了孝道理论，将他们的行为置于北马其顿痴呆症护理的更大背景中。
有人认为，北马其顿缺乏正规护理服务与该冲突密切相关。因此，结论是，该案例在伦理上的不当之处与其说是在于医疗保健专业人员的行为，不如说是在于国家，因为国家未能提供专业护理服务，使得医疗保健专业人员无法采取符合伦理的合理行动来应对家庭成员在提供非正式痴呆症护理时面临的总体负担。
