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临终关怀中的讲真话及伦理考量:东方视角

Truth-telling, and ethical considerations in terminal care: an Eastern perspective.

作者信息

Ma Qing, Wu Yi, Fang Ronghua

机构信息

West China Hospital, Sichuan University.

出版信息

Nurs Ethics. 2025 May;32(3):971-979. doi: 10.1177/09697330241312376. Epub 2025 Jan 9.

Abstract

Truth-telling for terminally ill patients is a challenging ethical and social issue for Chinese health care professionals. However, despite the existence of ethical and moral standards for nurses, they frequently encounter moral dilemmas when making decisions about truth-telling to patients with end-stage diseases in China. This article aims to provide ethical strategies for clinical nurses in China regarding truth-telling decisions for terminally ill patients on the basis of their individual autonomy. This article first presents a common case scenario in China and then critically discusses ethical issues related to ethical principles and philosophical theories. The aim is to provide the much needed strategy for truth-telling for nurses who are terminally ill rather than to focus on attitudes toward disclosure. This article focuses on nursing morality, ethics, norms, and philosophy in health care and discusses countermeasures taken by nurses in truth-telling decision-making in combination with Chinese Confucian culture. The analysis identifies key ethical strategies tailored to Chinese nurses' practices, emphasizing individual autonomy, cultural sensitivity, and family dynamics in truth-telling decisions. The complexity of end-of-life illness requires Chinese nurses to strengthen the communication training needed to deliver bad news, as well as critical and autonomous thinking and good communication skills when implementing patient- and family-centered care, to achieve true delivery of bad news, thereby increasing patient autonomy and promoting more successful collaboration among patients, families, and providers. To improve the quality of care. Chinese nurses should integrate ethical principles with Confucian values to enhance patient-centered communication, respecting autonomy while adapting to cultural nuances in end-of-life care.

摘要

对中国医护人员来说,向绝症患者告知实情是一个具有挑战性的伦理和社会问题。然而,尽管存在针对护士的伦理和道德标准,但在中国,护士在决定是否向晚期疾病患者告知实情时,仍经常面临道德困境。本文旨在为中国临床护士提供关于基于绝症患者个人自主权进行告知实情决策的伦理策略。本文首先呈现一个中国常见的案例场景,然后批判性地讨论与伦理原则和哲学理论相关的伦理问题。目的是为绝症患者的护士提供急需的告知实情策略,而非专注于对披露的态度。本文关注医疗保健中的护理道德、伦理、规范和哲学,并结合中国儒家文化讨论护士在告知实情决策中采取的对策。分析确定了适合中国护士实践的关键伦理策略,强调在告知实情决策中的个人自主权、文化敏感性和家庭动态。临终疾病的复杂性要求中国护士加强传递坏消息所需的沟通培训,以及在实施以患者和家庭为中心的护理时具备批判性和自主性思维及良好的沟通技巧,以实现真正的坏消息传递,从而提高患者自主权,并促进患者、家庭和医护人员之间更成功的协作,提升护理质量。中国护士应将伦理原则与儒家价值观相结合,以加强以患者为中心的沟通,在尊重自主权的同时适应临终护理中的文化细微差别。

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