Buhr Eike, Schweda Mark
Ethics in Medicine, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.
Front Psychiatry. 2025 Jan 13;15:1437813. doi: 10.3389/fpsyt.2024.1437813. eCollection 2024.
The concept of privacy marks an astonishing gap in the discussion about care for people with dementia (PwD). In general, questions of privacy play an important role and attract much attention in the ethics of nursing care. Yet, when it comes to dementia care, there is hardly any systematic ethical debate on the topic at all. It almost seems as though PwD lost any plausible interest in privacy and no longer had a private sphere that needed to be considered or protected. However, this not only contradicts widespread moral intuitions but also ignores the views and needs of those affected.
This conceptual analysis sets out to explore the value of privacy for PwD. We first outline the origins and dimensions of the concept of privacy itself and point out problems and limitations in the context of dementia. Especially the prevalent liberal conceptions' dependence on the idea of individual autonomy poses considerable challenges to an adequate understanding of the moral significance of privacy for PwD. Therefore, we subsequently examine alternative ways of conceptualizing the value of privacy in the context of dementia care.
We argue that autonomy-based concepts of privacy may still apply in the early stages of dementia. In the further course of the syndrome, however, the relevance of other normative aspects comes to the fore, especially respect for remaining personal preferences as well as objective criteria of dignity and well-being. Thus, we outline in a differentiated way how and to what extent privacy can be of normative importance even beyond the purview of autonomy and should consequently be considered in dementia care.
隐私概念在关于痴呆症患者护理的讨论中存在惊人的空白。总体而言,隐私问题在护理伦理中起着重要作用并备受关注。然而,在痴呆症护理方面,几乎没有关于该主题的系统性伦理辩论。几乎就好像痴呆症患者对隐私失去了任何合理的兴趣,不再有需要被考虑或保护的私人领域。然而,这不仅与广泛的道德直觉相矛盾,也忽视了患者的观点和需求。
本概念分析旨在探讨隐私对痴呆症患者的价值。我们首先概述隐私概念本身的起源和维度,并指出在痴呆症背景下的问题和局限性。特别是普遍的自由主义观念对个人自主性的依赖,对充分理解隐私对痴呆症患者的道德意义构成了相当大的挑战。因此,我们随后研究在痴呆症护理背景下将隐私价值概念化的替代方法。
我们认为基于自主性的隐私概念可能仍适用于痴呆症的早期阶段。然而,在该综合征的进一步发展过程中,其他规范性方面的相关性变得突出,特别是对患者剩余个人偏好的尊重以及尊严和福祉的客观标准。因此,我们以一种有区别的方式概述了即使超出自主性范围,隐私如何以及在多大程度上具有规范性重要性,因此在痴呆症护理中应予以考虑。