Castor T D, Meier D E, Levy R N
Department of Geriatrics, Mount Sinai Medical Center, New York, NY, USA.
Clin Orthop Relat Res. 1995 Jul(316):93-8.
Ethical aspects of care of the geriatric orthopaedic patient include respecting patient self-determination as the primary standard of decision making; using advance directives or appropriate surrogate decision makers when patient decisional capacity is lost; and balancing the benefits and burdens of any intervention and its alternatives in arriving at a treatment decision. With an increase in managed care plans, questions of justice in care of the elderly will be raised. Physicians face fiscal incentives that encourage fewer surgical procedures and lower levels of health care particularly in the elderly, a group that notably has benefited from the functional enhancement permitted by modern orthopaedic techniques. Professional vigilance is required of physicians to ensure that appropriate health care services continue to be available to patients.
将尊重患者的自主决定权作为决策的首要标准；当患者丧失决策能力时，使用预先指示或合适的替代决策者；在做出治疗决策时，权衡任何干预措施及其替代方案的利弊。随着管理式医疗计划的增加，老年护理中的公平问题将会出现。医生面临着经济激励，这种激励鼓励减少手术操作和降低医疗保健水平，尤其是在老年人中，而老年人明显受益于现代骨科技术所带来的功能增强。医生需要保持职业警惕，以确保患者能够继续获得适当的医疗保健服务。
