McGrath P
University of Queensland, Australia.
Cancer Nurs. 1995 Apr;18(2):97-103.
This article is written in response to anecdotal evidence from patients, reports from nurses, sociological studies, and documentation from oncologists, which all suggest that the process of refusing treatment for chemotherapy is not an easy one. There is substantial evidence to suggest that pressures that are counterproductive to informed consent are having an impact on the decision making of vulnerable individuals coping with the stress of terminal illness through cancer. Informed consent is a basic ethical principle underpinning any medical or nursing intervention (Johnstone M. Bioethics: a nursing perspective. Sydney: Harcourt Brace Jovanovich, 1989). The following focus on informed consent is an attempt to begin to address the present hiatus which exists in the health literature on ethical issues surrounding the modality, chemotherapy (Young D. An ethical approach to chemotherapy in private practice. J Natl Cancer Inst 1992;84:810). Recent research suggests that the holistic orientation of nurses, in comparison to the reductionist stance of physicians, allows them to be emotionally close to their patients and hence, more aware of the difficulties individuals experience in coping with stressful regimens (Uden G, Norberg A, Lindseth A, Marhaug V. Ethical reasoning in nurses' and physicians' stories about care episodes. J Adv Nurs 1992;17:1028-34). Consequently, it is anticipated that ethical issues in relation to chemotherapy, a modality that has been described as distressing and capable of seriously compromising quality of life (Burish T, Tope D. Psychological techniques for controlling the adverse side effects of cancer chemotherapy: findings from a decade of research. J Pain Sympt Man 1992;7:287-301), will have an impact on the working life of many oncology nurses.
本文是对来自患者的轶事证据、护士的报告、社会学研究以及肿瘤学家的记录所做出的回应，所有这些都表明拒绝化疗治疗的过程并非易事。有大量证据表明，那些不利于知情同意的压力正在影响弱势群体的决策，这些人正通过癌症应对绝症带来的压力。知情同意是任何医疗或护理干预的一项基本伦理原则（约翰斯通·M.《生物伦理学：护理视角》。悉尼：哈考特·布雷斯·约万诺维奇出版社，1989年）。以下对知情同意的关注旨在尝试解决目前健康文献中关于化疗这种治疗方式所涉及伦理问题的空白（杨·D.《私人执业中化疗的伦理方法》。《美国国家癌症研究所杂志》1992年；84:810）。最近的研究表明，与医生的还原论立场相比，护士的整体取向使他们能够在情感上与患者亲近，因此，更能意识到个体在应对压力治疗方案时所经历的困难（乌登·G、诺伯格·A、林德塞思·A、马尔豪格·V.《护士和医生关于护理事件的故事中的伦理推理》。《高级护理杂志》1992年；17:1028 - 34）。因此，可以预期，与化疗相关的伦理问题——化疗这种治疗方式被描述为令人痛苦且能够严重损害生活质量（伯里什·T、托普·D.《控制癌症化疗不良副作用的心理技术：十年研究结果》。《疼痛症状管理杂志》1992年；7:287 - 301）——将对许多肿瘤护士的工作生活产生影响。
