Osman H, Perlin T M
Social Work Department, Tampa General Hospital, FL 33601.
Health Soc Work. 1994 Nov;19(4):245-52. doi: 10.1093/hsw/19.4.245.
Ethical dilemmas are inherent in health care decision making. The Patient Self-Determination Act of 1990 provides health care facilities with guidelines to address patients' advance directives. Family members who are charged with the responsibility to implement their loved ones' wishes often feel emotional conflicts because of the many difficulties that arise from making life and death decisions for another person. The PRACTICE model discussed in this article allows health care practitioners to think about ethical issues in a structured and systematic way. Social workers have a vital role to play in facilitating the implementation of patients' advance directives by working with the patient in creating clear and accurate directives, by supporting the family in allowing these directives to be carried out, and by working with the treatment team to resolve ethical dilemmas.
伦理困境在医疗保健决策中是固有的。1990年的《患者自我决定法案》为医疗保健机构提供了处理患者预先指示的指导方针。负责执行亲人意愿的家庭成员常常会感到情感冲突，因为为他人做出生死抉择会引发诸多困难。本文所讨论的PRACTICE模型使医疗保健从业者能够以结构化、系统化的方式思考伦理问题。社会工作者在促进患者预先指示的实施方面发挥着至关重要的作用，他们要与患者合作制定清晰准确的指示，支持家属执行这些指示，并与治疗团队合作解决伦理困境。
