Kane R A, Penrod J D, Kivnick H Q
J Case Manag. 1994 Spring;3(1):3-12.
As case management programs mature, ethical questions undoubtedly arise. Yet there are few, if any, standards by which case managers can guide their actions and decisions. In this article, the authors present the results of a survey of 251 frontline case managers in 10 states who were asked to describe the ethical challenges they face. The respondents were conscious of struggling with difficult, even life-and-death decisions involving important choices in their clients' lives. Generally, the case managers were committed to the ideology of respect for client autonomy but found themselves making uneasy compromises with the concept at every turn. Ethical issues arose not only with the client but also with the client's family, colleagues, and providers. Case managers, long-term care providers, and governmental policymakers could all benefit from both theoretical and practical explorations of desirable approaches to individual and societal long-term care decisions.
随着病例管理项目的成熟，伦理问题无疑会出现。然而，几乎没有（如果有的话）可供病例管理人员指导其行动和决策的标准。在本文中，作者展示了一项对10个州的251名一线病例管理人员的调查结果，这些人员被要求描述他们所面临的伦理挑战。受访者意识到自己在艰难的，甚至涉及客户生活中重要选择的生死决策中挣扎。总体而言，病例管理人员致力于尊重客户自主权的理念，但发现自己在每一个环节都与这一概念进行着令人不安的妥协。伦理问题不仅出现在与客户的关系中，也出现在与客户的家人、同事和供应商的关系中。病例管理人员、长期护理提供者和政府政策制定者都可以从对个人和社会长期护理决策的理想方法进行理论和实践探索中受益。
