Lucke K T
University of Pittsburgh, School of Nursing, and Associate, Center for Medical Ethics, PA, USA.
Nurs Clin North Am. 1998 Jun;33(2):253-64.
The establishment of special caring relationships between spinal cord injured individuals (SCI) and nurses or therapists during rehabilitation creates unique ethical dilemmas. This paper will explore the practical and ethical implications for health care professionals who feel a moral imperative, compelled by their special relationship with a particular SCI individual, to "break the rules" within a rehabilitation bureaucracy in order to provide individualized health care. From the staff perspective two issues will be examined: the status of special relationships in a health care organization and the ability to maintain one's personal and professional standards in a managed care environment. From the administrative perspective two ethical issues will be explored: the challenge of pursuing the good of the patient and the organization while navigating between the public and private spheres of health care in a health care system that values standardization.
脊髓损伤患者（SCI）与护士或治疗师在康复期间建立特殊的关怀关系会产生独特的伦理困境。本文将探讨对于那些出于道德义务，受其与特定脊髓损伤患者的特殊关系驱使，为提供个性化医疗保健而在康复官僚体系中“打破规则”的医疗保健专业人员而言，实际和伦理方面的影响。从工作人员的角度将审视两个问题：医疗保健组织中特殊关系的状况以及在管理式医疗环境中维持个人和专业标准的能力。从行政角度将探讨两个伦理问题：在一个重视标准化的医疗保健系统中，在医疗保健的公共和私人领域之间进行权衡时追求患者和组织利益的挑战。
