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題名:說與不說--失智症病情告知的倫理兩難
書刊名:榮總護理
作者:吳淑敏許樹珍
作者(外文):Wu, Shu-minSheu, Shuh-jen
出版日期:2015
卷期:32:2
頁次:頁128-135
主題關鍵詞:失智症病情告知倫理兩難DementiaTruth-tellingEthical dilemma
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(0) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:0
  • 共同引用共同引用:28
  • 點閱點閱:2
病情告知是從事診斷與治療時重要的溝通過程,告知實情往往在尊重病人自主與不傷害兩倫理原則間權衡與取捨。失智症是一種慢性、漸進性認知功能退化症候群,目前尚無法有效地治療,伴隨情緒控制、語言技巧與社會行為之惡化,常使得失智症病情告知或不告知出現兩難的困境,時至今日仍然沒有標準的答案或做法。本文建議以倫理情境作為告知過程中的指南,臨床中藉由對話、溝通建立共識,透過醫療人員間共同討論失智症病情,且依照其個別性來做彈性判斷,以「人」為本,以家庭為整體,以病人為中心,繞著家屬角色、伴著倫理角色,進行情緒滴定的過程,並理解這些被時間困住的長輩們,學習如何跟他們溝通的方式,建立與失智患者的對話能力,進而做出「對」的決定。結論失智症的病情告知是一連串的溝通、關懷行動,融合成一種磋商、諮商、交流、討論等形式,過程中體現對於人的真誠關懷與照護內涵。
Truth-telling is crucial in patient diagnosis and treatment. Deciding whether to be truthful with patients regarding their dementia diagnoses requires balancing the patient's autonomy against health care professionals' obligation to avoid harm. Dementia is a chronic progressive cognitive degeneration syndrome, which causes mood instability as well as the deterioration of language and social skills. Currently, dementia cannot be effectively treated, contributing to the dilemma as to whether to be truthful with patients regarding their dilemma diagnoses. Medical professionals can take ethical considerations into account when deciding whether to truthfully report dementia diagnoses to patients. In addition, the judgment of health care professionals regarding truth-telling should be flexible and oriented toward the patients' families as well as patient-role-centered, familyrole- centered and ethical-role-centered, through the process of emotional titration. We must realize that dementia patients are trapped time, and learn to communication with them before making an appropriate truth-telling decision. In conclusion, truth-telling involves communication and caring for patients and should be considered carefully by health care professionals.
期刊論文
1.郭淑娥、唐秀治、高振益、唐婉如(2008)。探討影響醫師對乳癌病人病情告知之研究。安寧療護雜誌,13(3),265-281。new window  延伸查詢new window
2.許樹珍、林明慧、歐美、陳祖裕、黃淑鶴(2011)。醫病關係中的癌末真相告知--從權力倫理原則到臨床專精的展現。應用倫理評論,50,1-25。new window  延伸查詢new window
3.林冠宏(2006)。阿茲海默症。慈濟醫學,18(5),39-48。  延伸查詢new window
4.紀櫻珍、紀琍琍、吳振龍、黃松元(2006)。醫學倫理與醫病關係。北市醫學雜誌,3(12),1-11。  延伸查詢new window
5.許禮安(2003)。建構而成的病情世界。安寧療護雜誌,7(4),342-351。new window  延伸查詢new window
6.楊秀儀(20071000)。醫療人員所必備的倫理觀--倫理只是八股教條嗎?。澄清醫護管理雜誌,3(4),4-7。  延伸查詢new window
7.蔡甫昌(2002)。診療室中的道德議題之二病情告知的倫理。健康世界,323,103-107。  延伸查詢new window
8.劉秀枝(20080300)。告知與不告知--失智症的倫理議題。臺北市醫師公會會刊,52(3),13-16。  延伸查詢new window
9.Carpenter, B.、Dave, J.(2004)。Disclosing a dementia Diagnosis: A review of opinion and practice, and a proposed research agenda。The Gerontologist,44(2),149-158。  new window
10.Cornett, P. F.、Hall, J. R.(2008)。Issues in disclosing a diagnosis of dementia。Archives of Clinical Neuropsychology,23(3),251-256。  new window
11.Hertogh, C. M.、The, B. A.、Miesen, B. M.、Eefsting, J. A.(2004)。Truth telling and truthfulness in the care for patients with advanced dementia: An ethnographic study in Dutch nursing homes。Social Science & Medicine,59(8),1685-1693。  new window
12.Jotkowitz, A. B.、Clarfield, A. M.、Glick, S.(2005)。The care of patients with dementia: A modern Jewish ethical perspective。Journal of the American Geriatrics Society,53(5),881-884。  new window
13.Kaduszkiewicz, H.、Bachmann, C.、van den Bussche, H.(2008)。Telling "the truth" in dementia--do attitude and approach of general practitioners and specialists differ?。Patient Education and Counseling,70(2),220-226。  new window
14.Marzanski, M.(2000)。Would you like to know what is wrong with you? On telling the truth to patients with dementia。Journal of Medical Ethics,26(2),108-113。  new window
15.Meyers, B. S.(1997)。Telling patients they have Alzheimer's disease。British Medical Journal,314(7077),321-322。  new window
16.Pinner, G.、Bouman, W. P.(2003)。Attitudes of patients with mild dementia and their carers towards disclosure of the diagnosis。International Psychogeriatric,15(3),279-288。  new window
17.Raicher, I.、Shimizu, M. M.、Takahashi, D. Y.、Nitrini, R.、Carameli, P.(2008)。Alzheimer's disease diagnosis disclosure in Brazil: A survey of specialized physicians, current practice and attitudes。International Psychogeriatrics,20(3),471-481。  new window
18.Schermer, M.(2007)。Nothing but the truth? On truth and deception in dementia care。Bioethics,21(1),13-22。  new window
19.Turnbull, Q.、Wolf, A. M.、Holroyd, S.(2003)。Attitudes of elderly subjects toward "truth telling" for the diagnosis of Alzheimer's disease。Journal of Geriatric Psychiatry Neurology,16(2),90-93。  new window
20.Woods, B.、Pratt, R.(2005)。Awareness in dementia: ethical and legal issues in relation to people with dementia。Aging & Mental Health,9(5),423-429。  new window
21.劉雅文、莊秀美(20060600)。探討失能老人家庭選擇長期照護福利服務之決策過程--老人自主權之分析研究。東吳社會工作學報,14,91-123。new window  延伸查詢new window
學位論文
1.郭淑芬(2004)。從癌症病人及家屬觀點探討病情告知之經驗(碩士論文)。臺灣大學,台北。  延伸查詢new window
2.吳淑敏(2013)。失智症病情告知(碩士論文)。國立陽明大學,台北。  延伸查詢new window
其他
1.台灣失智症協會(2013)。認識失智症-失智症人口知多少,http://www.tada2002.org.tw/tada_know_02.html。  延伸查詢new window
2.內政部(2014)。103年第30週內政統計通報(103年6月底人口結分析),http://www.moi.gov.tw/stat/news_content.aspx?sn=8664。  延伸查詢new window
圖書論文
1.胡中宜(2008)。長期照顧的倫理與法律。長期照顧。台北:新文京。  延伸查詢new window
2.洪凌鈺、蔡甫昌(2007)。失能病患的醫療決定。臨床倫理病案討論。台北:橘井文化。  延伸查詢new window
3.許凰珠(2008)。倫理決策過程--以常見的倫理兩難議題為例。護理倫理概論。台北:教育部。  延伸查詢new window
4.謝博生(2003)。醫療的法律規範。醫療與社會--拓寬醫業執行的社會視野。台北:國立台灣大學醫學院。  延伸查詢new window
 
 
 
 
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