崎聤療護常見倫理議題 - vghtc.gov.tw

1 ( ) ( ) Peter A Singer 2003 P210 Peter A Singer 2003 P211 Ethical issues Ethical issuesEthical issuesEthical issuesEthical issuesbearing upon the rights or wrongsof human behaviour arise when the answers proposed to any given question are uncertain or conflicting. DJ Roy and N MacDonald.

2 Oxford Textbook of Palliative Medicine. Ethics - 1990 (Consequentialism) : An action is morally judged in terms of the consequences it brings about. : (Jermy Bentham, , 1748-1832) (Utilitarianism): (the happiness promoted) (the greatest happiness for the greatest number) (Deontology) / : (Immanuel Kant, , 1728-1804) (Categorical Imperative) / ( ) ( ) / (Guidelines)Search for Evidence.

3 Evidence-Based Medicine ( ) (PAS) 2008 (medical futility (medical uncertainty) (decision-making) (Advance Directives) (assessment of decision making capacity) 2008 Beauchamp and Childress (1983) Autonomy Non-maleficence (doing no harm) Beneficence (doing good) Justice = vs.)

4 / 1. The legal test 2. Gut-feeling test 3. The front-page test ( / )4. Role-Model test - 10 2008 IDP: Issue, DiscussionDiscussionDiscussionDiscussion , Plan Jonsen, Siegler,Winslade.

5 Clinical Ethics A Practical Approach to Ethical Decisions in Clinical Medicine. 5thed. New York, NY McGraw-Hill;2002. The Four Topics (four boxes) Medical indications Patient preferences Quality of life Contextual features The Four Topics (four boxes) Medical indications Patient preferences Quality of life Contextual features The Four Topics (four boxes) Medical indications Patient preferences Quality of life Contextual features The Four Topics (four boxes)

6 Medical indications Patient preferences Quality of life Contextual features In medical ethics Beneficence Nonmaleficence Jonsen, Siegler,Winslade. Clinical Ethics A PracticallApproach to Ethical Decisions in Clinical Medicine. 7thed.; ratio ratio the last analysis, (evaluate it in light of his or her own values)Jonsen, Siegler,Winslade. Clinical Ethics A PracticallApproach to Ethical Decisions in Clinical Medicine.

7 7thed.;2010 1 ? ? ? ? 2 3 4 5 Jonsen, Siegler, Winslade. Clinical Ethics A Practical Approach to Ethical Decisions in Clinical Medicine. 7thed. New York, NY McGraw-Hill 2006. ( ) (to the extent possible I a given clinical setting, set and reset goals realistically)Jonsen, Siegler,Winslade. Clinical Ethics A Practicall Approach to Ethical Decisions in Clinical Medicine.

8 7thed.;2010 Indicated or non-indicated indicatedJonsen, Siegler,Winslade. Clinical Ethics A PracticallApproach to Ethical Decisions in Clinical Medicine. 7thed.;2010 Indicated or non-indicated nonindicated :1. 2. Jonsen, Siegler,Winslade. Clinical Ethics A PracticallApproach to Ethical Decisions in Clinical Medicine. 7thed.;2010 Non-indicated 3.

9 4. indicated 44 15 MS 12 MS urosepsis

10 Indicated for (a dying patient) (terminally ill patient) (an incurable patient)The Dying Patient non-indicated. Dying (dis-integrating), actively dying or imminently dying in the advanced stage of MS Deep decubitus ulcers and osteomyelitis; ( ) ICU ICU sepsis in the advanced stage of MS increasingly stiff lungs, poor oxygenation.