چالش‌های اخلاقی مراقبت‌های پایان زندگی و بیماری در مراحل انتهایی؛ یک مطالعه‌ی مروری

نوع مقاله : مقاله مروری

نویسندگان

1 دانشجوی دکتری تخصصی، گروه حقوق، واحد اراک، دانشگاه آزاد اسلامی، اراک، ایران

2 متخصص پزشکی اجتماعی، مرکز تحقیقات پیش‌گیری سرطان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشیار، مرکز تحقیقات اخلاق و حقوق پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

چکیده

مقدمه: مراقبت‌های پایان زندگی (End of life یا EOL) و مراقبت بیماران مراحل انتهایی (End stage یا ED) به طور معمول در محیطی آکنده از انواع چالش‌های احساسی و اخلاقی ارایه می‌شود که شناخت آن‌ها، می‌تواند در بهبود کیفیت این خدمات مؤثر باشد.روش‌ها: در این مطالعه‌ی مروری روایتی، برخی از ابعاد مراقبت‌های پایان زندگی شامل تشخیص زمان مرگ یا تشخیص مرحله‌ی انتهایی بودن بیماری، اتونومی بیمار، استفاده از درمان‌های طولانی کننده‌ی حیات و مساعدت در مرگ بیماران با جستجوی هدفمند در 8 بانک اطلاعاتی و مرور 40 منبع از منظر اخلاقی مورد واکاوی قرار گرفت.یافته‌ها: در تشخیص نزدیکی زمان مرگ یا مرحله‌ی انتهایی بیماری، عدم قطعیت یک اصل است. اتونومی در پایان زندگی محدودیت دارد و سایر اصول اخلاقی مانند سودرسانی و عدالت، مهم‌تر از آن به نظر می‌رسد. شروع نکردن درمان‌های طولانی کننده‌ی ‌حیات، به خصوص در کشور ما پذیرش اخلاقی و دینی بیشتری از قطع آن دارد. شیوه‌ی برخورد با انواع مرگ مساعدت شده‌ی پزشکی در جوامع مختلف جهان، متفاوت است و جهت پذیرش یا نفی اخلاقی آن، توجیهات متنوعی ارایه شده است.نتیجه‌گیری: مسایل اخلاقی در EOL، ماهیت پیچیده‌ای دارد و با نگرش‌های فردی، عقاید مذهبی و شرایط اجتماعی فرد عجین شده است. ارتباط صحیح درمانگران با بیمار و بستگان او، مهم‌ترین عامل در پیش‌گیری و رفع چالش‌های EOL می‌باشد.

کلیدواژه‌ها

عنوان مقاله [English]

Ethical Aspects of End-of-Life Care and End-Stage Disease: A Review Article

نویسندگان [English]

  • Elaheh Moazam 1
  • Elham Moazam 2
  • Mahmoud Abassi 3
1 PhD Student, Department of Law, Arak Branch, Islamic Azad University, Arak, Iran
2 Community Medicine Specialist, Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Background: End of Life Care (EOL) and End-Stage Patients Care (ED) is usually presented in an environment full of a variety of emotional and moral challenges, the recognition of them can improve the quality of EOL services.Methods: In this narrative review, ethical aspects of EOL sucs as diagnosing the time of death or the final stage of the disease, patient's autonomy, the use of life sustaining treatments, and assisted dying were reviewed in 8 databases and 45 sources.Findings: Uncertainty is a principle in determining the proximity of the death or the final stage of a disease. In EOL, autonomy is limited, and some consider other moral principles, such as beneficence and justice, to be more important. Withholding of life sustaining treatments, especially in our country, is more moral and religious acceptance than withdrawing it. Approach medically assisted dying varies in different nations, and there are various moral justifications for accepting or denying it.Conclusion: Ethical issues in EOL are complex in nature, and are intertwined with individual attitudes, religious beliefs, and social conditions. Proper communication between the patient, family members, and clinicians is the most important factor in preventing and resolving EOL challenges.

کلیدواژه‌ها [English]

  • Terminal care
  • End of life care
  • Ethics

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مجله دانشکده پزشکی اصفهان
دوره 38، شماره 584 - شماره پیاپی 584
مرداد و شهریور 1399
صفحه 528-536

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سابقه مقاله

  • تاریخ دریافت: 28 فروردین 1399
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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