Patient Autonomy Versus Intervention: Geriatric Care Dilemmas.

IF 2.1 Q3 GERIATRICS & GERONTOLOGY Gerontology and Geriatric Medicine Pub Date : 2024-08-27 eCollection Date: 2024-01-01 DOI:10.1177/23337214241276796
Zhongxi Gao
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Abstract

Background: The ethical challenges faced by physicians when patients or their families refuse medical interventions are particularly complex in geriatric care. This manuscript explores the delicate balance between professional recommendations and patient autonomy, focusing on the nuanced decisions surrounding enteral nutrition in older patients. Methods: Two case studies are presented: a 99-year-old woman with a history of hypertension, diabetes, and coronary heart disease, and an 82-year-old man with Alzheimer's disease. Both cases involve the recommendation of a nasogastric tube for enteral nutrition, and the subsequent patient and family responses to this intervention. Results: In the first case, the patient and her family initially refused the tube due to personal beliefs and financial concerns, leading to a focus on psychological support and symptom management. The patient eventually agreed to the tube, but tragically passed away shortly after. In contrast, the second case resulted in the patient's family agreeing to the tube after a thorough discussion, leading to a successful recovery and the patient's ability to eat orally 6 months later. Conclusions: The cases underscore the importance of patient-centered care, clear communication, and empathy in geriatric medicine. They highlight the need for healthcare providers to respect patient autonomy, be aware of their own biases, and engage in open dialogue with patients and families. The manuscript advocates for a nuanced approach to medical ethics, where the patient's journey is guided with respect and care, honoring their wishes while striving for the best possible outcomes.

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病人自主与干预:老年护理困境。
背景:当患者或其家属拒绝接受医疗干预时,医生所面临的伦理挑战在老年病护理中尤为复杂。本手稿探讨了专业建议与患者自主权之间的微妙平衡,重点关注老年患者肠内营养方面的微妙决定。方法:本文介绍了两个病例研究:一个是 99 岁的妇女,有高血压、糖尿病和冠心病病史;另一个是 82 岁的男子,患有阿尔茨海默氏症。两个病例都涉及鼻胃管肠内营养的建议,以及随后病人和家属对这一干预措施的反应。结果:在第一个病例中,患者及其家人起初出于个人信仰和经济方面的考虑而拒绝插管,从而将重点放在了心理支持和症状控制上。患者最终同意插管,但不久后不幸去世。与此相反,第二个病例中,病人的家人经过充分讨论后同意插管,结果病人成功康复,并在 6 个月后能够口服进食。结论:这些病例强调了老年医学中以患者为中心的护理、清晰的沟通和同理心的重要性。它们强调了医疗服务提供者需要尊重患者的自主权,意识到自己的偏见,并与患者和家属进行坦诚的对话。该手稿提倡对医学伦理采取细致入微的态度,在尊重和关爱患者的过程中引导他们,尊重他们的意愿,同时尽可能争取最好的结果。
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来源期刊
Gerontology and Geriatric Medicine
Gerontology and Geriatric Medicine Medicine-Geriatrics and Gerontology
CiteScore
2.90
自引率
3.70%
发文量
119
审稿时长
12 weeks
期刊介绍: Gerontology and Geriatric Medicine (GGM) is an interdisciplinary, peer-reviewed open access journal where scholars from a variety of disciplines present their work focusing on the psychological, behavioral, social, and biological aspects of aging, and public health services and research related to aging. The journal addresses a wide variety of topics related to health services research in gerontology and geriatrics. GGM seeks to be one of the world’s premier Open Access outlets for gerontological academic research. As such, GGM does not limit content due to page budgets or thematic significance. Papers will be subjected to rigorous peer review but will be selected solely on the basis of whether the research is sound and deserves publication. By virtue of not restricting papers to a narrow discipline, GGM facilitates the discovery of the connections between papers.
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