发展终末期肾病护理的伦理框架:从实践到政策

IF 19.3 2区 医学 Q1 UROLOGY & NEPHROLOGY Kidney International Supplements Pub Date : 2020-03-01 DOI:10.1016/j.kisu.2019.11.003
Valerie A. Luyckx , Dominique E. Martin , Mohammed Rafique Moosa , Aminu K. Bello , Ezequiel Bellorin-Font , Tak Mao Chan , Rolando Claure-Del Granado , Walter Douthat , Somchai Eiam-Ong , Felicia U. Eke , Bak Leong Goh , Vivekanand Jha , Evie Kendal , Adrian Liew , Yewondwossen Tadesse Mengistu , Elmi Muller , Ikechi G. Okpechi , Eric Rondeau , Manisha Sahay , Michele Trask , Tushar Vachharajani
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引用次数: 10

摘要

临床医生和伦理学家正在越来越多地讨论与终末期肾病(ESKD)护理有关的伦理问题,但在政策层面或在卫生保健专业人员的教育和培训中仍然很少考虑到这些问题。在大多数低收入国家,透析等肾脏替代疗法的可及性并不普遍,这导致了公开或隐性的资源配给,并可能使那些无法维持自费支付的人被排除在护理之外。这些情况造成了国家内部和国家之间在获得ESKD护理方面的严重不平等,并给参与决策和提供护理的患者、家属和卫生保健工作者带来了情感和道德负担。在所有国家的ESKD护理背景下,临终决策也可能给决策者、专业人员、患者及其家属带来伦理困境。本综述概述了世界各地ESKD护理管理中出现的复杂挑战的几个伦理含义。我们认为,需要做更多的工作来发展ESKD护理的伦理,以便为决策提供伦理指导,并为专业人员提供教育和培训,以支持ESKD护理的伦理实践。我们简要回顾了实现这一目标可能需要的步骤,讨论了潜在的障碍和成功的策略。
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Developing the ethical framework of end-stage kidney disease care: from practice to policy

Ethical issues relating to end-stage kidney disease (ESKD) care are increasingly being discussed by clinicians and ethicists but are still infrequently considered at a policy level or in the education and training of health care professionals. In most lower-income countries, access to kidney replacement therapies such as dialysis is not universal, leading to overt or implicit rationing of resources and potential exclusion from care of those who are unable to sustain out-of-pocket payments. These circumstances create significant inequities in access to ESKD care within and between countries and impose emotional and moral burdens on patients, families, and health care workers involved in decision-making and provision of care. End-of-life decision-making in the context of ESKD care in all countries may also create ethical dilemmas for policy makers, professionals, patients, and their families. This review outlines several ethical implications of the complex challenges that arise in the management of ESKD care around the world. We argue that more work is required to develop the ethics of ESKD care, so as to provide ethical guidance in decision-making and education and training for professionals that will support ethical practice in delivery of ESKD care. We briefly review steps that may be required to accomplish this goal, discussing potential barriers and strategies for success.

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来源期刊
Kidney International Supplements
Kidney International Supplements UROLOGY & NEPHROLOGY-
CiteScore
11.80
自引率
0.00%
发文量
13
期刊介绍: Kidney International Supplements is published on behalf of the International Society of Nephrology (ISN) and comes complimentary as part of a subscription to Kidney International. Kidney International Supplements is a peer-reviewed journal whose focus is sponsored, topical content of interest to the nephrology community.
期刊最新文献
Editorial Board Table of Contents Variations in kidney care management and access: regional assessments of the 2023 International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) Update on variability in organization and structures of kidney care across world regions Capacity for the management of kidney failure in the International Society of Nephrology Newly Independent States and Russia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)
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