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富山医 科薬科 大 学看護学 会 誌 第² 号 ^{1 99 9}

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‑ C on si deration t hr o ugh a C a s e Stud_y ^‑

A i ko S A W A D A

Scho ol of N u r s l ng^, T oy a m a M edic al a nd P ha r m a c e utic al U niv e r si_{t y}

要 約

N u r s e s a r e s o m etim e s w o r ried abo ut ethic al d il^{e m m a s} in n u r s l ng ^{C a r e.} H o w e v e r,

u ntil n o w w e ha v e n ot d is c u s s ed m u ch s u ch a p^{r o}ble m in spite of its im p ^{o r}ta n c e.

T oday, n u r s e s in U ^.S ^. a r e inte r e sted in the c o n c ep t ^of ^"n u r s l ng ^adv o c a cy

"

･ It m e a n s adv o c a cy ^of p^atie nts

'b e st inte r e sts a nd ri_{g h t}s b_y n u r s e s

'd utie s. W hat kind of m ethod

c a n n u r s e s a s

"

p ^atie nt adv o c ate

"

ha v e in o rde r to s olv e ethic al dile m m a s in d iffic ult

c a s e s? T o s olv e thⁱs pr obl^{e m} , Tho m p^{s o n} J E a nd T ho m p ^{s o n} H 0 _pr e s e nt te n step ^s to bio etbic al de cisio n s. T he s e a r e : 1^. r e vie w the situ atio n 2 ^. _gathe r ad ditio n al info r^‑ m atio n 3 . i de ntif_y the ethic al is s u e s 4 . i de ntif_{y p} e r s o n al a nd p^{r o}fe s sio n al v alu e s

5 ^. id e ntif_{y t}he v alu e s of key indivi du als 6 . i de ntif_{y t}he v alu e c o nflicts 7 ^. dete r min e w ho sh o ul d de ci de 8 ^. i d e ntif_{y t}he r a n ge of a ctio n s a nd a ntici_pated o utc o m e s 9 .

d e ci de o n a c o u r s e of a ctio n a nd c a r ry it o ut 1 0^. e v alu ate th e r e s uls etc. In this a rticle, this p r o c e s s is e x plain ed c o n c r etel_{y t}hr o u gh a d e m e ntia ol d w o m a n

'

s c a s e in

Jap ^{a n ･} It is s u r e t h at a n i de al m eth od of c a r ry^{i n}g ^{O u}t ethic al n u r s i ng ^{C a r e S}ho uld be m ade b_y r e vie w l ng today ^s is s u e s of de cisio n m ak ing ^{l n} n u r S l ng ^{C a r e.}

I

E ey ^{w o r}ds

n u r s l ng ^adv o c a cy , ethic al dil^{e m m a s}in n u r s l n g ^{C a r e}, p ^atie nts

' be st inte r e sts_, b io eth ic al de cisio n m ak ing^, b io etb ic al _pr l n Ci_ple s

Intr odu etio n

N u r s e s s o m etim e s e xp^{e r}ie n c e et hic al di^‑ le m m a s in n u r s l ng ^{C a r e .} S mith a nd D a vis cla s sified th e s e d ile m m a s into fiv e c ateg ^{o ‑}

r l e S.

1)

1 ^. c o nflicts betw e e n tw o eth ic al p^{r l n C}iple s o n e hol d^s

2 ^. c o nflicts b etw e e n t w o p ^{o s s}i b^le a ctio n s

in wh ich th e r e a r e s o m e r e a s o n s fo r a nd ag^ain st the s a m e a ctio n s

3 . c o nflicts bet w e e n a d e m a n d fo r a ctio n s a nd the n e ed fo r tim e to r efle ct o n a situ atio n n ot p ^{r e v}io u sl_y e n c o u nte r ed 4 ^. c o nflicts betw e e n tw o eq ^{u a}ll_y u n s atis^‑

fa cto ry ^alte r n ativ e s

5 ^. c o nflicts betw e e n o n e

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s ethic al _p r l n Ci^‑ ple s a nd o n e

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s oblig^atio n s a s a n u r s e

The s e a r e a fe w e x a m ple s of the eth ic al dile m m a s fo r n u r s e s. T he fir st o n e is a n e x a m ple of c ateg ^{o r}y 1 ^. P atie nt A h a s a

br ain tu m o r a nd s o m etim e s lo s e s c o n s cio u s^‑

看護行為^にお け る ジ^レンマと倫理的意思 決定

n e s s. B e c a u s e of th is, he is fo r c ed to w e a r a r e str ain l ng b^{a n}d to p ^{r e v e n}t a fall fr o m

his b ed ^{. H} e d o e s n ot li ke it a nd a sk s the n u r s e s t o r e m o v e it. Alth o ugh t he n u r s e s w a nt to r ele a s e hi m fr o m t h e ba nd a s r eq ^{u e s}ted, they ^{c a n n o}t do it be c a u s e of diffic ul_{t y} of c o n sta ntl_y atte nding t o him .

T his is a dile m m a b et w e e n r e sp ^{e c}t fo r the

p ^{r l n C}i_ple of a uto n o m y ^{a n}d r e sp ^{e c}t fo r the

p ^{r l n C}i_ple of n o n m alefic e n c e^.

H e r e is a n oth e r e x a m ple. P atie nt B is in a te r min al stag^{e a n}d do e s n ot wish to r e ^‑ c eiv e a cti_{v e} th e r ap^{l e S} tO p^{r o}lo ng his life.

His d o cto r_, h o w e v e r, is try^{l n}g ha rd to p ^{r o ‑} lo ng h is p ^atie nt^'s li fe. T ho u gh n u r s e s d o n ot w a nt to g^{l V e} h im l nj^{e ctio n s of a ntic a n ‑}

c e r d r ug^{s o u}t of r e sp ^{e c}t fo r th e p ^atie nt^'s a uto n o m y, it is n ot p e r mitted fo r the m to op p ^{o s e} the ph_y s I Cia n

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s o rde r s. T hey ha v e a n obli_gatio n to be loy^al to th o s e o rde r s.

T his is a n e x a m ple of c ateg^{o r}y 5 ^.

W he n n u r s e s a r e p^ut in s u ch dile m m a s

,

h o w do they c op e with the m ? T his p r oble m

ha s n ot be e n adeq ^{u a}tel_y dis c u s s ed u ntil r e ^‑ c e ntl_y, in spite of its im p^{o r}ta n c e. In m o st

c a s e s, influ e ntial ind i^vi du als

' inte ntio n s,

wh ich m e a n s p h_y s I Cia n

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s int e nt io n s etc.,

ha v e be e n p ^ut into a ctio n a nd _p r oble m s

ha v e be e n left u n s ettled witho ut c o n si de r a ^‑

tio n fo r p ^atie nts

'inte ntio n s.

T _oday , the c o n c ep t of ^"n u r s l n g adv o c a cy

"

is attr a cting the atte ntio n of m a ny n u r s e s

in the U nited State s. T his c o n c ep t ^{m e a n s} the adv o c a cy ^of _p atie nts

' be st iⁿte r e sts a nd

rig h t^s by n u r s e s^. H e r eby n u r s e s c a n b e c all^‑

ed ^"_p atie nt adv o c ate s

"

a nd their m ain ethi^‑

c al r e sp ^{o n s}i b ili_{t y} lie s in a c c o m plishing th is r ole.

2) T h is c o n c ep t is n o w int_{r o}du c ed ⁱn the ethic al c ode fo r n l ユr S e S Of t he A m e ric a n

N u r s i n g A s s o ciatio n .

"

N u r s l n g adv o c a cy ^{l S}

岩i ⁼

a fu nda m e ntal id e a fo r s olving the ethic al dile m m a s in n u r s l ng C a r e . N u r s e s a s p^atie nt

adv o c ate s sh o ul d try to s olv e the p ^{r o}b le m s et h i_{c a}ll_y l n diffic ult c a s e s

, a nd in t he be st

inte r e sts of their p ^atie nts. If that is the c a s e, what k ind of _{m e}t h od s c a n they ^{u s e} to s olv e th e s e dile m m a s? T he s e p ^{r o}ble m s

will be c o n si de r ed in t h is a rticl_e.

A m ethod of bio eth ic al d e cisio n m ak in g to s olv e the d il^{e m m} a s in n u r s l ng ^{C a r e}

T o s olv e the p ^{r o}ble m s m e ntio n ed abo v e,

"

B io ethic al D e cisio n M ak ing fo r N u r s e s

' '

b_y T ho m p^{s o n} J E a nd Tb o m p^{s o n} H O will be helpful fo r n u r s e s. In t his b o ok _,the a u ^‑

tho r s p ^{r e s e n}t t^{e n s}tep^s to r e a ch bio ethic al de cisio n s.

3)

Step ^{o n e :} R e vie w the situ atio n

Step t ^{w o :} G at he r ad d itio n alinfo r m atio n

Step thr e e : Id ^{e nt}if_y the et hic al is s u e s

Step fo u r :Ide ntif_{y p} e r s o n al a nd _p r ofe s ^‑ sio n al v allユ e S

Step fiv e :I d e ntif_{y t}he v alu e s of key ind i^‑

vidu als

Step ^six :I de ntify the v alu e c o nflicts,if

a ny

Step ^{s e v e n :} D ete r min e w h o sh o ul d de ci de

Step ^ei_ght :Id e ntif_y th e r a ng ^{e o}f a ctio n s a nd a nticip ^ated o utc o m e s

Step ⁿin e : D e cid e o n a c o u r s e of a ctio n a nd c a r ry it o ut

Step t^{e n :}

‑

E v alu ate the r e s ults

ln th is a rticle, the w a y to r e a ch a bio ^‑ eth ic al de cisio n will be e xp】ain ed c o n c r etel_y b_y u s i ng ^{a C a s e O}f o n e old w o m a n s uffe ring fr o m de m e ntia in Jap ^{a n a s a n e x a m} ple.

Th is is a r e al c a s e in o n e of the fa cilitie s

fo r n u r s l ng ^Stud e nts

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p ^{r a c}tic e . H o w e v e r, the a utho r in this a rticle had n ot a dir e ct c o n ^‑ n e ctio n to it. In this c a s e_, a fe w fictio n s a r e als o in clud ed to g^{･u a r}d t he p r l V a Cy ^Of t he p ^atie nt a nd he r fa m il y^. At e a ch step ^, the a utho r s

' the o ry ^will be e xplain ed briefl_y fir st･ T he c a s e will be a n al_y z ed follo w l ng