摘要
目的:从医学伦理学视角剖析癫痫疾病的医疗伦理问题及其对改善癫痫患者群体生活质量的影响。资料来源:应用计算机检索《中国医学伦理学》、《中国临床神经科学》、《中华医学杂志》、《中华神经医学杂志》、《中国神经精神疾病杂志》1989-01/2004-12期间的相关文章,检索词为“癫痫、医学伦理、社会歧视”,语言种类为汉语,选择了沈铭贤主编的《生命伦理学》,周正新主编的《癫痫的防与治》两部著作作为参考。资料选择:对所有资料进行初步筛选,选出从流行病学、社会学、伦理学三个角度进行研究的98篇文章。资料提炼:在98篇文章中排除重复或类似研究,提炼出10篇关于癫痫患者群体存在的问题及该病对其生活质量影响的文章和著作。10篇文章和著作涉及到了很多交叉学科,如生命伦理学、医学伦理学、社会伦理学,使本文能够站在更为广阔的视角对癫痫患者群体进行关注。资料综合:伦理是指人与人之间相互关系的基本道理和准则,本文探讨的伦理学指规范伦理学,伦理学的通用原则包括尊重原则、受益原则、均衡原则、公平原则。由于一些患者缺乏对癫痫疾病及正确治疗方法的了解,以及在医疗保健过程中受到的歧视,未治疗或非正规治疗的居多,因此医护人员要秉持对癫痫患者尊重的态度,所有的行为应当有利于当事人的福利。关于癫痫患者的治疗用药尤其是女性患者在妊娠初期服用抗癫痫药,婴儿畸形的发生率很高,有利原则应当体现在母亲身上还是孩子身上,目前的学术争论仍然较大,癫痫患者采用手术治疗的数量日益增加,而手术本身就是一种风险行为,如果没有良策可循,可供选择的方案都是有利有弊,医护人员只好两害相权取其轻,尽最大努力使患者承受最小的伤害并取得最大的效益。在癫痫患者意识模糊的状态之下可能出现攻击行为,将癫痫患者的活动范围有意识的控制起来是符合一般认同的伦理行为,反之如果将其封闭起来,即有违道德伦常,医疗效果也不会很好。癫痫患者的极端行为表现为自杀,其中失业者、未婚独居者、男性、及癫痫性精神病患者居多,失业及社会经济地位较低,得不到社区、家庭、朋友的理解关心是造成其轻生的直接原因。对于癫痫患者来说,将他们视为一个正常人就是最为合情合理的伦理原则。结论:癫痫群体是一个需要社会、家庭各方面关爱的弱势群体,适度把握伦理原则看待这一群体,是一种人文关怀的精神,也是帮助这一群体真正恢复健康,提高生活质量的有力保证。
OBJECTIVE：To analyze the medico-ethical problems of epilepsy from Medi-ethies and its effect on improving the quality of life of the persons with epilepsy. DATA SOURCES：Articles were colnputer-searched from Chinese Journal of Medico-ethics, Chinese Journal of Clinical Neurology, Chinese Medical Journal, Chinese Journal of NeuroMed, Chinese Journal of Nerval Mental Disorder from January 1989 to December 2004 with the key words of “epilepsy, medico-ethics and social discrimination”. And the language was restricted to Chinese. And we also selected two books, which were Bioethics written by Shen Ming-xian. and The Prevention and Therapy of Epilepsy written by Zhou Zheng-xin for reference. STUDY SELECTION： From all the preliminarily screened papers, 98 papers were obtained related to epidemiology, sociology and ethics. DATA EXTRACTION： Repeated and similar papers were excluded. 10 papers and books were selected from the 98 papers, which touched upon the problems of the epileptics and their life quality. The 10 papers have involved many cross discipline subjeets, such as Bioethics, Medico-ethics, and Socio-ethics, which provided more coneern about the epileptics from multiple directions. DATA SYNTHESIS： Ethics indicate the principles and guidelines for relationships between people. The ethics explored here refer to normative ethics. Generally, the basic ethical principles are： respect, beneficialness, balance and justice, Since some epileptic patients lack in the knowledge of epilepsy and proper treatment and suffer from discrimination in the health care, more untreated and non-proper treatment, doctors and nursing persons should take the attitude of being beneficial to the patients. Medication for the epileptics, especially the female patients at the first period of pregnancy, the incidence of the deformed children was high. Should the principle of beneficence be applied to mothers or children？ The number of the operative treatment was more and more in patients with epilepsy, while surgery itself is a risk behavior .If there is no better method to choose, and all the available choices have their advantage and disadvantages. Physicians can only choose tlle better one from the two kinds of harm, trying to make the patients suffer the least harm with the largest effect. Aggressive behaviors can be observed during seizure or unconsciousness state. Controlling the moving range of the patients with epilepsy consciously is in accord with the general ethical behavior, on the contrary, confinement disobeys the morals and the curative effect is not good. The extreme behavior of the patients with epilepsy is suicide and occurred more in unemployed, unmarried and living alone, male, and patients with mental disorders in epilepsy. The direct reasons of suieide are unemployment, low social status, and fittle understanding and care from their communities, families and friends. The sensible ethical principle for epileptics is to treat the patients as normal people in the society. CONCLUSION： Epileptic crowd need care from the society, family and other factors. Proper considering ethical principle in treating the population is the humane solicitude and to help the patients regain health and improve the life quality.
出处
《中国临床康复》
CSCD
北大核心
2005年第32期237-239,共3页
Chinese Journal of Clinical Rehabilitation
基金
国家社会科学基金(02BRK007)
北京大学"985"
"211"基金项目(20020903)~~
