2003-2004 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Chung, PM

Chung, YM

Leung, WK

Pang, MC

White, P

PolyU Institutional Repository

·??????·??????????????????????彭美慈 1 ,梁颖琴 1 ,钟佩雯1 ,白彼德 2 ,钟英明 3(香港理工大学 1.护理学院;2.眼科视光学及放射学系;3.应用生物及化学科技学系 ,香港)??:???????? ,???????????????????????。??????????????? ,??????????。???????????? ,?? “???? ”???????????? ,??? “???? ”??????????。 ??? “???? ”?????????????;??????? “???? ”,?????????????????????????????????。?? ,????????? ,????????????? 、? 、????????。?????????????? ,???????????。???:????;????;????;?????????:C931.2　　?????:C　　????:1671-315X(2004)08-0051-03Analysisofthemeaningofnegligenceofcareinthecontextofethicalresponsibilityandlegalliability/PANGMei-che1 , LEUNGWing-kam1 , CHUNGPui-man1 , PETERWhite2 , CHUNGYing-ming3 //JournalofNursingAdministration, -2004, 4(8):51.Abstract:Theprofessionalresponsibilitiesofhealthcareprovidersaremultifacetedandareshapedbyethicalresponsibilityandlegalliability.Infulfilingtheirprofessionalresponsibilities, healthcareprovidersareoftencaughtincompetingrolerequirementsinrelationtothepatients, theprofessionalbodiesandthepublicatlarge.Whilehealthcareprovidershavetopreparethemselvesforbearingprofessionalandlegalconsequenceswhentheycommitanyactsoromis-sionswhichmayconstitutenegligenceofcare, thephenomenonofdefensivehealthcarealsoemergesinday-to-dayhealthcarepractice.Thisuneasytensionactualyjeopardizesthefiduciaryrelationshipbetweentheprofessionalandthepublic.Thispaperatemptstoanalyzethemeaningofnegligenceofcarefrombothethicalandlegalperspectives.Bymeansofanillustrationofcaseexamplesonend-of-lifecareofpatientswithadvanceddementiaandcardio-pulmo-narydisease, theimplicationsofethicalandlegalresponsibilitiesfornegligentactsoromissionsarediscused, andthewaystohalttheviciouscycleofde-fensivehealthcarearesuggested.Tothisend, healthcareprovidersarerequiredtoacquirerelevantlegalandethicalknowledge, becompetentincriticalthinkingandmoralreasoning, andbepreparedtoprovideclinical, ethicalandlegaljustificationsfortheirhealthcareacts.Moreimportantly, theyneedtobeempathetic, articulateandrespectfulininteractingwithpatientsandtheirfamiliessoastoenhancetruthfulandtrustworthyrelationship.Author' saddress:1.SchoolofNursing;2.DepartmentofOptometry?Radiotherapy;3.DepartmentofAppliedBiology?ChemistryTechnology, theHongKongPolytechnicUniversity, HungHom, HongKong, ChinaKeywords:negligenceofcare;medicalincident;professionalethics;legalliability????:2004-05-17;????:2004-06-15????:???(1955-),? ,????? ,??? ,???? , ?????????????。　　??????????? “???????” (belea-gueredruler),??????????????? [ 1] 。 ????????? , ??????????????????。????????????????? , ??????????????????? , ??????????? ,????????????? 、????。 ?? , ??????????? , ???????????????????????? , ???????????????????????? , ???????????????????。??????????????? ,?????????。???????? , ????????? [ 2] 。??????????? , ????????????? , ???????? , ??????????。 “??”???? , ?????????????。???????? ,????????????????????。??????????????? , ???? “????”???????。?????????????? ,????????????????? [ 3] 。?? , ??????????????????? , ????????????????????;??????????。?????????????????? , ?? “????” 、???????? , ??????????????????? , ???? 、???????。????????????????? ,?? “????”???????????? ,??? “???? ”?????????。????????? “???? ”??????????????????????(G-YD44)。1　“????”????????????1.1　“????”????????????????????????????????????? [ 2, 4] 。????????? , ??????????????? “????”?????。??:???????????? , ????????????????????????。?????????????? , ??????????? , ????????? “????”???。?????????? “????”??? , ???????????·51·?????? 2004? 8?? 4?? 8??????????? ,??????????????。??????????????????? , ???????????????? , “????”????????? ,??????。?????????????? , ??????????????????? 、???????????????????????。1.2　“????”???“????”??????????????? , ???????????。??????? , ??????????????(tort)??? “??”(negligence)??? , ????????? 3?:①??(???)???(???)?????? (dutyofcare);②???????? (breachofduty);③??????????????????????? (directcauseofdamage/injury)[ 5]。?????????????? , ????????????????? , ? 2????? , ?? 3????????????????。 《????????》???????? , ???????? ,???????? ,???????:①???????? , ???????? 、?? 、?????;②???????????????????????????;③???????????;④????????????????????????? [ 6] 。?? , ?????????????????? , ??????????? , ????????。??????????? 3? ,?????????。????????????? , ????????? , ??????????????。1.3　??????? “????”????????????????? , (????????? , ??????? 、???? 、???? 、??????????),????????????????????? ,????????????????。?????? , ?? Ahronheim、Gasner? Volmann????????????? , ???????????? , ????????????????? [ 7～ 8] 。?? , Morris? Volicer?????????????????????。 ???????????????????? [ 9] 。????????????? ,????????????????????。????????????????? , ??????????? , ???????(??????)????????。???????? , ??????????????????????? ,???????????????????? , ?????????????????(advancedirective),?????。?????????? , ????????????? , ???????????????(healthcareproxy)[ 10] 。?? “?????”, ?????????????????????????????? , ???????????????? [ 10] 。??? , ?????????? , ??????????????????。??????????????? ,???????????????? , ???????? ,??????????????????? ,??????? , ?????????? , ???????????? [ 4, 11] 。????????????? ,?????????????????????????????????? , ??《????????》????? , ????? “????????”,???????????????? ,??????? “????”, ???????????? [ 6] 。?? , ??????? 、?????????????? “????”, ??? “???? ”??????? , ????????? 。2　“????” 、?????????2.1　????????????????????? ,???? 、?? 、??。????????? , ????????????? /??????????? , ????????? [ 12]。 ??????????? , ??????????? ,?????????。????????????????????????。???????? , ?????????? , ????? , ???????????? , ???? “??”?? , ??????????? 、?? 、?? 、???????。??????????? , ????? , ????????????????????????????。2.2　“????”?????2003? 8? , 1???????????????????? , ???????。????????????????? , ???????????。?????????????? “????”???????? , ????????????????? , ?????????。???????????????????????????。 ?????????? ,?????????????????????????? [ 13] 。?????????????。?????????? (PersonalDataPrivacyOrdinance), ????(???????)???????????????? , ???????????? [ 14] 。?? , ?????????????????? , ????? , ????????????????????? [ 13] 。???????????????????? ,????????????。2.3　???????????????????? ,???????????????????????? “??????”??? ,???? “????”??。?? ,??????????????? ,???????????。???? ,??????? , ????????????。????? “??”?? , ????“????????”????? , ??????????????。?? , ???????????。???????·52· ?????? 2004? 8?? 4?? 8?????????????? ,?????????。???????? , ?????? , ??????????? “????”??? ,????????????????????????。3　????????????????? , ????????????????? ,?????????????????????。??? “???? ”?????。 ??????? “????”,????????????????????????????????? , ????????。????????????? , ????? “????”??? , ??????????????? 、? 、???????。???????????? ,?????????。?????? , ???????????? 、??????????????。????:[ 1] 　MayWF.BeleagueredRulers:ThePublicObligationoftheProfes-sional[ M ]. Louisvile:Westminster John Knox Press,2001.27 ～ 52.[ 2] 　???, ???.????? [ M] .??:????? , 2000.66～ 101.[ 3] 　GlofecheskiR.TortLawinHongKong[ M] .HongKong:Sweet?MaxwelAsia, 2002.11 ～ 58.[ 4] 　??? ,???.????????????:?????????? [ J] .?? , 2002, (54):38 ～ 54.[ 5] 　???.? 、? 、? ,???????? [ M] .??:????????? , 2001.194 ～ 197.[ 6] 　???.???????????? [ M] .??:????? ,1998.47～ 113.[ 7] 　AhronheimJC, GasnerMR.Thesloganismofstarvation[ J] .TheLancet, 1990, (335):278 ～ 279.[ 8] 　VolmannJ.Rethinkingtheroleoftubefeedinginpatientswithadvanceddementia(correspondence)[J].NEnglJMed, 2000,(342):1755～ 1756.[ 9] 　MorrisJ, VolicerL.NutritionalmanagementofindividualswithAlzheimer' sdiseaseandotherprogressivedementias[ J] .NutrClinCare, 2001, 4(3):148～ 155.[ 10] 　VolicerL, HurleyA.HospiceCareforPatientswithAdvancedProgressiveDementia[ M] .NewYork:Springer, 1998.48 ～ 67.[ 11] 　?????.????????????? [ M].??:?????, 2002.19 ～ 20.[ 12] 　TheCharterofPublicAccountability[ EB/OL].htp://www.freedomtocare.org, 2004-06-10.[ 13] 　???.?????????? 4??? “?? ”???? [ N] .?? , 2004-04-18(A4).[ 14] 　PersonalPrivacyOrdinance.HongKongSARGovernment[EB/OL].htp//:www.justice.gov.hk/eng/doc/subindex.doc.2004-06-10.(????:张　岚)·?????·????????????????赵玉香(解放军总医院 南楼临床部 ,北京　100853)??:??????????????? ,???? 、????????? ,??????????? ,?????????;????????? ,?????? 、?????? ,??????????? ,???????????? ,??????????。??????????? 、???????????? ,???????。???:????;????;?????????:C931.2　　?????:B　　????:1671-315X(2004)08-0053-03Theexperienceoforganizingthenursingwardroundbythechiefnurse/ZHAOYu-xiang//JournalofNursingAdministration, -2004, 4(8):53.Abstract:Throughthenursingwardroundforthepatientswhosufersenilediseasebythechiefnurse, weidentifythenursingdiagnosisofthedificultandcomplicatedcasesandremedythedeficiencyinnursing, soastoprovideperfectnursingserviceforthepatients.Accordingtothecharacteristicsofthespecialnursingofgerontology, wearangedandorganizedtheteachingwardarounddesignedlyandevaluatethenursingwardroundinvariousforms, whichhasenhancedtheapplicationofnursingprocessandpromotedtheteachingandlearningapproach.Thispracticestrengthenednurses' comprehensiveabili-tyofobserving, analyzingandresolvingproblems, andimprovedthequalityofnursing.Author' saddress:ClinicalDepartmentofSouthBuilding, theGeneralHospitalofPLA, Beijing100853, ChinaKeywords:chiefnurse;nursingwardround;qualityofnursing????:2004-04-19;????:2004-06-14????:???(1946-),? , ??? ,???? ,???? , ?? ,???????????。·53·?????? 2004? 8?? 4?? 8?

Analysis of the meaning of negligence of care in the context of ethical responsibility and legal liability

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