阿尔茨海默病后期患者照料及伦理学问题探讨  

Ethical Issues and Individual Care in Patients with Late Alzheimer's Disease

作　　者：曾令烽[1,2] 刘军[2] 潘建科[2] 李晓彦[2] 曹烨[3] 王璐[4] 曾星[2] 曹倩[2] 张茜[2] 王奇[1,2] 梁伟雄[2] 

机构地区：[1]广州中医药大学临床药理研究所,广州510405 [2]广州中医药大学第二附属医院(广东省中医院),广州510120 [3]中山大学附属肿瘤医院临床研究部国家药物临床试验机构,广州510060 [4]世界中医药学会联合会伦理审查委员会,北京100101

出　　处：《世界科学技术-中医药现代化》2016年第5期749-754,共6页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家自然科学基金委面上项目(81473698):浸润性T淋巴细胞表达IRF-7对骨性关节炎微环境的调控作用与补肾活血中药干预的研究;负责人:刘军;广州中医药大学校级创新工程/省级优博培育项目(广中医研〔2014〕55号):循证医学在Alzheimer病防治应用及伦理学问题研究;负责人:曾令烽;广东省财政厅项目([2014]157号):中老年退行性膝骨关节炎中医药防治管理体系;负责人:刘军;科学技术部国家科技重大专项(2012ZX09303009-003):中药新药临床评价技术平台研究;负责人:梁伟雄;国家教育部博士点基金项目(20124425110004):基于P38MAPK信号通路的间充质干细胞对骨关节炎免疫调剂机制及补肾活血中药干预研究;负责人:刘军

摘　　要：目的:阿尔茨海默病(AD)患者多伴随进展性认知功能下降,为此对诊疗自主决策能力不乏影响,在研究层面陆续引发不少伦理学问题。当前此类伦理研究主要侧重在参与临床前期预防性试验、及以缓解症状为主的临床治疗研究过程所涉及的问题。然而,绝大多数AD患者的大部分时间却用在后期照料等医疗语境之外的活动,故有必要对AD后期患者生活相处期相关伦理问题进行探讨。本文围绕上述核心问题在AD后期医疗照料伦理风险(如抗精神病药物使用、喂养方式选择等)、非医疗背景照料伦理风险、及公民其他基本权利保障等方面进行阐述,并就决策科学性与伦理合理性等层面进行分析,以期为AD后期个体照料及伦理实践提供参考。As their processive loss of cognitive abilities, most patients with Alzheimer’s disease（AD） suffer from problems in autonomous decision-making. Therefore, a series of ethics issues have emerged in AD’s research, focusing on preventive study in the preclinical stage and clinical trials of symptom alleviation. However, a majority of AD subjects largely spent their time in later care activities that beyond the medical context. Admittedly, ethical issues in the medical care of their daily lives of patients with late AD need to be discussed. In this review, controversial bioethical issues in ethics risks in late AD medical care（e.g. the use of antipsychotic drugs, selection of feeding approaches） and non-medical background care were elucidated over the priorities listed above, and so were the involved management of scientific decisions and rationality of ethics.We hope that these considerations will provide the bioethical understanding for the studies of late AD and scientific decisions in further ethical practice.

关 键 词：认知障碍 痴呆后期 个体照料 权利保护 伦理学问题 

分 类 号：R-052[医药卫生]