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Moral dilemmas in (not) treating patients who feel they are a burden

机译：（不）治疗患者的道德困境

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Working as clinical ethicists in an academic hospital, we find that practitioners tend to take a principle-based approach to moral dilemmas when it comes to (not) treating patients who feel like a burden, in which respect for autonomy tends to trump other principles. We argue that this approach insufficiently deals with the moral doubts of professionals with regard to feeling that you are a burden as a motive to decline or withdraw from treatment. Neither does it take into adequately account the specific needs of the patient that might underlie their feeling of being a burden to others. We propose a care ethics approach as an alternative. It focuses on being attentive and responsive to the caring needs of those involved in the care process-which can be much more specific than either receiving or withdrawing from treatment. This approach considers these needs in the context of the patient's identity, biography and relationships, and regards autonomy as relational rather than as individual. We illustrate the difference between these two approaches by means of the case of Mrs K. Furthermore, we show that a care ethics approach is in line with interventions that are found to alleviate feeling a burden and maintain that facilitating moral case deliberation among practitioners can supports them in taking a care ethics approach to moral dilemmas in (not) treating patients who feel like a burden.
机译：作为一个学术医院的临床伦理学家，我们发现从业者倾向于采取基于原则的道德困境方法，当涉及（不）治疗感觉像一个负担的患者，在这方面倾向于胜过其他原则。我们认为，这种方法不充分地处理专业人士的道德怀疑，因为感受到您是拒绝或退出治疗的动机的负担。它也没有充分估计可能使他们对他人负担的感觉来患者的具体需求。我们提出了一种照顾道德方法作为替代方案。它侧重于关注和响应于参与护理过程的人的关怀需求 - 这可能比接受或退出治疗更具体。这种方法考虑了患者身份，传记和关系的背景下的这些需求，并将自主视为关系而不是个人。我们通过K的情况说明了这两种方法之间的差异。此外，我们表明护理道德方法与发现的干预措施符合措施，以减轻感受到负担并维持在从业者之间审议的促进道德案件可以支持他们在（不）治疗觉得造成负担的患者中对道德困境的照顾伦理方法。

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