!""#
!"#$%&'()*+,-./0123 United Nations420015+6789#:!";<= 2050:>?@&'!"ABC 21% .DEFG# :!"H@I!"C 8.86% JK7L 2036 :#:! "?@ 21.68%4MNOJ 20005JPQR#!ST U-?VWX&'+YZ[\]. ^_FG#:!"AB+`aJ#!STbc de4dementia5+fghV`a.ijkl+3 mnJcdeoZpqrstu+vwJ07xi y3z{;|}n+#!~• 60€80%+!•cd eJ‚z{iƒ„+#!…• 10€20%+!•†‡ˆ‰Š‹+U-4Hillan, 1993; Ott, van Breteler, & Harskamp, 19955.‚3M+#!!"Œ•Žy3m •J•0‘x 65 ’“”#!••cdeCA–…
• 2%€4%45€8—!5J˜K™QRV^_#!
!"`a‚`a4š›œ•žVJ 1997 Ÿ ¡ ¢¡£¡¤J 2000 Ÿ Liu, Lin, & Chen, 19965J¥ ¦JQR#!ST+fg§¨V`a. iFGJDEcde#!+S©ª«¬-“z m«®ƒ„«¯°p±J‚|}«S©²••J• |}«+ST³´hiµ¶`an4Liu, et al., 19965.cde#!i·¸ST¹‘nJº»¼½ ¾STˆ«J¿À¨Á‰ÂCSTU-J±Ãi; •Ä+†‡¡ÅÆ¡ÇÈÉ)ÊË”ÌÊÍc+U -J®S©ÄΕÏÐÑÒÓÔÕ+Ö×Øsp 4Norberg & Athlin, 19895J¥¦JiST”ÙÚÛ
ÜÝÞ[YÃ.
ßcde#!Íc¿àáS©[âãÊË>J º•¿spVWXäå¡VæçèéJVêëìc íà±*J˜¨Áî¤Ò!Rïâã®ðñfgJ
Ethical Concerns for Elderly With
Dementia in Long-Term Care
C. J. Hsieh W. Y. Chang
òóôõö÷3šFG¬øTùøúûÀüöJýþFÿëø¬øTùø¹!"J3šFG¬ø#($ž øœ$žNã[%ùúûÀ&ö'úûž.
()*õö÷y3+,-./a0¬øTùsN&öJýþFÿëø¬øTùø¹1ù23.
$""%
Pž4+56ÎWX784Schultz, 20005.pgê #!+59J123; 2002 :#$s:3;ã< 4the International Strategy for Action on Ageing5n² =9‰ê 21 >?+!"#$J@ABa@“#! C!Cp±CSTJDE#!+F[GJZ#!p • H Ù [ • 5 6 + I J J “ / K ê : L + M Z 4United Nations, 20015.¥¦JYZcde•Ä+
!CJi·¸STNù+7´”%OßYÃ+.
&'()*+,-./
cde+ÂPÇý“¬Q+†‡ÌÊRSp ± J % T E « + U t . ± à  P Ç ý V W † ‡ 4cognition5¡sp4behavior5[XYZ[4mental status5\ˆ‰+S$JP]›^_+ÇÈà`+ ab.eZic¸+>dJÎo†p%e¾fÎ+ #$ývJ‚Îog<.•^_th+EiJi 4 €5:jkk9ýlÛ+†‡mnJ]›çùoÎ žpqr>sVom¼]aX.cdeKt†‡Ì Ê+Š‹uJt•Î•v-Àw+x†‡ÌÊ+e Z4noncognitive symptoms5Jbyz¡{|¡} ~¡•€•.yzn²“o‚{zƒÎbJP΄ Hv-sp”+äå[ST+U-J…m¼iS© ”Ú×܆ÏJ‡h%t•{E순ƒÎb+‰ ¥.•t•9ýcŠJ‹Jp:WXŒ•>J²ë ì S T ” Ù Û Ü Ú a † Ï t 4 Keating & Scarfe, 19985. i‰êcde•Ä>JŽ•%Ò+TöJ•? Vb½ï•Œ‘…’H“RK”cdt••–—˜ ™šìp:>+äåJ•…VOê›`at•+œ •Ö¡ž:ºŸ¡ ¡¡®o¢£+ÖWJÀ“ Haddad419995¤,“ƒ•+H“pšì‰²•p ¥ß.¦uJ¥nGØYGcde+t•)Χ• ¨©”+U-J˜iª¸+cde•ÄÚ‘ÊV« ¬©rØ-J+®¯J¦>S©Ä°b½ï±•’ !²+%³´©µ•—%’¿ÒuË+ˆ›@a´ ©•—%º%Ò•¶¦JNù+,-²V·ý9R 4Norberg & Athlin,19895.bî0౉²Jt• •C,â¸ÒÓ%¹E©J•icdet•²¥] ›É)®]›à±JŽ%•aº+É)J…»ýº2ù+¼½J‡êS©Ä‚¾J¿%O߆Ï+À ÁJ¥ÂÏítÑÃÄ%êt••,+—%VíÅ ÒÓ. Tolson, Smith Ø Knight419995²89c de#!VA¿ÒeÆ#!ià±*”ÇWX±È —ÉÈ”+Å . Hillan41993589iTùCm—·¸S©p ±+ëœnJÊËC%ê{Ì+¦eST”+, -JÍ•ÎtÏ+ÐÑ%Ò•Ó+JÔÁC+…’ ê#:+{Ìh%ŠÕ+JST+p:~•Ö%î 0|}M+ÎׂŸØJ‚••7´I!+fg. Œëœ‘ÊÙ;#Ú¡Ÿ&+7´J‚Û¸ÜÉ× ²Jb¦¿„H{ÌØÝÞ—ß¼à•ÏáâfÎ +\ãJäL„Håæ+ývlž.À“JSTÄ b½i‡çÏ+èéêëÜÚìB%QRÀÃíË +ˆî.
&'()*01-+,23
^_ïðST+ñò$؃Vó}+ôõJž 4öp+ÀÁHp÷øùø+,-.Nù@AêI Jà±C+5YJ•i·¸STn¿]›^&Õ ýJ¥zmTù¯°+êvúx^&%ûš+ ( full independent ) IJJÒÓ‘Ê%üý+JfOþ— ^&ÿ1+JPiNù+7´”BÚ!"ÖGJ“ ÐÑÃÄ%{Ì+fgs%ƒYÃ+4Waymack, 19985.eÆ‚¾JNùV#$I±Ã+%&‰ ²Jþ'bê÷ !autonomy" ౉²%àáײ ( self-rule ) —pà`(• IJèé+ÊËJ˜ºpÒ!ÀÅ —%Ò!ê# !,)À*x+s:J%±(I!•Ù++C,J hÙ%IJàáâ¸ÊË+5YJ®,a¿Êpà `ï9ƒ-.¸˜ºÅ à`+âã. Dowine 419895†pà±*úx/% “ • ” — “] ” +¸ 0JÙÍ12%33li9R+J‚#!²%4 T+cíJPà±%•5*¡‘õ+%&. Day, DroughtØ Davis419955+úû89Ù;6Tt• ౉²JfÃ7¿tÑØ,ašìx8+MôJ ßIJÊ9tÑO\:;>JsÊï9•2<+â¸[.=.‡è,a4informed consent5±Ã+Ì ’i;6TØDEI!+à±J>‘“…?@!A ®|}õÜÚaBCJ…•\+?@!AÚ•6 mJ…t!Ø?@!ACàÚaDþJh…ƒV¬ EêëìØúûÚa¢F.•¥cd#!¿à±Ê ËÍcJ¿âãØs:Î%GHTù!ARÿ1¿ Iâ¸Jb¦%¹JKt•à±+C,4Hillan, 19935J¦U-%LÜMN+. !privacy" Êˉ²%†pI!•C⸺,hG+N z¡èÖ—I!:;6Oº7Ò!‡÷JiëìP hQVWR=S+kš¡tTÅU¡tèVW•J KxÙ;@°”+fÃJ‘;xk¢«+ëìXY Z » J ¹ ² I p ë ì ! A B ê t • + Ê Ë 6 O 4Waymack, 19985.ÊËC+%&;#!ST+è é%¨ÁoYZ+J[\%êcde•Ä]¿Y ÃJ¥¦JqD^t•+_Ouh%5YIJ+Ç ý.¦uJ·¸ST>hV#têH“+Œ•Øê P`ab+c¸J“®>‘“ÔÁdRHpÒ,e +f§+â¸4Johson, 19995.Œ¦‰²%¼•º !J+g²J•ê#!+ST‚¾¿%±Ã+‰ ². !beneficence" ph‰²±(ptÒ!+,)Jij-çJ¦ ‰²ê#!¡mk¡?@¯°Ä=lmn¡ho— ê¿•,+øsJ“`Et•+pq®r•êt• +Å J•Ž†pê:·Ä%-+ÙsÒíïJt …%ÒÓºuºa—/+Ò•qvoW‡J¦ï› lÛ›Jwt5Y!+౉². Haddad419995 +_ph‰²ØxÅ ‰²Jx‘Ê;²In=l t•ƒ¬+-çJØx‘ʺíÅ ÒÓJÀ“@ AH“+çyx‘Êr••-J[\%êcde• Ä‚¾ÚÁÃzC[r•J“…¿p:ºVWXŒ •J˜‘áâ¿564Castle, Fogel, & Mor, 19975.
!non-maleficence" ºÅ ‰²%˜™êt•+ž4Ÿ&„HÅ J p h ‰ ² Ø º Å ‰ ² ) Î % , > ö i + 4Day et al., 19955Jb÷#!ºz{¯TùCmJ• Ù;ðñ¿S©”+fg‚¨Á{¯Jb¦‘ÊV ¥ëì$çybH“J‚„H#!õÜÚaüýØ {|./0y3XYëøV4American Psychiatric Association, APA589ßI}t?lžÅ!¡à Å—~•è€‚¿Òˆ›]•>J‘’6TH“ çyRK”4Joint Commission on Accreditation of Healthcare Organiza-tions, 19965.PH“¨Á%p t6Tt•®¿Ò!AŸ&J˜%šì*¡¨Á> s…’J‚xV‚t•C²!.,>J/0XY$ ž›isƒ²„…†‡lÛˆŠt•¡ˆ“¿‰J —Š‹¿s:àHJBHë"†p•¿¨Ã>Js ÊÕiJúB;tTŒl¿ˆ«¡ùH®•Ž>à 4FGMN•$žçJ 19935.•t%b¦J¥cd e#!ºÇ•‘›É)JbÿºoÅ JS©Ä Ø¿ß!%•ëì’Höi+Jî0ph¡ºÅ ‰²Js%“Y+cde#!STD”. !justices" #Ú‰²@A#÷[f•J‘–—ÈؘÈ+ ™‰RZ»J—Èš8º»I!¡¾›¡|}n+ #!—žt+›œ‚¾J˜È²%8•[¸ý§› œ+#!Jf“#Ú2ù+çq[GRêžJ/0 Ÿ® 420005+È¡JÃÈ#fJƒV¨Á¢Ë £¤¥¾±¡ÉÈ+º#ÚJ¦iq‰k§yuN 7J]¿êý§›œbcde#!Ú%Ã*‰ç ›Jëì=lÄB+_#Ú¡#f+ˆ«S©Ò Ó.iëìèénJSTÄΉÂXÃb½Èq# Úu+écJBbicde#!S©PhJ•Œ+ !Ë[>àêJb½#Ú+þ¨S©>àJ¿‰² p½•‡™‰À7•+%q?@+÷ø©þuJ% LÜáÓa“ªNJ˜S©Ä…‘lýJ«ŽÊ+ _7•t•+ÖWJ¬Ä²•ÇHÌÈHÀÃ^H +D”J˜ÊÔf+#Ú2ù4Day et al., 19955. !fidelity" -Õ%ê!+59•°J[^D•°+ÇýJ %![!CàÉ)ƒ•®+ÃgJbº“-OžJ ²]›O¯Dþ4Johson, 19995.;ëìabM+ À•!VW?@¡°?@¡S©Ä¡m¼¡ÝÞ
•J±¦o¸²;S©êv”ÃÊ-Õêž.êc de+S©«Žêt•—m¼Ñ³º^&4under-disclosure5—ºïѳ4nondisclosure5J‡ÖJw t-Õ+‰².êžcde#!º´³µ¶R·¸ ÒJ—%^¹+º¸J•ÂP”pt˜™ÒÓ»ž ¼GºŸJäLà½Jºît•Ñ³YetèJ¦ pqmn+º¸uJ%e¾ºJwph‰²ØºÅ +sp+e¾. !accountability" ¾©þ‰²i?@¿À%@AÃÊ’x8Á« Âà ( nondirective counseling )ØBC+ˆ«4delib-erative approach5Rs1¦mkHAÄ܃Å+: ;Jÿ1¿ïâ¸.[\%i·¸S©ëìƧ nJýÇ$ëì^h+µ¶liJž$ñò+l ÈJ…ž4:ŒÚaÈ·JêÉÊ+[Gh^Cô õJBb÷½¾èé+lžsËïÉÊJ[\%É Ê+lžúx%̶ÍΛJ˜ê;º,IJ²• ¼¬+ÏÐ[G[ÑL.ê;cdež4ª¸+# !JÚ%fÃ5YJVW‰êž4ÒÓ¸+5Y[ 56C[GJ=lÔ<*ÿ1eZ+(•JK”Õ Ö+lžØ(•J=llif΃V$\ã+| VJ=l•ÄiS©Øšì>(,F[+C,Ji S©p:Ph!•þ×Øâãx8ÊËJ˜ÄÜO \:ØJ!•àHÔÁ;mkÙéŸÎÉÊ+C, 4Johson, 19995.
4,*5&'(
)*06789:-;<
Waymack41998589ßIJ•†‡ÊËŠ‹ >J²mk)ÎÚÛ_YÃ+âã¿ÀJ…%mk ÜXèÜÝâ+Ë´J‡ØÞ*ëìST%•Â¬ Ï Ð + . Rhymes, McCullough, Luchi, Teasdale Ø Wilson420005=9¥m¼žpÙéØt•pƒO ßJ%ƒ‘ßâãÇù!.á3Ì›„$…†‡× ¸t•Ž¥WÅ—žt‚Á¢àá¡a⺕—X Yã|JºÊs…à±C>J•\¿ëìBH„\ Äbt!+¨ä¡›¸Çù!¡åT!—›¸æˆ •°abM+çßÇRès.ëT!Ap¦ét• isëìçù>JBvëÜ”'„\Ä+,aJs ‘isJ•ÞêKu.¥¦Jßt•Øm¼+¸ž º,—•ëì>JÙfEsÿAJ[\%ß•m¼ í¼F[cde•ÄS©+âã>J@Aîv7• t•+ï-%ƒYÃ+.•¦â¸B%ºWm¼º zð¾ñ—ºzðòóS©t•J‚•Àôõ+. i·¸ST”JTù!AÚÛ_¼YÃ+¿ÀJº •‘³%qt•Ç¾!uJ…%t•C,+6T ÄJPTù!AêI}•öþW‡+÷©J¦÷© VW÷t!ioW‡+PhnJTù!A•÷©í ø¸I}•ÊËís…,aCŸ—%it!I⸠+PhnJÊ9ØKùú—(•+ôõ¥û.b¦ sÊø6I}oW‡+C,®ÝâI}à±+⸠4Annette & Lueckenotte, 19965.•iÒ•spÊË +t•JitlE•spÊË>jKšüýÄJ— Ò•Kšüý+!“®žjÙQþ•spÊË+ !J²ùßHm¼ïÇù!Jÿt•ƒó,)+” gJÇpIâ¸.eƆpm¼BÊ!"t!+ƒ ó,)J••>hº#Î.PTù!Alým¼. =•ºß—•$’+%v>JB±:&'Ñâ( ›J“6Tt•+ƒó,).1,+,-=>
3;TùÿV; 1953 :“°#)Tù!AN ù×aJ*P-°+Û[ø†J; 2000 :=9ƒ Å+,+J-)89Tù!A•æ.Ù+©þ÷D Eïð¡K”Ut¡/‚ïð[r0Ö1.êTù !A‚¾J‡%&'e¢*+fgŸ…%TùC+ 2.TùS©êv%ºV¥:L¡3À¡D&¡) $¡cÊ—Ut¡*\¡34¡N5¡¾›—ƒV ›§‚•Àº,+4International Council of Nurses, 20015. 6‘+žrë쪫J%“žršì+ˆ«R çyUtJ?!ZpH]³ƒ7¡89¡:;82 ‚H+IJJÒÓ±¦<¯I’RÈXžr+JM ÚìJ;¦ª«Œh@AƒVØFù¥ûJ•±Ã Q%?];‰J+™‰JŽTù+Ù=p¦J²Á îÎ×Tù¡”g$+p:rh؉JTùp± >J•t•?I}+ÑL%Ãʆ‡XIJ+fgÏÐ*J˜¨Á=l2´+Tùp:JTùPh •IYÃ+µ*Jti;þ½+Tùx8E-% IJ+@7Øø†fgJsÊðñ¿ST+fg 4Hillan, 19935.• Robertson419965;#:XYñ tÏAA¿Nù‰²lýJê;t•Nù+ph‰ ²Øà±C+5YJëT!Aà•_º,+[GJ Tù!A;O,+Nù‰²>J•“yø+[2R 7´[@At•+à±CJ‚ë"²ß••“,) +BÁp±JPùø+ÑL[ST+Ù=%º#O ,+4Watson, 19935.Tù!A%·¸ST+± ËJiS©cd#!>VÇý9Õ°Nù”ÀÁ+ 7´JPTù!A%Nù+KBÄJ…%\]Ä. •¥cde#!¿†‡ÌÊ”•Š‹J˜žp”V 9ýî¤+spJÀ“]›ïoΞp+âã. Hasselkus419975²=9Œcde;oàST+C §>JDo؃VÙéOß+èéžpJ¿öiv -Nù”+U-JÀ“¨ÁN7÷qßVôõIJ sp>¿,aCp½•u.bDo+p:oäåJ ˜Nù+Î×”gWXEF>J¦ÇGjHPsp +cI ( cross the line )JBa“(•4JJ 20025. i 21 >?+KLJ‰ê3Mcde+#!! "³D`aJa”ëìñò+li…ÜNùU-õ ÜMRMÝÞJÀÃ\]+Nù™‰…NRNOJ À“iëìS©”+â¸PPÂÏI9o-+. =.•º»%zm«¡ƒ„«—|}«+STª «J–q#!XYTù+?@!AJp=QRS2 +Tù[Ù;ê!é+\T[5YJBí¼öÕà `+?@ÎâJâóUW2VØWXJˆÊ`@S T+"ÖGJ“…cde#!+NùSTײܓ YZ®¿ž456Ü“áT.
?.@A
MNO420005[#!p,NãÕix\[%]V W[Fÿ÷IÄ. —Vá419975[#!ST+ý][li[š›œ• žV±(J 1997 ^u3;#!STúZV¬V_`[F ÿ÷3maSb3;Û!c. FGMN•$žç419935[XY$ž›def[g hi÷IÄ. Ÿjk¡ ll420005[ëøNùøCù»[‰ ²[ëø2VJ 4415J 3 m 22 . Jyn420025[TùNù2V+MN[ÅFÿTù ¸oJ 4415J 1 m 8 . pq¡¢rÈ¡£st¡¤uv420005[FGc de+rstø[B’FùúûJ 7 J 157 m 169 .Annette, G., & Lueckenotte, M. S. (1996). Gerontological nursing. New York: Mosby.
Castle, D., Fogel, E., & Mor, A. (1997). Risk factors for physical restraint use in nursing home: Pre-and post-implementa-tion of the Nursing Home Reform Act. The Gerontologist, 37, 737 _ 747.
Day, L., Drought, T., & Davis, A. J. (1995). Principle-based ethics and nurses' attitudes towards artificial feeding. Journal of Advanced Nursing, 21(2), 295 _ 298.
Dowine, R. (1989). Paternalism and the rights of profes-sionals to interfere. In J. Tanya (Chair), Proceeding of age concern conference. Edinburgh.
Haddad, A. (1999). Ethics in action: An 85-year-old man with mild dementia often threatens the safety of other patients when he gets out of bed. RN, 62(5), 27 _ 30.
Hasselkus, B. R. (1997). Everyday ethics in dementia day care: Narratives of crossing the line. Gerontologist, 37(5), 640 _ 649.
Hillan, E. M. (1993). Nursing dementing elderly people: Ethical issues. Journal of Advanced Nursing, 18, 1889 _ 1894.
International Council of Nurses. (2001). The ICN code of ethics for nurses. Switzerland: Author.
Joint Commission on Accreditation of Healthcare Organiza-tions. (1996). Insert of standards for three accreditation manuals. Joint Commission Perspectives, 16(1), RS1 _ 8.
Johson, T. F. (1999). Handbook on ethical issues in aging. London: Greenwood Press.
Keating, D., & Scarfe, C. (1998). Creating a nursing devel-opment unit in a dementia care context. International Journal of Nursing Practices, 4, 120 _ 125.
Liu, C. K., Lin, R. T., & Chen, Y. F. (1996). Prevalence of dementia in an urban area in Taiwan. Journal of Formosa Medicine Association, 95, 762 _ 768.
Norberg, A., & Athlin, E. (1989). Eating problems in severely demented patients issues and ethical dilemmas. Nursing Clinics of North America, 24(3), 781 _ 789.
Ott, A., van Breteler, M. M., & Harskamp, F. (1995). Prevalence of Alzhemer's disease and vascular dementia: Association with education. The Rotterdam study. British Medical Journal, 15(310), 970 _ 973.
Rhymes, J. A., McCullough, L. B., Luchi, R. J., Teasdale, T. A., & Wilson, N. (2000). Withdrawing very low-burden inter-vention in chronically ill patients. Journal of American Medical Assoication, 283(8), 1061 _ 1063.
Robertson, D. W. (1996) Ethical theory, ethnography, and differences between doctors and nurses in approaches to patient care. Journal of Medical Ethics, 22(5), 292 _ 299.
Schultz, S. K. (2000). Dementia in the twenty-first century. The American Journal of Psychiarty, 157(5), 666 _ 668.
Tolson, D., Smith M., & Knight P. (1999). An investigation of the components of best nursing practice in the care of acutely ill hospitalized older patients with coincidental dementia: A multi-method design. Journal of Advanced Nursing, 30(5), 1127 _ 1136.
United Nations. (2001). The UN principle for older persons. United Nations Millennium Development Goals. Available http: //www.un.org/esa/socdev/ageing/waa/ISAA1E.htm
Watson, R. (1993). Measuring feeding difficulty in patients with dementia: Perspectives and problems. Journal of Advanced Nursing, 18, 25 _ 31.
Waymack, M. (1998). Old ethical frameworks: What works, what doesn't ? Generations, 22(3), 11 _ 14.
