老年慢性病患者的医务社会工作与伦理挑战

Medical Social Work and Ethical Challenges in Elderly Patients with Chronic Diseases

摘要: 疾病有急性疾病与慢性疾病之分，本文通过回顾医务社会工作在中国的发展历程、发展阶段以及医务社会工作者针对慢性病患者的两种不同介入倾向，阐述了医务社会工作在中国社会工作实践发展中的状况。此外，在关注医务社会工作发展的同时，也关注医务社会工作在针对老年慢性病患者的介入过程中可能遇到的伦理困境。文章以一个老年慢性病的个案为例，通过对该案例的分析，发现在慢性病患者的介入过程中，存在案主自决与最佳利益、社会工作者的职业倦怠与伦理责任、家庭关系与沟通、长期护理资源的分配与案主知情权的权衡等五个比较常见也较为容易产生伦理困境的问题。

Abstract: Diseases can be categorized into acute and chronic conditions. This paper examines the development trajectory and stages of medical social work in China, as well as the two distinct intervention tendencies adopted by medical social workers when working with chronic-disease patients, thereby illustrating the place of medical social work within the broader evolution of Chinese social-work practice. While tracing this development, the paper also highlights the ethical dilemmas that may arise when medical social work intervenes with elderly chronic-disease patients. Using a case involving an elderly chronic-disease patient, the analysis identifies five recurrent and particularly problematic areas of ethical tension: the conflict between client self-determination and best-interest considerations; social workers’ professional burnout versus their ethical responsibilities; family dynamics and communication barriers; and the balance between allocating long-term care resources and safeguarding the client’s right to informed consent.