Dorothy Guellec
The
ufulu wa wodwalayo kutsogolera chithandizo chamankhwala ndi zotsatira za thanzi lake, zodziwika
monga kudziyimira pawokha moleza mtima, komanso ufulu wa anthu kuti azilamulira ndikugawa
"zinthu zochepa", zomwe zimadziwika kuti chilungamo chogawa zidzatero
kugundana. M'dziko labwino, kapena m'magulu ogwirizana, anthu onse angathe
kukhala ndi mwayi wopeza chithandizo chamankhwala.
The
Dongosolo lazaumoyo ku US tsopano likuganizira zofunikira zamakampani
oyang'anira, ma sheya, ndi gulu loyika ndalama kuwonjezera pa
zofuna za wodwala. M'nkhani zapitazi ndatchula mwachidule za PSDA (Patient
Self Determination Act) ndi malangizo ena a Advance Care. Funso lenileni ndilakuti:
ndi zomanga ndipo ngati zili choncho kwa ndani? Mu March 1999 AMA's (American Medical
Association) Council on Ethical and Judicial Affairs inafalitsa pepala mu
kuyesa kuthetsa mikangano. Panali zinthu 5 koma 2 ndi 3 ndi maso
kutsegula. Iwo anati, “Odwala ndi obereketsa ayenera kudziwitsidwa zimenezo
madokotala alibe udindo wopereka chithandizo chachabechabe. Zachabechabe kapena zachipatala
chisamaliro chosayenera sichiyenera kuperekedwa 'mwachidziwitso' ndi chiyembekezo
kuti akanidwa.” Izi zikutanthauza kuti Advance Directives alibe malamulo
kukakamiza konse, ndipo odwala, mabanja ndi opereka chithandizo amakhala akutaya nthawi yawo
ndi kuchititsa chisoni m'maganizo osapindula chifukwa zokhumba zilibe mphamvu
malamulo.
In
m’mbuyomu, anthu amene ankapereka chithandizo chamankhwala ankaganiziridwa kuti amatsatira zimene amakhulupirira
m'gulu la maudindo a chikhalidwe ndi chikhalidwe omwe adatsogolera
nkhawa zachuma. Izi sizowonanso. Malinga ndi Hiller (1986), zisanu ndi chimodzi
mfundo zamakhalidwe abwino ndizoyenera kwa atsogoleri azaumoyo. Iwo ndi: ubwino,
kusachita zoipa, kulemekeza anthu, chilungamo, zothandiza komanso kunena zoona. Izi
zonse ndizongoyerekeza. M’dziko lenileni odwala ndi mabanja awo alibe
dziwani zomwe zimatsimikizira zotsatira. Kuonjezera zovuta za mapeto a moyo
Nkhani, olemba ena akulemba za bioethics apereka malingaliro ndikutsutsa mwamphamvu
kuti, ngati pali mwayi wochepa wochira, madokotala angakane
kupereka chithandizo chochirikiza moyo, ngakhale atapemphedwa ndi odwala kapena obereketsa. Chani
ndi wodwala kuchita? Yankho labwino ndilo kukhulupirira dokotala wanu. Kulibe
wachibale kapena woberekera atha kulembedwa kuti atsimikizire za wodwalayo
zofuna koma mavuto angabwere.
The
Dongosolo la America limadalira kwambiri mulingo wolowetsedwa woweruza. System,
yemwe ali ndi zaka pafupifupi 15, akufuna kudziwa munthu womutsatira kuti apange chisankho
zomwe wodwala akanapanga - kudziyika yekha mu nsapato za wodwalayo
anali. Imadalira ndikugwera pamalo omwe wolowa m'malo akudziwapo kanthu
zomwe wodwalayo amakonda. Maphunziro ambiri awonetsa kulephera kwa
achibale kapena anthu ena kulosera zofuna za odwala. Ngakhale odwala
okha amene amalizitsa malangizo pasadakhale akakhala athanzi, ndi otheka
asinthe malingaliro awo pambuyo pake, chifukwa cha zomwe Rebecca Dresser adatcha "the
Metaphysical Objection to Advance Directives." Iye akutsutsa kuti ndi
ndikofunikira kwa odwala omwe akukwaniritsa malangizo amtsogolo kuti amvetsetse
matenda omwe angadzakumane nawo pambuyo pake. Iye akuti, “Motero
kumvetsetsa ndikofunikira osati kutsimikizira kudziyimira pawokha kwa wosankha koma
kuonetsetsa kudziyimira pawokha kwa munthu wosachita chilichonse. Mwalamulo anthu awiriwa
ndi ofanana (mwachitsanzo onse a Michael Martin), koma ndi osiyana kwambiri 'okha'
(monga Michael Martin pamaso ndi Michael Martin pambuyo ngozi). Wopambana
kusiyana kwa zikhalidwe, malingaliro, ndi mikhalidwe yofananira yomwe anthu nthawi zambiri
amakumana pamene iwo sakwanitsa kupanga munthu pa nthawi ina
munthu wina.” M’mawu ena, munthu amene analemba patsogolo pake
malangizo ndi "munthu" wosiyana ndi munthu wosayenerera womangidwa naye
izo. Munthu amene akukumana ndi imfa si munthu yemweyo monga poyamba. Izi
chiphunzitsocho sichikugwirizana bwino ndi mmene malamulo a Azungu amachitira ndi anthu. Wovala
amatcha izi "zovuta paternalism." Ndipo amafunsa kuti, "amene amatsatira ndiye wabwino kwambiri
Zokonda zimatanthauzidwa ndi munthu yemweyo m'nthawi yakale, m'malo mwake
kuposa chipani china. Izi zikuyenera kukhala zokwanira kuchotsa zachikhalidwe ndi
kukhudzidwa kwalamulo kumadzetsa utate?” Anthu athanzi sangaganize zimenezo
mipando ya olumala okwera mtengo ndi zoyendera mpweya zinali zofunika, chifukwa ankaona
kuti moyo wolumala unali wotsika kwambiri ndipo sungakhale wochuluka
adakwezedwa. Komabe, n’zosadabwitsa kuti odwala akangoyamba kudwala amakhala kutali
nthawi zambiri amakonda kukhala ndi moyo wautali wolumala kuposa waufupi wopanda
izo. Anthu ambiri amene amatsatira malangizo a pasadakhale amapeputsa moyo wawo
ndi olumala chifukwa anthu amazolowera kulumala kwawo. Yeniyeni
vuto ndi loti anthu akupanga zisankho za tsogolo lawo
anthu am'tsogolo awo sakanafuna kupangidwa.
Recent
zosintha
izi
sabata lipoti lodabwitsa lidawonekera lotchedwa "Kulakwitsa ndi Munthu" Izi 200+
bukhu lamasamba limapereka njira zambiri zaboma, makampani, ogula,
ndi othandizira azaumoyo kuti achepetse zolakwika zachipatala, ndipo imayitanitsa Congress kuti
pangani dziko lachitetezo cha odwala kuti mupange zida zatsopano ndi machitidwe ofunikira
kuthana ndi mavuto osatha. Ndinalankhula ndi mmodzi mwa mamembala a komitiyi Dr.
Joseph Scherger, Wothandizira Dean for Clinical Affairs, University of California
ku Irvine College of Medicine. Anati, "Zipatala ndi malo oopsa komanso
odwala amafunika kuwalimbikitsa panjira iliyonse.” Izi zinandikhudza mtima kwambiri
kuloledwa. Kafukufuku wina wamkulu adapeza kuti zolakwika zachipatala zimapha anthu pafupifupi 44,000 a
chaka mzipatala. Wina amaika chiŵerengero chokwera kwambiri pa 98,000. Izi zikhoza kukhala
nsonga ya madzi oundana chifukwa cha zochitika zonse zomwe sizinafotokozedwe. Ngakhale
pogwiritsa ntchito chiŵerengero chochepa, anthu ambiri amafa ndi zolakwa zachipatala chaka chilichonse kuposa
chifukwa cha ngozi zapamsewu, khansa ya m’mawere, kapena AIDS. Odwala m'chipatala tsopano ali
mtundu wa edgy. Mitu yopangidwa ndi kafukufukuyu ikuwapangitsa kukhala ndi mantha. WHO
angawaimbe mlandu? Madokotala akuyesa kuimba mlandu anamwino omwe nawonso amatero
kuyesera kudzudzula ena, ndi kuzungulira ndi kuzungulira izo zimapita. Kutulutsa atolankhani kuchokera ku
National Academy of Sciences ndi Institute of Medicine omwe adafalitsa
lipoti likuti "Ziwopsezo zazikuluzikulu za zolakwika zachipatala - zomwe zimabweretsa
imfa, kulumala kosatha, ndi kuzunzika kosafunikira - ndizosavuta
zosavomerezeka m'zachipatala zomwe zimalonjeza choyamba 'kusavulaza.'
anakwanitsa
nkhani zapaintaneti
1)
Kodi mabizinesi azachipatala ayenera kugwiridwa ndi miyezo yaukadaulo? Izi ndi za
Dr.Koop Surgeon General adapuma pantchito ndipo Dr. Koop.com.
2)
Aetna atha kutengera chitsanzo cha United Health kuti apatse madokotala kunena zambiri pazamankhwala
(Wall St. Journal)
3)
Loya akufuna thandizo la anthu kuti athetse vutoli ndi HMO's (Wall St. Journal) High
loya wa mbiri Richard Scruggs wakhala akuyesera kukopa chidwi cholemba
Zochita zamakalasi zimatsutsana ndi ma HMO. Iye ndi loya pa mlandu wa fodya.
4)
Othandizira akuchoka ku Aetna, akuwonetsa kusakhutira. (Philadelphia Inquirer)
Zipatala ndi magulu a madokotala omwe amwazikana mdziko muno achoka
mamiliyoni a madola pazopeza odwala kuchokera ku Aetna US Healthcare motsatizana
za mikangano pakati pa anthu ndi inshuwaransi yoyang'anira.
5)
Kulimbikitsidwa ndi 'gulu,' othandizira kusiya chisamaliro choyang'aniridwa. Zaka zinayi zapitazo a
gulu la Connecticut psychotherapist lidasuntha mowopsa kwambiri pantchito zawo.
Analeka maubwenzi ndi makampani ambiri a inshuwaransi ndipo anapanga mgwirizano wa
odziyimira pawokha.
6)
Madyerero amachulukirachulukira pakubweza azaumoyo - Kuchepetsa kubweza kwa boma
akakamiza makampani angapo azachipatala kuti alowe mu bankirapuse chaka chino
7)
Pharmabid.com imagulitsa magazi, plasma, ndi zinthu zamankhwala pa Webusaiti (APW
Boston.com) Orange, Calif. Zipatala zomwe zimafuna madzi a m'magazi kapena ma syringe zili ndi zatsopano
gwero: kugulitsa pa intaneti komwe zinthu kuyambira katemera mpaka magulovu a rabara
amagulitsidwa kwa ogula kwambiri.
Chani
ndi "Hospital"?
A
hospitalst ndi dokotala yemwe amagwira ntchito zachipatala. Chatsopano
England Journal of Medicine mu 1996 idati izi zitha kupitilira
zifukwa zingapo. Choyamba, chifukwa cha "zovuta zamtengo wapatali, chisamaliro chosamalidwa
mabungwe azipereka mphotho kwa akatswiri omwe atha kupereka chisamaliro choyenera." In
Kutengera mtundu wa matendawo, ndikofunikira kuti dokotala adziwe kuchuluka kwa shuga m'magazi
kupereka chisamaliro gulu lalikulu la odwala ndi kupezeka mu ofesi kuona
iwo mwachangu ngati pakufunika. Palibe cholepheretsa chachikulu pakuchita bwino
chisamaliro chakunja kuposa kufunikira kopita kuchipatala kukawona zosayembekezereka
chiwerengero cha odwala. Mchitidwe wachipatala ukuwonekera kale pazophunzitsa zonse ziwiri
ndi zipatala zosaphunzitsa m'madera omwe chisamaliro choyendetsedwa chazika mizu- pafupifupi
kulikonse. Mantha oipitsitsa a Internists okhudza gulu lachipatala akuwoneka kuti ali
zikuchitika ku South Florida.
Malinga
kwa ACP-ASIM Observer May 1999 Mu February, Prudential HealthCare-South
Florida idauza madotolo ake 3,000 kuti iwafuna kuti asamuke
chisamaliro champhamvu cha odwala awo kwa azipatala. Kuyambira pa Marichi 15, 1999
azachipatala adayamba kusamalira mamembala a Prudential mzipatala zisanu ndi zinayi ndi khumi ndi awiri
sub-acute zipangizo. Pulogalamu ya Prudential ndi imodzi mwazambiri mdziko muno
kuyesetsa kwambiri kugwiritsa ntchito ovomerezeka ovomerezeka - zitha kukhudza 230,000
odwala m'dera limodzi. Zomwe zidachitika kwa dokotala wodwala
mgwirizano pakati pa kunenepa ndi kupsinjika? Madokotala ambiri anadabwa ndi za Prudential
nkhani yoti afunika kupereka chisamaliro cha odwala omwe ali m'chipatala.
"Tikuganiza kuti ndikusokonekera kwina kwa ubale wa odwala ndi dokotala komanso
kumalimbikitsa kudzipatula kwina kwa dokotala."
Apo
ndi zosintha zambiri, pafupifupi tsiku lililonse kotero kuti ndizovuta kupitilira, koma mwina ndife
kusamukira ku chitsanzo chabwino cha chisamaliro chaumoyo.