• 作者：A. Corvol ; F. Balard ; G. Moutel ; D. Somme
• 关键词：Refus de soins ; Gestion de cas ; Anthropologie ; Sujet â ; gé ; É ; thique ; É ; tude qualitative
• 刊名：La Revue de Medecine Interne
• 出版年：January, 2014
• 年：2014
• 卷：35
• 期：1
• 页码：16-20
• 全文大小：414 K

Purpose

Case management is a new professional field in France. It is addressed to elderly persons living in community whose situation is regarded as particularly complex. Case managers have to assess needs and coordinate necessary services. One common criteria of complexity is refusal of care. The objective of this study is to compare the words of users with those of case managers about refusal of care, in order to understand its meaning, professionals鈥?attitudes and ethical challenges.

Methods

Two researchers have cooperated on this qualitative research: the first one, anthropologist, interviewed 19聽individuals, and 11 of their caregivers. The second one, geriatrician and researcher in medical ethics, lead four focus groups gathering a total of 18聽case managers.

Results

Refusal of care often is the result of the will of preserving one's identity, compromised by illness. Individuals seek control on their life. Facing this behaviour, case managers try to secure the individual, by establishing a personal relationship that respects their choices, even if care has to be delayed. Refusal of care may sometimes disclose a desire to vanish, in front of which professionals meet their own limits.

Conclusion

To recognise an elderly person that refuses care as a unique individual who can make choices secure his identity, and allow him to change.