The increase in the incidence and prevalence rate of Chronic Kidney Disease poses challenges and ethical dilemmas that patients, family members and health professionals must face daily. The objective of this article is to present a reflection on the way in which patients make recourse to third parties as participants in their decision-making, which would require an approach based on solidarity autonomy. The analysis of twelve semi-structured interviews conducted with patients 60 years of age and older, from different programs of the Nephrology Unit of the Hospital Universitario San Ignacio in the period 20172018 Colombia, is presented. This article proposes the need for family-centered decision making of patients with chronic diseases, before their state is advanced and states of unconsciousness prevent their self-determination, considering the social determination of autonomy.

中文翻译：

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晚期慢性肾病的以家庭为中心的决策。从个人自治到家庭或社区自治

慢性肾病发病率和患病率的增加带来了患者、家庭成员和卫生专业人员每天必须面对的挑战和道德困境。本文的目的是对患者在决策过程中求助于第三方的方式进行反思，这需要一种基于团结自治的方法。介绍了对 2017-2018 年哥伦比亚圣伊格纳西奥大学医院肾病科不同项目的 60 岁及以上患者进行的十二次半结构化访谈的分析。本文提出慢性病患者需要以家庭为中心的决策，在他们的状态进展和无意识状态阻止他们的自决之前，