Withholding life prolonging treatment, and self deception
Withholding life prolonging treatment, and self deception
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DOI：
10.1136/jme.28.6.347
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发表时间：
2002-12-01
影响因子：
4.1
通讯作者：
Perera, S
中科院分区：
文献类型：
--
作者：
Sayers, GM;Perera, S
目的：比较全科医生和老年医生对小插曲的反应做出的非治疗决策。以了解医生的决定是基于伦理理由还是法律理由。设计：定性研究，从当地从业者名单中随机抽取顾问老年医生和全科医生(GP)进行访谈。医生们被问及是否应该将五个小插曲中描述的患者送往医院接受进一步治疗，并给出支持理由。他们被问及他们将向谁咨询，他们认为谁应该做出这样的决定，以及亲属的偏好是否会影响他们的决定。主要措施：分析影响医生决定不让其他晚期患者住院进行延长生命治疗的因素。结果：17名全科医生和18名老年医生完成了访谈。所有的小插曲在两组之间的决策中产生了强烈的一致性。10%的医生会为患有严重脑损伤的患者提供延长生命的治疗。大多数人会接纳手术患者，而不考虑年龄或残疾。医疗原因在很大程度上被用来解释决策。亲属的意愿是有影响的，而资源考虑则没有影响。结论：几乎没有人试图将决策与伦理或法律概念联系起来，而且可能不承认或否认不承认的伦理后果。决策的过程可能涉及欺骗。这可能是有意识的，因为安乐死是非法的，或者是无意识的(自我欺骗)，因为根深蒂固的医学和社会不愿接受故意不延长生命的治疗可能等同于故意导致死亡。
Objectives: To compare non-treatment decision making by general practitioners and geriatricians in response to vignettes. To see whether the doctors' decisions were informed by ethical or legal reasoning.Design: Qualitative study in which consultant geriatricians and general practitioners (GPs) randomly selected from a list of local practitioners were interviewed. The doctors were asked whether patients described in five vignettes should be admitted to hospital for further care, and to give supporting reasons. They were asked with whom they would consult, who they believed ought to make such decisions, and whether the relatives' preferences would influence their decision making.Main measures: To analyse the factors influencing the doctors' decisions not to admit otherwise terminally ill patients to hospital for life prolonging treatment.Results: Seventeen GPs and 18 geriatricians completed the interview. All vignettes produced strong concordance in decision making between both groups. Ten per cent of the doctors would provide life prolonging treatment to patients with severe brain damage. Most would admit a surgical patient regardless of age or disability. Medical reasons were largely used to explain decision making. The wishes of relatives were influential and resource considerations were not. There was variability regarding decision making responsibility.Conclusions: Little attempt was made to link decision making with ethical or legal concepts and there may have been non-recognition, or denial, of the ethical consequences of failure to admit. The process of decision making may involve deception. This may be conscious, because of the illegality of euthanasia, or unconscious (self deception), because of deepseated medical and societal reluctance to accept that intentionally withholding life prolonging treatment may equate with intentionally causing death.