Challenges in end-of-life care in the ICU - Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003
Challenges in end-of-life care in the ICU - Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003
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DOI：
10.1007/s00134-004-2241-5
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发表时间：
2004-05-01
影响因子：
38.9
通讯作者：
Thompson, BT
中科院分区：
文献类型：
--
作者：
Carlet, J;Thijs, LG;Thompson, BT
陪审团指出了 ICU 临终治疗的许多问题，包括实践的可变性、死亡预测模型不充分、对患者偏好的了解难以捉摸、工作人员和代理人之间的沟通不畅、医疗保健提供者培训不足或缺乏、使用不精确和不敏感的术语以及病历中的记录不完整。陪审团强烈建议进行研究以改善临终关怀。陪审团提倡护理人员团队和患者代理人采用“共享”的临终决策方法。应向家属传达对患者自主权的尊重以及尊重患者拒绝不需要的治疗的决定的意愿。这个过程就是一场谈判，结果将由参与者的个性和信仰决定。最终，作为医疗团队领导者的主治医生有责任决定计划行动的合理性。如果发生冲突，ICU 团队可能同意在预定时间内继续提供支持。大多数冲突都可以得到解决。然而，如果冲突持续存在，道德咨询可能会有所帮助。护士必须参与该过程。必须确保患者无痛苦地死亡。共识会议的陪审团赞同禁止实施专门用于加速死亡的治疗的道德和法律原则。必须给予患者充分的镇痛以减轻疼痛和痛苦；如果这种镇痛会加速死亡，那么这种“双重效应”不应偏离确保舒适的主要目标。
The jurors identified numerous problems with end of life in the ICU including variability in practice, inadequate predictive models for death, elusive knowledge of patient preferences, poor communication between staff and surrogates, insufficient or absent training of health-care providers, the use of imprecise and insensitive terminology, and incomplete documentation in the medical records. The jury strongly recommends that research be conducted to improve end-of-life care. The jury advocates a "shared" approach to end-of-life decision-making involving the caregiver team and patient surrogates. Respect for patient autonomy and the intention to honour decisions to decline unwanted treatments should be conveyed to the family. The process is one of negotiation, and the outcome will be determined by the personalities and beliefs of the participants. Ultimately, it is the attending physician's responsibility, as leader of the health-care team, to decide on the reasonableness of the planned action. In the event of conflict, the ICU team may agree to continue support for a predetermined time. Most conflicts can be resolved. If the conflict persists, however, an ethics consultation may be helpful. Nurses must be involved in the process. The patient must be assured of a pain-free death. The jury of the Consensus Conference subscribes to the moral and legal principles that prohibit administering treatments specifically designed to hasten death. The patient must be given sufficient analgesia to alleviate pain and distress; if such analgesia hastens death, this "double effect" should not detract from the primary aim to ensure comfort.