Withdrawal of ventilation at the patient's request in MND: a retrospective exploration of the ethical and legal issues that have arisen for doctors in the UK.
Withdrawal of ventilation at the patient's request in MND: a retrospective exploration of the ethical and legal issues that have arisen for doctors in the UK.
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DOI：
10.1136/bmjspcare-2014-000826
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发表时间：
2017-06
影响因子：
2.7
通讯作者：
Faull C
中科院分区：
文献类型：
--
作者：
Phelps K;Regen E;Oliver D;McDermott C;Faull C
通气支持的益处包括延长运动神经元疾病（MND）呼吸衰竭的生存期。在某些时候，一些患者可能希望停止干预。美国国家健康与护理卓越研究所（NICE）的指导建议，需要对通气撤回进行研究。很少有文献关注医生在应患者要求撤回通气时遇到的问题。与医生一起确定和探讨他们在MND患者要求下撤回通气时遇到的伦理和法律的问题。对24名医生（包括姑息治疗、呼吸、神经病学和全科医生）关于MND患者撤机支持经验的访谈进行回顾性主题分析。受访者发现，应MND患者的要求撤机对以下五个主题提出了法律的、伦理和道德挑战：退出治疗的伦理和法律的权利;与家人的讨论;与同事的讨论;法律的建议的经验;导致伦理复杂性的问题。虽然在理论上明确了撤回治疗的合法性，但实践中却导致了伦理和道德上的不确定性和复杂的感情。许多受访者经历了其他医疗保健专业人员的负面反应，当这些同事不清楚症状缓解，停止治疗和协助死亡之间的区别时。支持希望退出通气的MND患者的专业人员需要法律的、伦理的和实践的指导。需要对道德挑战进行公开讨论，并对专业人员进行教育和支持。
Ventilatory support has benefits including prolonging survival for respiratory failure in motor neurone disease (MND). At some point some patients may wish to stop the intervention. The National Institute of Health and Care Excellence (NICE) guidance recommends research is needed on ventilation withdrawal. There is little literature focusing on the issues doctors encounter when withdrawing ventilation at the request of a patient. To identify and explore with doctors the ethical and legal issues that they had encountered in the withdrawal of ventilation at the request of a patient with MND. A retrospective thematic analysis of interviews of 24 doctors (including palliative care, respiratory, neurology and general practice) regarding their experiences with withdrawal of ventilation support from patients with MND. Respondents found withdrawal of ventilation at the request of patients with MND to pose legal, ethical and moral challenges in five themes: ethical and legal rights to withdrawal from treatment; discussions with family; discussions with colleagues; experiences of legal advice; issues contributing to ethical complexity. Though clear about the legality of withdrawal of treatment in theory, the practice led to ethical and moral uncertainty and mixed feelings. Many respondents had experienced negative reactions from other healthcare professionals when these colleagues were unclear of the distinction between palliation of symptoms, withdrawal of treatment and assisted death. Legal, ethical and practical guidance is needed for professionals who support a patient with MND who wishes to withdraw from ventilation. Open discussion of the ethical challenges is needed as well as education and support for professionals.
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