Clinical Report-Forgoing Medically Provided Nutrition and Hydration in Children
Clinical Report-Forgoing Medically Provided Nutrition and Hydration in Children
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DOI：
10.1542/peds.2009-1299
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发表时间：
2009-08-01
期刊：
影响因子：
8
通讯作者：
Botkin, Jeffrey R.
中科院分区：
文献类型：
--
作者：
Diekema, Douglas S.;Botkin, Jeffrey R.
人们普遍认为，当有能力的患者提出要求时，或者在患者没有决策能力的情况下，当干预措施不再给患者带来好处或与干预措施相关的负担超过所获得的好处时，扣留或撤回医疗干预措施在道义上是允许的。在成人和儿童的临终护理中，撤回或暂缓尝试复苏、使用呼吸机和重症监护药物等措施是很常见的。就成人而言，法律和伦理界已达成共识，液体和营养的医疗管理与使用呼吸机等其他医疗干预措施并无根本区别；因此，当有能力的成年人或合法授权的代理人请求撤回或当干预措施不再为患者提供净收益时，可以放弃或撤回干预措施。在儿科领域，由于儿童无法做出自主决定以及喂养作为儿童护理基本要素的情感力量，放弃或撤回药物给予的液体和营养更具争议性。本声明回顾了与扣留或撤回儿童医疗提供的液体和营养相关的医学、伦理和法律问题。美国儿科学会的结论是，在有限的情况下，停止为儿科患者提供液体和营养在道德上是可以接受的。当考虑特别困难或有争议的决定时，强烈建议进行道德咨询。儿科2009; 124：813-822
There is broad consensus that withholding or withdrawing medical interventions is morally permissible when requested by competent patients or, in the case of patients without decision-making capacity, when the interventions no longer confer a benefit to the patient or when the burdens associated with the interventions outweigh the benefits received. The withdrawal or withholding of measures such as attempted resuscitation, ventilators, and critical care medications is common in the terminal care of adults and children. In the case of adults, a consensus has emerged in law and ethics that the medical administration of fluid and nutrition is not fundamentally different from other medical interventions such as use of ventilators; therefore, it can be forgone or withdrawn when a competent adult or legally authorized surrogate requests withdrawal or when the intervention no longer provides a net benefit to the patient. In pediatrics, forgoing or withdrawing medically administered fluids and nutrition has been more controversial because of the inability of children to make autonomous decisions and the emotional power of feeding as a basic element of the care of children. This statement reviews the medical, ethical, and legal issues relevant to the withholding or withdrawing of medically provided fluids and nutrition in children. The American Academy of Pediatrics concludes that the withdrawal of medically administered fluids and nutrition for pediatric patients is ethically acceptable in limited circumstances. Ethics consultation is strongly recommended when particularly difficult or controversial decisions are being considered. Pediatrics 2009; 124: 813-822