Awake and (Only Just) Aware? A Typology, Taxonomy, and Holistic Framework for Withdrawing Clinically Assisted Nutrition and Hydration in the Minimally Conscious State
Awake and (Only Just) Aware? A Typology, Taxonomy, and Holistic Framework for Withdrawing Clinically Assisted Nutrition and Hydration in the Minimally Conscious State
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清醒并且（仅仅）意识到？
DOI：
10.1093/medlaw/fwx058
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发表时间：
2017
影响因子：
1.7
通讯作者：
A. Samanta
中科院分区：
文献类型：
--
作者：
J. Samanta;A. Samanta
对处于最低意识状态的人停止临床辅助营养和水合 (CANH) 的决定取决于继续 CANH 是否符合个人的最佳利益这一问题，并且传统上使用“资产负债表”方法来确定。该领域新出现的判例法表明，决策可能显得不一致，并且流程缺乏足够的确定性和清晰度。通过对成文法、普通法和学术评论的分析，我们为参与这些决策的要素阐明了类型。接下来，我们构建了一个总体法律和道德问题的分类法，然后继续开发一个用于整体决策的新颖框架。我们根据其所依据的原则来验证这一点：元素的连贯权重和概念的理论证明。该框架具有潜在的深远好处，包括决策的一致性和透明度，从而实现更加统一的司法方法。我们建议将此作为在此背景下决策的基本范例。
Decisions to withdraw clinically assisted nutrition and hydration (CANH) from people in the minimally conscious state are predicated on the question as to whether it is in the individual's best interests to continue with CANH and determined traditionally using a 'balance sheet' approach. The emerging case law in this area suggests that decisions may appear inconsistent and lack sufficient certainty and clarity of process. Using an analysis of statute, common law and academic commentary we articulate a typology for the elements that tend to engage in these decisions. Next, we construct a taxonomy of overarching legal and ethical issues and then proceed to develop a novel framework for holistic decision-making. We validate this on the principle upon which it is grounded: coherent weighting of elements and theoretical proof of concept. The framework has potentially far-reaching benefits that include consistency and transparency of decision-making, thereby enabling a more uniform judicial approach. We suggest this as a foundational paradigm for decision-making in this context.