Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice
Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice
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DOI：
10.1136/archdischild-2014-306666
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发表时间：
2015-05-01
影响因子：
5.2
通讯作者：
Brierley, Joe
中科院分区：
文献类型：
--
作者：
Larcher, Vic;Craig, Finella;Brierley, Joe
皇家儿科和儿童健康学院(RCPCH)的第一版文件《暂停或取消儿童救生治疗：实践框架》于1997年出版，是新成立的学院编制的首批文件之一。第一版是在道德操守咨询委员会举行一系列讲习班、公开会议和讨论之后出版的。咨询了广泛的临床医生、宗教团体和家长团体的代表以及残疾人本身。鉴于这一问题的艰巨性和情绪性，以及所征求意见的众多和不同意见，原始文件承认不可能达成完全协商一致，但确定了可在其上建立框架的共同点。2004年出版的第二版反映了实践和新立法的变化，但保留了与第一版相同的道德和法律原则。1将其标题从“挽救生命的治疗”改为“维持生命的治疗”，以反映在这些情况下经常给予的治疗不是治愈性的，而是支持性的。在过去两年中，皇家儿科协会伦理和法律咨询委员会(ELAC-RCPCH)审议了对该文件进行修订的必要性。我们再次征询了使用过该文件的人的意见，并吸收了英国和其他地方个人和团体的意见。同以往一样，我们试图综合不同的观点和价值观，以达成共识。我们还注意到，对患有生命限制条件的个人的决策重点发生了变化，如总医务委员会(GMC)文件所述：“临终治疗和护理：决策的良好做法”。2我们已经纳入了自上一版以来已决定或颁布的相关判例法和成文法。我们还考虑到了临终关怀服务的发展和决策过程中越来越多的伦理和其他支持，以及在回应前两份文件时出现的问题。特别是，我们已经取代了以前用来确定可能讨论治疗限制的情况的五个标准，而是基于生活数量或质量的更正式的分类。我们纳入了一个类别，正式承认那些能够自己做出决定的年轻人的愿望和偏好，尽管他们得到了家人和专业人员的支持。
The first edition of the Royal College of Paediatrics and Child Health (RCPCH) document ‘Withholding or Withdrawing Life Saving Treatment in Children: A Framework for Practice’was published in 1997 and was one of the first documents produced by the newly-formed College. The first edition followed a series of workshops, public meetings and discussions in the Ethics Advisory Committee. There was consultation with a wide range of clinicians, representatives of faith groups and parents’ groups and from individuals with disabilities themselves. Given the difficult and emotive nature of the subject, and the significant number and differing views of those consulted, the original document acknowledged the impossibility of achieving total consensus, but did identify common ground on which a framework could be built. The framework document was widely used; it did inform constructive debate and provided clarification in this difficult and emotive area.The second edition, published in 2004, reflected changes in practice and new legislation but retained the same ethical and legal principles as the first. 1 Its title was changed from ‘life-saving treatment’to ‘life-sustaining treatment’to reflect the fact that the treatment that is often given in these circumstances is not curative but supportive. The need for a revision of the document has been considered over the past 2 years by the Ethics and Law Advisory Committee of the RCPCH (ELAC-RCPCH). Once again, we have consulted those who have used the document and have incorporated comments from individuals and groups, both in the UK and elsewhere. As before we have attempted to synthesise differing views and values in reaching a consensus. We were also mindful of the change in emphasis in decision making with individuals with life-limiting conditions, as exemplified in the General Medical Council (GMC) document:‘Treatment and care towards the end of life: good practice in decision making’. 2 We have incorporated relevant case and statute law decided or enacted since the last edition. We have also taken into account developments in palliative care provision and the growing availability of ethical and other support in decision making, as well as issues that have arisen in response to the two previous documents. In particular, we have replaced the five criteria that were previously used to identify situations in which limitation of treatment might be discussed with a more formal classification based on quantity or quality of life. We have included a category that formally acknowledges the wishes and preferences of those young people who are able to make decisions for themselves, albeit with the support of their families and professionals.