The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making
The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making
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DOI：
10.1186/2049-6958-9-14
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发表时间：
2014-01-01
影响因子：
2.3
通讯作者：
ten Have, Henk A. M. J.
中科院分区：
文献类型：
--
作者：
Welie, Jos V. M.;ten Have, Henk A. M. J.
暂停或撤回维持生命的治疗往往是非常具有挑战性的卫生保健提供者，病人和他们的家庭成员一样。当病人的生命似乎接近尾声时，人们普遍认为，从道德上讲，最好的办法是尝试新的干预措施，继续所有的治疗，尝试实验性的行动方案，简而言之，做点什么。与这种常见做法相反，作者认为，在大多数情况下，道德上更安全的途径实际上是放弃维持生命的治疗，特别是当它们实现真正有益结果的可能性相对于伤害患者的可能性变得很小时。伦理分析分三个阶段进行。首先，解释了疏忽不作为与消极默认的区别。其次，任何医疗的两个必要条件，即，在维持生命的干预措施中，必须采用医学上有指征并征得同意的方法。最后，讨论了暂停和撤销维持生命治疗之间的区别。在论文的第二部分中，作者展示了这些理论伦理学考虑如何指导临床伦理学决策。介绍了一个关于术后无法脱离呼吸机的患者的病例小插曲。对这一案件的伦理分析分三个阶段进行。首先，它表明，以及为什么在这种情况下撤下呼吸机并不等同于协助自杀或安乐死。接下来，提出了一个问题，继续通气是否可以在医学上证明是合理的，或者已经变得徒劳。最后，需要为医疗保健团队获得同意继续通风进行了讨论。
Withholding or withdrawing a life-sustaining treatment tends to be very challenging for health care providers, patients, and their family members alike. When a patient's life seems to be nearing its end, it is generally felt that the morally best approach is to try a new intervention, continue all treatments, attempt an experimental course of action, in short, do something. In contrast to this common practice, the authors argue that in most instances, the morally safer route is actually to forgo life-sustaining treatments, particularly when their likelihood to effectuate a truly beneficial outcome has become small relative to the odds of harming the patient. The ethical analysis proceeds in three stages. First, the difference between neglectful omission and passive acquiescence is explained. Next, the two necessary conditions for any medical treatment, i.e., that it is medically indicated and that consent is obtained, are applied to life-sustaining interventions. Finally, the difference between withholding and withdrawing a life-sustaining treatment is discussed. In the second part of the paper the authors show how these theoreticalethical considerations can guide clinical- ethical decision making. A case vignette is presented about a patient who cannot be weaned off the ventilator post-surgery. The ethical analysis of this case proceeds through three stages. First, it is shown that and why withdrawal of the ventilator in this case does not equate assistance in suicide or euthanasia. Next, the question is raised whether continued ventilation can be justified medically, or has become futile. Finally, the need for the health care team to obtain consent for the continuation of the ventilation is discussed.