Guidance on Forgoing Life-Sustaining Medical Treatment
Guidance on Forgoing Life-Sustaining Medical Treatment
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DOI：
10.1542/peds.2017-1905
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发表时间：
2017-09-01
期刊：
影响因子：
8
通讯作者：
Christian, Cindy W.
中科院分区：
文献类型：
--
作者：
Weise, Kathryn L.;Okun, Alexander L.;Christian, Cindy W.
儿科保健的目的是促进儿童的最大利益。治疗通常是在有利于维持生命的假设下进行的。然而，在某些情况下，孩子的利益和负担的平衡导致放弃生命维持医疗（LSMT）在道德上是可支持的或可取的。在大多数情况下，父母在有关子女临终关怀的决策方面拥有广泛的自由度。在患者疾病的整个发展过程中，如果可能的话，通过所有利益相关者（包括医务人员、家属和患者）之间的充分沟通，可以改善围绕 LSMT 的协作决策。建议明确沟通总体护理目标，以促进商定的计划，包括复苏状态。专业团队之间的分歧可能会给家庭带来压力。与此同时，了解治疗建议背后的一系列专业意见对于为家庭决策提供信息至关重要。在考虑放弃 LSMT 的决定时，姑息治疗、伦理学、教牧关怀和其他学科专家的意见可以增强对家庭和医务人员的支持。了解与前述 LSMT 相关的机构、地区、州和国家法规的具体适用性对于在现有法律框架内以道德方式实践非常重要。本指南是美国儿科学会 1994 年关于放弃 LSMT 声明的更新。
Pediatric health care is practiced with the goal of promoting the best interests of the child. Treatment generally is rendered under a presumption in favor of sustaining life. However, in some circumstances, the balance of benefits and burdens to the child leads to an assessment that forgoing life-sustaining medical treatment ( LSMT) is ethically supportable or advisable. Parents are given wide latitude in decision-making concerning end-of-life care for their children in most situations. Collaborative decision-making around LSMT is improved by thorough communication among all stakeholders, including medical staff, the family, and the patient, when possible, throughout the evolving course of the patient's illness. Clear communication of overall goals of care is advised to promote agreed-on plans, including resuscitation status. Perceived disagreement among the team of professionals may be stressful to families. At the same time, understanding the range of professional opinions behind treatment recommendations is critical to informing family decision-making. Input from specialists in palliative care, ethics, pastoral care, and other disciplines enhances support for families and medical staff when decisions to forgo LSMT are being considered. Understanding specific applicability of institutional, regional, state, and national regulations related to forgoing LSMT is important to practice ethically within existing legal frameworks. This guidance represents an update of the 1994 statement from the American Academy of Pediatrics on forgoing LSMT.