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倫理委員会と介護を制限する決定. マサチューセッツ総合病院での体験
1Division of General Medicine, Brigham and Women's Hospital, MA 02115.
JAMA
|August 12, 1988
まとめ
オプティマムケア委員会 (OCC) は,末期病患者のケアを制限するための倫理的指針を提供しています. 彼らのケースレビューは,明確な臨床的違いと進化する使用を明らかにし,ケアを中止する決定における継続的な倫理的および法的問題を強調しています.
科学分野:
- 医療倫理 医療倫理について
- 医療法 医療法に関する法律
- 臨床的意思決定について
背景:
- マサチューセッツ総合病院の最適ケア委員会 (OCC) は,13年間,末期病患者のケアを制限することを医師に助言しました.
- 介護の撤回に関する決定には,複雑な倫理的,法的配慮が伴う.
研究 の 目的:
- マサチューセッツ総合病院の最適ケア委員会 (OCC) が1974年から1986年にかけて73例の患者を診察した経験を振り返る.
- OCCに相談された症例と,OCCの入力なしに,ドー・ノット・リ蘇生 (DNR) ステータスを受ける患者の比較.
- OCCのケースを分類し,新興傾向と残った倫理的/法的疑問を特定します.
主な方法:
- 73件のOCC協議事件 (1974年−1986年) を遡及的に検討した.
- OCC症例を3ヶ月の期間中,OCCの入力なしでDNRステータスを授与された患者113人と比較した.
- 倫理的,法的問題に基づいて,OCC事件を6つの別々のグループに分類する.
主要な成果:
- 臨床的変数の有意な差異は,OCCと相談した症例と,OCC以外のDNR状態を有する症例の間で発見されました.
- OCCのケースは6つのタイプに分類され,それぞれが独自の倫理的,法的課題を提示しています.
- OCCの利用は,特に特定のケースのカテゴリーでは増加しています.
結論:
- OCCは,議論の多い終末期介護の問題を一貫して倫理的に扱ってきました.
- 委員会の努力にもかかわらず,未解決の法的および道徳的な問題は依然として残っています.
- 介護停止の決定における倫理委員会の役割に関して,さらなる対話が必要である.
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