新生儿生命终端决策:10个欧洲国家的医生态度和与自我报告实践的关系
M Rebagliato1, M Cuttini, L Broggin
1Department of Public Health, Miguel Hernandez University, Alicante, Spain. rebagli@umh.es
JAMA
|November 14, 2000
概括
新生儿医生对预后不佳的婴儿的生命末期决定因国家而异. 优先考虑生活质量的态度与限制密集干预相关,国家差异是最具影响力的.
科学领域:
- 医学伦理 医学伦理
- 新生儿科学 新生儿科学
- 跨文化研究 跨文化研究
背景情况:
- 新生儿生命终结决策中的伦理困境是复杂的,缺乏跨不同文化广泛的经验数据.
- 了解医生的态度和价值观对于导航这些敏感决策至关重要.
研究的目的:
- 调查10个欧洲国家的新生儿医生对终身护理的态度.
- 检查这些态度与限制新生儿重症监护的实际做法之间的联系.
主要方法:
- 在1996年至1997年期间,对10个欧洲国家的142个新生儿重症监护室 (NICU) 的1391名医生进行了调查.
- 评估了医生对生命价值与生活质量的看法,以及自我报告的限制对神经预后不佳的婴儿进行密集干预的情况.
主要成果:
- 观察到跨国态度的显著差异,意大利和匈牙利等国家的医生倾向于维持生命,而英国,荷兰和瑞典的医生倾向于考虑生活质量.
- 诸如女性性别,没有孩子,新教徒或没有宗教背景,以及在婴儿护理中心工作,其中婴儿出生时体重非常低的婴儿数量很高,这些因素与支持生活质量的立场有关.
- 具有更强烈的生活质量取向的医生更有可能报告限制密集干预 (调整后的几率比率为每单位变化1.5).
结论:
- 医生决定限制对预后不佳的婴儿进行密集的新生儿干预,这与他们对生命价值的态度有关.
- 在考虑了其他因素之后,实践的国家成为医生态度和他们报告的生命终结实践的最重要的预测因素.
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