伦理委员会和限制护理的决定. 在马萨诸塞州总医院的经历
1Division of General Medicine, Brigham and Women's Hospital, MA 02115.
JAMA
|August 12, 1988
概括
最佳护理委员会 (OCC) 提供了限制终极病患者护理的伦理指导. 他们的病例审查揭示了明显的临床差异和不断变化的使用,突出了撤回护理决策中的持续的伦理和法律问题.
科学领域:
- 医学伦理 医学伦理
- 医疗保健法律 医疗保健法律
- 临床决策 - 临床决策
背景情况:
- 马萨诸塞州总医院的最佳护理委员会 (OCC) 建议医生在13年内限制对绝症患者的护理.
- 关于撤销护理的决定涉及复杂的伦理和法律考虑.
研究的目的:
- 审查马萨诸塞州总医院的最佳护理委员会 (OCC) 在1974年至1986年的73起病例中的经验.
- 为了比较OCC咨询的病例与没有OCC输入的接受做不复苏 (DNR) 状态的患者.
- 将OCC案件分类,并确定新出现的趋势和剩余的伦理/法律问题.
主要方法:
- 追溯审查73个OCC咨询案件 (1974-1986年).
- 与113名获得DNR身份的患者进行了OCC病例的比较,在三个月内没有OCC输入.
- 基于伦理和法律问题,OCC案件被分为六个不同的类别.
主要成果:
- 在OCC咨询的病例和非OCC DNR状态的病例之间发现了临床变量的显著差异.
- OCC案件被分为六种类型,每种类型都存在独特的伦理和法律挑战.
- 对OCC的使用增加了,特别是在特定类别的案件中.
结论:
- OCC一直以一致和道德的方式解决有争议的终身护理问题.
- 尽管委员会做出了努力,但仍存在未解决的法律和道德问题.
- 关于伦理委员会在退出护理决定中的作用,需要进一步对话.
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