拒绝提供或继续要求的维持生命治疗:医院解决冲突政策的经验
Emily B Rubin1, Ellen M Robinson2,3, M Cornelia Cremens2,4
1Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, Bullfinch Building, Boston, MA, 02114, USA. erubin3@partners.org.
Journal of bioethical inquiry
|June 28, 2023
概括
使用程序方法解决关于维持生命治疗 (LST) 的难以解决的冲突是可行的,但具有挑战性. 这个过程,虽然有时会为代孕产妇提供缓解,但可能会漫长,可能会升级冲突,限制其整体有用性.
科学领域:
- 医学伦理 医学伦理
- 关键护理医学 关键护理医学
- 医疗保健 解决冲突 解决冲突
背景情况:
- 关于维持生命治疗 (LST) 的难以解决冲突的指导方针于2015年发布.
- 关于LST的医疗保健专业人员和代孕产妇之间的难以解决的冲突需要一个结构化的解决过程.
研究的目的:
- 报告经验并评估程序方法的可行性,以解决难以解决的LST冲突.
- 评估与实施LST冲突解决程序相关的挑战和结果.
主要方法:
- 伦理咨询的回顾性,单一中心的队列研究.
- 从2000年到2020年,分析涉及2000年至2020年关于LST难以解决的冲突的案件.
- 审查冲突解决的程序方法及其结果.
主要成果:
- 对10名患者进行了11次冲突解决过程.
- 伦理委员会建议在所有情况下撤销LST.
- LST撤回平均需要24.8天;由于患者死亡,转移或法律禁令,有7起案件未能完成.
- 这个过程造成了痛苦,有时还会采取法律行动,但一些代孕产妇感到宽慰.
- 实施的挑战包括时间消耗和在紧急情况下的有限实用性.
结论:
- 实施LST冲突的正当程序方法是可行的.
- 诸如时间,冲突升级的可能性和紧急情况等因素限制了该程序的有用性.
- 程序方法提供了一个结构化的方法,但需要仔细考虑其实际局限性.
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