拒绝复苏 - 瑞典系统的规则和挑战
Eva Piscator1,2, Therese Djarv1,3
1Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Resuscitation plus
|November 29, 2023
概括
瑞典医生在执行"不尝试心肺复苏" (DNACPR) 命令时面临挑战,尽管法律要求患者和家人进行咨询. 要使实践与法律原则保持一致,需要对文件编制和决策采取系统的方法.
科学领域:
- 医学伦理 医学伦理
- 医疗保健法律 医疗保健法律
- 心脏病学 心脏病学
背景情况:
- 医院内心脏骤停 (IHCA) 每年发生在约2200名瑞典患者中,30天生存率为35%.
- 在医院死亡的患者中,只有很小一部分 (6-13%) 开始进行复苏,这表明需要明确的"不要尝试心肺复苏" (DNACPR) 协议.
- 瑞典目前关于DNACPR的临床实践尚未完全理解,DNACPR订单的频率尚不清楚.
研究的目的:
- 概述瑞典当前的法律,临床实践和DNACPR决策的未来前景.
- 解决在医院内心脏骤停时无用的复苏的伦理考虑和实际挑战.
- 评估在DNACPR命令中对共享决策的法律要求的遵守.
主要方法:
- 对瑞典有关医疗伦理决策和患者权利的立法进行审查.
- 分析瑞典医院对DNACPR订单的临床实践.
- 讨论临床医生在风险评估,结果预测和了解患者愿望方面面临的挑战.
主要成果:
- 瑞典法律强制要求医生做出决定,在DNACPR命令时必须咨询患者,亲属和其他医疗保健从业人员.
- 寻求共享决策,但仅在约10%的案例中,协商记录发生.
- 临床医生报告说,缺乏工具来评估IHCA风险,预测结果,并准确地衡量患者的偏好.
结论:
- 瑞典对DNACPR决策的法律原则的遵守是不够的,原因是咨询的文件和计划不一致.
- 医生需要更好的工具和支持,以便及时和知情地做出DNACPR决策.
- 为了满足法律要求和改善与DNACPR有关的患者护理,对文档和协作会议采取更有系统的方法至关重要.
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