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"但我有一个心脏起器......没有理由参与假设的场景":一个不迫在眉的死亡患者要求关闭心脏起器的请求
Bridget A Tracy1, Rosamond Rhodes2, Nathan E Goldstein3
1Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ, USA.
概括
一名痴呆症患者要求关闭心脏起器,尽管他有决策能力,但这突显了生命终端护理的伦理困境. 临床医生必须在尊重这些请求时导航患者的自主权和个人信仰.
科学领域:
- 医学伦理 医学伦理
- 心脏病学 心脏病学
- 神经学 神经学
背景情况:
- 患有晚期痴呆症的患者可能保留决策能力.
- 要求关闭维持生命的设备,如心脏起器,提出复杂的道德挑战.
- 现有的文献缺乏关于非即将死亡的患者要求关闭心脏起器的报道.
研究的目的:
- 报告一个患有痴呆症的患者要求关闭心脏起器的病例.
- 探索围绕患者自主权和设备停用的伦理考虑.
- 为了突出临床医生在尊重这些请求时所面临的挑战.
主要方法:
- 病例报告详细介绍了患者的评估和随后的起器停用.
- 评估患者的决策能力.
- 对临床和伦理方面的考虑进行审查.
主要成果:
- 尽管该患者患有老年痴呆症,但被发现具有决策能力.
- 外部医院的临床医生拒绝了停用请求.
- 患者的心脏起器在我们的医院被停用,导致大约9天后死亡.
结论:
- 必须尊重患者的自主权,即使要求关闭维持生命的设备.
- 当患者的要求挑战他们的个人信仰或舒适度时,医疗保健提供者可能面临道德冲突.
- 这一案例强调了需要明确的指导方针和支持临床医生管理复杂的终生决策.
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