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撤除生命维持干预的伦理学辩护

张迪 宁晓红

张迪, 宁晓红. 撤除生命维持干预的伦理学辩护[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0332
引用本文: 张迪, 宁晓红. 撤除生命维持干预的伦理学辩护[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0332
ZHANG Di, NING Xiaohong. Ethical Arguments for Withdrawing Life-sustaining Medical Intervention[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0332
Citation: ZHANG Di, NING Xiaohong. Ethical Arguments for Withdrawing Life-sustaining Medical Intervention[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0332

撤除生命维持干预的伦理学辩护

doi: 10.12290/xhyxzz.2022-0332
基金项目: 

中国医学科学院北京协和医学院教学改革项目(2019zlgc0119)

详细信息
    通讯作者:

    宁晓红,E-mail:ningxh1973@foxmail.com

  • 中图分类号: R-052

Ethical Arguments for Withdrawing Life-sustaining Medical Intervention

Funds: 

The Education Reform Projects of Chinese Academic of Medical Sciences & Peking Union Medical College(2019zlgc0119)

  • 摘要: 撤除生命维持干预(life-sustaining medical intervention,LSMI)是临床实践中常见的伦理学问题。本文分别从尊重患者自主性、无效医疗和患者最佳利益三个方面,尝试对撤除LSMI的伦理学可辩护性进行梳理和分析,并结合案例为临床实践中撤除LSMI提出可操作性建议及对策。笔者认为符合下述任一条件时,撤除LSMI可得到伦理学辩护:(1)患者给出有效同意;(2)生命维持干预被判定为无效医疗;(3)撤除生命维持干预符合患者的最佳利益。最后,笔者指出实践中撤除LSMI所面临的挑战及可能的解决途径。
  • [1] Zhu Y, Zhu X, Xu L, et al. Clinical Factors Influencing End-of-Life Care in a Chinese Pediatric Intensive Care Unit:A Retrospective, post-hoc Study[J]. Front Pediatr, 2021, 9:601782.
    [2] Liu H, Su D, Guo X, et al. Withdrawal of treatment in a pediatric intensive care unit at a Children's Hospital in China:a 10-year retrospective study[J]. BMC Med Ethics, 2020, 21:71.
    [3] Baker J. A matter of life and death[J]. J Med Ethics, 2017, 43:427-434.
    [4] Janofsky JS, Mccarthy RJ, Foistein MF. The Hopkins Competency Assessment Test:a brief method for evaluating patients'capacity to give informed consent[J]. Hosp Community Psychiatry, 1992, 43:132-136.
    [5] Etchells E, Darzins P, Silberfeld M, et al. Assessment of patient capacity to consent to treatment[J]. J Gen Intern Med, 1999, 14:27-34.
    [6] Tay M, Chia SE, Sng J. Knowledge, attitudes and practices of the Advance Medical Directive in a residential estate in Singapore[J]. Ann Acad Med Singap, 2010, 39:424-428.
    [7] Wiesing U, Jox RJ, Hessler H, et al. A new law on advance directives in Germany[J]. J Med Ethics, 2010, 36:779-783.
    [8] Wade D. Back to the bedside?Making clinical decisions in patients with prolonged unconsciousness[J]. J Med Ethics, 2017, 43:457-458.
    [9] Menikoff JA, Sachs GA, Siegler M. Beyond Advance Directives-Health Care Surrogate Laws[J]. N Engl J Med, 1992, 327:1165-1169.
    [10] Yang PC, Shih MJ, Liu YA, et al. Web Search Trends of Implementing the Patient Autonomy Act in Taiwan[J]. Healthcare (Basel), 2020, 8:353.
    [11] Hospital Authority. Guidance for HA Clinicians on Advance Directives in Adults[R]. Hong Kong, China:Hospital Authority, 2016.
    [12] 贾平.缓和医疗、徒劳争端及其法律规制[J].医学与哲学, 2021, 42:1-5, 12.
    [13] Doty WD, Walker RM. Medical futility[J].Clin Cardiol, 2000, 23:Ⅱ 6-Ⅱ 16.
    [14] Schneiderman LJ. Defining Medical Futility and Improving Medical Care[J]. J Bioeth Inq, 2011, 8:123-131.
    [15] Mohindra RK. Medical futility:a conceptual model[J]. J Med Ethics, 2007, 33:71-75.
    [16] Helft PR, Siegler M, Lantos J. The Rise and Fall of the Futility Movement[J]. N Engl J Med, 2000, 343:293-296.
    [17] Brody BA, Halevy A. Is futility a futile concept?[J]. J Med Philos, 1995, 20:123-144.
    [18] Aghabarary M, Dehghan Nayeri N. Medical futility and its challenges:a review study[J]. J Med Ethics Hist Med, 2016, 9:11.
    [19] Clarke CM. Do parents or surrogates have the right to demand treatment deemed futile?An analysis of the case of Baby L[J]. J Adv Nurs, 2000, 32:757-63.
    [20] Limerick MH. The process used by surrogate decision makers to withhold and withdraw lifesustaining measures in an intensive care environment[J]. Oncol Nurs Forum, 2007, 34:331-339.
    [21] The British Psychological Society. Best Interests Guidance on determining the best interests of adults who lack the capacity to make a decision (or decisions) for themselves[R]. Leicester:The British Psychological Society, 2007:7-10.
    [22] 薛晓艳,朱继红.临终患者不同救治态度的转归及影响因素分析[J].医学与哲学, 2011, 32:27-28,33.
    [23] 王雪松,杨新良,刘玮. ICU不能回避的课题:生命支持系统的撤除[J].医学与哲学, 2009, 30:66-68.
    [24] 王晓燕,梁立智,鲁杨,等.医患关系现状的医方因素及对策研究[J].中国医学伦理学, 2008, 21:33-36.
    [25] 李倩."中断医疗型"安乐死在德国的刑法教义学考察[J].北方法学, 2017, 11:61-71.
    [26] 鲍博.论医生死亡协助在我国刑法中的正当化——从比较法的视角[J].中国卫生法制, 2021, 29:77-82.
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出版历程
  • 收稿日期:  2022-06-15
  • 录用日期:  2022-08-30
  • 网络出版日期:  2022-09-23

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