Veatch R M
Kennedy Institute of Ethics, Georgetown University.
Kennedy Inst Ethics J. 1993 Mar;3(1):1-19. doi: 10.1353/ken.0.0075.
While substantial progress has been made in reaching a moral and policy consensus regarding forgoing life-sustaining treatment, several holes exist in that consensus where more public discussion and moral analysis is needed. First, among patients who have not been found to be legally incompetent there is controversy over whether certain treatments can be refused. Controversies also remain over damages for treatment without consent, limits based on third-party interests and the ethical integrity of the medical profession, and cases where it cannot be agreed whether the patient is competent. Even greater dispute exists over care of incompetent patients. Perhaps the greatest gap in the consensus arises over limits to the use of the best interests standard. This article proposes replacing it with a "reasonableness standard" that takes into account disputes about what is literally the best for the patient and conflicts of interest between the patient and others.
虽然在就放弃维持生命治疗达成道德和政策共识方面已取得重大进展，但该共识仍存在一些漏洞，需要更多的公众讨论和道德分析。首先，在未被认定为无法律行为能力的患者中，对于某些治疗是否可以被拒绝存在争议。关于未经同意的治疗损害赔偿、基于第三方利益的限制以及医疗行业的道德完整性，以及无法确定患者是否有行为能力的情况，争议也依然存在。对于无行为能力患者的护理，争议更大。或许共识中最大的差距在于对最佳利益标准使用的限制。本文提议用一种“合理性标准”取而代之，该标准考虑到关于什么对患者真正最有利的争议以及患者与他人之间的利益冲突。
