Wyatt J S
University College London, UK.
Baillieres Best Pract Res Clin Obstet Gynaecol. 1999 Dec;13(4):503-11. doi: 10.1053/beog.1999.0045.
Life-sustaining treatment may be ethically withdrawn or withheld in critically ill or dying newborns if the action is genuinely in the best interests of the patient. This may occur in situations where life-sustaining treatment is futile because of a hopeless prognosis, or if the burdens of intensive treatment clearly outweigh its likely benefits. There is no fundamental ethical difference between the withholding of resuscitation and the withdrawing of life-sustaining treatment once it has commenced. However the actions may have different emotional and psychological implications. A decision to withdraw treatment should only be taken with the consensus of experienced staff caring for the baby and with the unpressurized agreement of the parents. Palliative care and symptomatic relief should always continue after life-support has been withdrawn. Emotional and practical support should be provided for parents and adequate training and support is essential for obstetric and neonatal unit staff.
如果撤掉或不给予维持生命的治疗确实符合患者的最大利益，那么在患有重症或濒死的新生儿身上，从伦理角度而言是可行的。这种情况可能发生在以下情形中：由于预后无望，维持生命的治疗毫无效果；或者强化治疗的负担明显超过其可能带来的益处。在开始进行复苏措施后再撤掉维持生命的治疗与一开始就不给予复苏措施，在伦理层面并无本质区别。然而，这些行为可能会产生不同的情感和心理影响。只有在照顾婴儿的经验丰富的工作人员达成共识，且父母在未受压力的情况下同意时，才能做出撤掉治疗的决定。在撤掉生命支持后，应始终继续提供姑息治疗和症状缓解措施。应为父母提供情感和实际支持，并且为产科和新生儿科的工作人员提供充分的培训和支持至关重要。
