Street K, Ashcroft R, Henderson J, Campbell A V
University of Bristol.
J Med Ethics. 2000 Oct;26(5):346-52. doi: 10.1136/jme.26.5.346.
To investigate the factors considered by staff, and the practicalities involved in the decision making process regarding the withdrawal or withholding of potential life-sustaining treatment in a children's hospital. To compare our current practice with that recommended by the Royal College of Paediatrics and Child Health (RCPCH) guidelines, published in 1997.
A prospective, observational study using self-reported questionnaires.
Tertiary paediatric hospital.
Consecutive patients identified during a six-month period, about whom a formal discussion took place between medical staff, nursing staff and family regarding the withholding or withdrawal of potentially life-sustaining treatments. The primary physician and primary nurse involved in the discussion were identified.
Two questionnaires completed independently by the primary physician and nurse.
Twenty-two patients were identified (median age 1 year; range 1 day-34 years). In 20 cases treatment was withdrawn or withheld, in two cases treatment was continued. Nursing staff considered family wishes and family perceptions of patient suffering as significantly more important factors in decision making than medical staff, who considered prognostic factors as most important. In only two cases were the patient's expressed wishes apparently available. In most cases staff considered the patient's best interests were served and the process would not be enhanced by the involvement of an independent ethics committee. The exceptions were those cases in which treatment was continued following disagreement between parties.
Our current practice is consistent with that recommended by the RCPCH. The contribution of the patient, provision of staff counselling and general practitioner (GP) involvement were identified as areas for improvement.
调查儿童医院工作人员在决定撤销或停止潜在的维持生命治疗时所考虑的因素以及决策过程中的实际情况。将我们目前的做法与1997年发表的皇家儿科与儿童健康学院（RCPCH）指南所推荐的做法进行比较。
采用自我报告问卷的前瞻性观察研究。
三级儿童医院。
在六个月期间连续确定的患者，医护人员与家属就撤销或停止潜在的维持生命治疗进行了正式讨论。确定了参与讨论的主治医生和责任护士。
主治医生和护士独立填写两份问卷。
确定了22名患者（中位年龄1岁；范围1天至34岁）。20例患者的治疗被撤销或停止，2例患者继续接受治疗。与认为预后因素最为重要的医护人员相比，护理人员认为家属意愿和家属对患者痛苦的认知在决策中是更重要的因素。只有两例明显参考了患者表达的意愿。在大多数情况下，工作人员认为符合患者的最大利益，独立伦理委员会的参与并不会改善这一过程。例外情况是那些各方存在分歧后仍继续治疗的案例。
我们目前的做法与RCPCH推荐的做法一致。确定患者的贡献、提供工作人员咨询以及全科医生的参与为需要改进的方面。
