Geiderman J M
Ruth & Harry Roman Emergency Department, Department of Emergency Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Acad Emerg Med. 2001 Mar;8(3):278-81. doi: 10.1111/j.1553-2712.2001.tb01306.x.
Patients in the emergency department frequently voice refusals of care or are unable or unwilling to consent to care. While general principles surrounding consent and refusal can be articulated in theory, it is often far more complicated in the real setting. Further, it is impossible to contemplate in advance every possible situation that might arise. In order to properly care for patients, the emergency physician has an obligation to understand ethical principles and the reasoning process one must go through to resolve an ethical dilemma. Emergency physicians face such complex decisions on a routine basis. Ethical reasoning skills are obviously a core competence in emergency medicine, even if easy answers are elusive. Two cases are presented that illustrate this complexity, and routes to resolution are discussed.
急诊科的患者经常表示拒绝治疗，或者无法或不愿意同意接受治疗。虽然围绕同意和拒绝的一般原则在理论上可以阐述清楚，但在实际情况中往往要复杂得多。此外，不可能预先考虑到可能出现的每一种情况。为了妥善照顾患者，急诊医生有义务理解伦理原则以及解决伦理困境时必须经历的推理过程。急诊医生日常都会面临如此复杂的决策。伦理推理能力显然是急诊医学的一项核心能力，即便很难找到简单的答案。本文介绍了两个案例来说明这种复杂性，并讨论了解决途径。
