Andereck W S
Program of Medicine and Philosophy, Pacific Presbyterian Medical Center, San Francisco, CA.
Camb Q Healthc Ethics. 1992 Winter;1(1):41-50. doi: 10.1017/s0963180100000074.
The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care. Most patients evaluated have been unable to clearly express their wishes concerning further treatments, highlighting the need for promoting advance directives. When resorting to substituted judgment, our committee has supported continued care in a majority of cases. Limitation of the consultation process to the attending physician has, in our experience, actually served to increase the credibility of the committee and has promoted acceptance of its recommendations. The committee's most useful function seems to be in assisting physicians and their patients in defining realistic goals and limitations of treatment. Within this context, the coming decade may find ethics committees concerned less with promoting the autonomous wishes of individual patients than with defining the limits of that autonomy against the competing demands of the larger society. Such a shift should be approached with caution.
本文介绍了一家城市社区医院伦理委员会的发展及咨询经验，并探讨了多种病例咨询方法。我们的委员会专注于临床评估模式。不出所料，大多数咨询都集中在撤除或限制医疗护理的问题上。大多数接受评估的患者无法清晰表达他们对进一步治疗的意愿，这凸显了推广预立医疗指示的必要性。在采用替代判断时，我们的委员会在大多数情况下都支持继续治疗。根据我们的经验，将咨询过程局限于主治医生实际上提高了委员会的可信度，并促进了对其建议的接受。委员会最有用的功能似乎是协助医生及其患者确定现实的治疗目标和限制。在这种背景下，未来十年伦理委员会可能较少关注促进个体患者的自主意愿，而更多地关注在更大社会的竞争需求背景下界定这种自主性的限度。这种转变应谨慎对待。
