Faber-Langendoen K, Bartels D M
Center for Biomedical Ethics, University of Minnesota, Minneapolis.
Crit Care Med. 1992 May;20(5):570-7. doi: 10.1097/00003246-199205000-00005.
The difficult decision to forgo (withhold or withdraw) life-sustaining treatment has received extensive commentary. Little attention has been paid to how physicians do, and should, care for dying patients once this decision is made. This study describes the characteristics of patients who forgo treatment, determines the range and sequential process of forgoing treatment, and suggests ethical and public policy implications.
The charts of all patients who died at the University of Minnesota Hospital during a 2-month period were reviewed. The patient information that was collected included age and sex, diagnoses, mental status, location in the hospital length of hospital stay, method of payment, the timing of the first decision to forgo treatment, and the range and sequence of interventions forgone.
All ICUs and general wards in a 586-bed tertiary care university hospital.
All patients who died at the University of Minnesota Hospital during May and June 1989.
A total of 52 (74%) of 70 patients who died had some intervention withheld or withdrawn before death. Those patients in whom treatment was forgone were more likely to have an underlying malignancy or impaired mental status and longer hospital stays. Thirty-two (62%) of 52 patients who declined some treatment were in an ICU; 26 (50%) of 52 patients required mechanical ventilation. On average, 5.4 separate interventions were forgone per patient. Resuscitation and/or endotracheal intubation were generally the first measures withheld; once a patient required a ventilator, withdrawing the ventilator was a late decision. Precise methods of ventilatory and vasopressor withdrawal varied considerably among patients.
Forgoing life-sustaining treatment is not a single decision but it often occurs in a sequential manner over several days. A strict analysis of the benefits and burdens of various interventions may be inadequate in deciding what interventions are appropriate in the care of the dying patient.
放弃（ withhold 或 withdraw ）维持生命治疗这一艰难决定已受到广泛评论。然而，对于医生在做出这一决定后如何以及应该如何照顾临终患者，却很少有人关注。本研究描述了放弃治疗的患者的特征，确定了放弃治疗的范围和顺序过程，并提出了伦理和公共政策方面的影响。
回顾了明尼苏达大学医院在两个月期间死亡的所有患者的病历。收集的患者信息包括年龄、性别、诊断、精神状态、在医院的位置、住院时间、支付方式、首次决定放弃治疗的时间，以及放弃的干预措施的范围和顺序。
一所拥有 586 张床位的三级护理大学医院的所有重症监护病房和普通病房。
1989 年 5 月和 6 月在明尼苏达大学医院死亡的所有患者。
70 例死亡患者中有 52 例（74%）在死亡前有某种干预措施被放弃或撤回。那些放弃治疗的患者更有可能患有潜在的恶性肿瘤或精神状态受损，且住院时间更长。52 例拒绝某些治疗的患者中有 32 例（62%）在重症监护病房；52 例患者中有 26 例（50%）需要机械通气。平均每位患者放弃 5.4 项不同的干预措施。复苏和 / 或气管插管通常是首先被放弃的措施；一旦患者需要呼吸机，撤掉呼吸机是较晚做出的决定。不同患者撤掉呼吸机和血管加压药的具体方法差异很大。
放弃维持生命的治疗不是一个单一的决定，而是常常在几天内以连续的方式发生。对各种干预措施的利弊进行严格分析，可能不足以决定在照顾临终患者时哪些干预措施是合适的。
