Welin Stellan, Sanner Margareta, Nydahl Anders
Linköpings universitet.
Lakartidningen. 2005;102(18-19):1411-2, 1414-6.
In the debate on organ donation it has been argued that all medical care of patients in intensive care units should be undertaken solely for the good of the patient and that it is wrong to initiate non-therapeutic ventilation in order that such a patient may later become an organ donor. We argue against this view. We think the ethically relevant instant is not the time of death but the point where the physicians deem it pointless to undertake curative measures. We envisage two cases for such non-therapeutic ventilation. One is when a patient is deemed to be in a terminal state (for example after having suffered significant intra-cranial bleeding), and there are no curative measures to be taken. In this case the patient is unconscious and the decision for ventilator treatment must be taken with short notice. Here we recommend that such patients are put on ventilators and the relatives are consulted afterwards. The other case is when a patient, already ventilated, is in a terminal state, unconscious, and the physicians deem that curative measures no longer can be taken. In this case we recommend that ventilation be continued. In both cases, such a policy might provide more organs for transplantation. It could benefit many and it will hurt no one.
在关于器官捐赠的辩论中，有人认为，重症监护病房中对患者的所有医疗护理都应仅为患者的利益而进行，为了使这样的患者日后成为器官捐赠者而启动非治疗性通气是错误的。我们反对这种观点。我们认为，从伦理角度来看，关键的时刻不是死亡之时，而是医生认为采取治疗措施毫无意义的那个点。我们设想了两种进行这种非治疗性通气的情况。一种情况是，患者被判定处于终末期（例如在遭受严重颅内出血之后），且没有可采取的治疗措施。在这种情况下，患者已失去意识，必须在短时间内做出是否进行通气治疗的决定。在此，我们建议对这类患者进行通气治疗，并随后与亲属商议。另一种情况是，患者已经在接受通气治疗，处于终末期，失去意识，且医生认为已无法再采取治疗措施。在这种情况下，我们建议继续进行通气治疗。在这两种情况下，这样的政策可能会为移植提供更多器官。它会使许多人受益，且不会伤害任何人。
