Muller J H
Department of Family and Community Medicine, University of California, San Francisco 94143.
Soc Sci Med. 1992 Apr;34(8):885-98. doi: 10.1016/0277-9536(92)90257-q.
One of the most difficult decisions facing physicians in contemporary medical practice is whether to initiate or withhold cardiopulmonary resuscitation (CPR) for patients who are critically ill. Because of the problems surrounding these decisions, hospital guidelines have recently been developed for the appropriate use of do-not-resuscitate (DNR) orders. Despite the establishment of these guidelines, problems with the application of DNR orders remain. This study examines one strategy used by internal medicine resident physicians to cope with the problematic nature of decisions regarding resuscitation--the use of partial or slow resuscitation attempts, known as 'limited codes.' It analyzes how these code efforts play a role within the context of resident work by enabling residents to circumvent ethical and practical dilemmas created by the circumstances of their clinical practice.
当代医疗实践中，医生面临的最艰难决策之一是，对于重症患者，是启动还是停止心肺复苏（CPR）。由于围绕这些决策存在诸多问题，医院最近制定了关于适当使用“不要复苏”（DNR）医嘱的指南。尽管制定了这些指南，但DNR医嘱的应用仍存在问题。本研究考察了内科住院医师用来应对复苏决策难题的一种策略——采用部分或缓慢复苏尝试，即所谓的“有限急救”。该研究分析了这些急救努力如何通过使住院医师规避其临床实践环境所造成的伦理和实际困境，而在住院医师的工作环境中发挥作用。
