Trotochaud Karen
Emory University Center for Ethics in Atlanta, GA, USA.
Case Manager. 2006 May-Jun;17(3):60-4. doi: 10.1016/j.casemgr.2006.04.009.
With the unrelenting development of new medical technologies and increasingly more complex treatments, health-care providers sometimes find themselves faced with requests to provide treatments they believe to be medically futile. This language and resulting argument based on it can produce an adversarial posturing on the part of providers and families that frequently anticipates or threatens a legal solution. Although our legal system will choose sides on an issue, futility cases that have ended up in the courts have generally failed to definitively answer questions about how to address future dilemmas. A more helpful process is a clear procedure for addressing both sides of the question with the ultimate decision-making remaining within the health-care setting. The ethically appropriate solution lies within the context of a shared decision-making process between patient/family and physician/health-care provider that honors the values of both parties without assuming a unilateral decision-making stance. Case managers and direct-care providers, when faced with requests for treatments deemed to be medically inappropriate or futile, are challenged to understand and pursue this shared process.
随着新医疗技术的不断发展以及治疗手段日益复杂，医疗服务提供者有时会发现自己面临提供他们认为在医学上无意义的治疗的请求。这种措辞以及基于此产生的争论可能会使医疗服务提供者和家属之间形成一种对抗姿态，这种姿态常常预示或威胁要采取法律手段解决问题。尽管我们的法律制度会在某个问题上表明立场，但最终诉诸法庭的医疗无效案例通常未能明确回答如何应对未来困境的问题。一个更有帮助的过程是有一个明确的程序，用于处理问题的双方，最终决策权仍保留在医疗环境中。符合伦理的恰当解决方案在于患者/家属与医生/医疗服务提供者之间的共同决策过程，该过程尊重双方的价值观，而不采取单方面的决策立场。当个案管理人员和直接护理人员面临提供被认为在医学上不适当或无效的治疗的请求时，他们面临着理解并推行这种共同决策过程的挑战。
