Kopelman Arthur E
Department of Pediatrics/Neonatology, The Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.
Mt Sinai J Med. 2006 May;73(3):580-6.
Parents and health care professionals may disagree about whether to continue or discontinue life support for infants in the neonatal intensive care unit (NICU) when the infant has an extremely poor chance of survival and/or probably has profound neurological damage. Conflict usually occurs when the parents want everything possible done to keep their infant alive, while the medical team believes that continued care will only prolong suffering and consume resources needed for other patients. The argument is made that often insufficient time and effort is made to fully understand the parents' reason(s) for requesting continued life support. Instead, they are advised to stop support, the advice is rejected, and this results in conflict with the family. A case is used to illustrate this situation, and five typical reasons families have for requesting continued life support, against the advice of the infant's physician, are presented. Each reason needs to be explored and addressed differently. Full appreciation of the reason for the family's request can often prevent conflict between the physician and the family and replace it with support and understanding. Increased emphasis on educating physicians about how to conduct end-of-life discussions, making time for repeated family conferences, and use of a palliative care consultant, should be considered as ways to improve family-physician communication and prevent unnecessary conflicts.
当新生儿重症监护病房（NICU）中的婴儿存活几率极低且/或可能存在严重神经损伤时，家长和医疗保健专业人员对于是否继续或停止维持生命的治疗可能会存在分歧。当家长希望尽一切可能挽救婴儿生命，而医疗团队认为继续治疗只会延长痛苦并消耗其他患者所需资源时，冲突通常就会发生。有人认为，往往没有投入足够的时间和精力去充分理解家长要求继续维持生命治疗的原因。相反，他们被建议停止治疗，建议被拒绝后，这就导致了与家庭的冲突。本文通过一个案例来说明这种情况，并列举了家庭不顾婴儿医生的建议而要求继续维持生命治疗的五个典型原因。每个原因都需要以不同的方式进行探究和处理。充分理解家庭提出请求的原因通常可以避免医生与家庭之间的冲突，并代之以支持和理解。应考虑更加强调对医生进行关于如何开展临终讨论的培训、为多次家庭会议留出时间以及聘请姑息治疗顾问，以此作为改善医患沟通并防止不必要冲突的方法。
