[治疗的 withhold 与 withdraw，伦理和法律层面] （注：这里“withhold”和“withdraw”在医学语境中可能有特定含义，比如 withhold 可能指 withholding treatment 即“ withhold 治疗”（可能是暂停、不给予等意思），withdraw 可能指 withdrawing treatment 即“撤回治疗”等，但仅根据所给英文难以确切完整翻译出准确医学含义，按字面翻译如上）

[Withholding and withdrawing treatment, ethical and legal aspects].

作者信息

Pedersen Reidar, Bahus Marianne Klungland, Kvisle Erik Martinsen

机构信息

Seksjon for medisinsk etikk, Universitetet i Oslo, Postboks 1130 Blindern, 0318 Oslo.

出版信息

Tidsskr Nor Laegeforen. 2007 Jun 14;127(12):1648-50.

PMID:17571104

Abstract

BACKGROUND

In the wake of medical progress an important ethical discussion has arisen about when to withhold and when to withdraw life-sustaining treatment.

MATERIAL AND METHODS

Literature on withholding and withdrawing life-sustaining treatment was assembled and analyzed, and common norms were compared with Norwegian legal regulations.

RESULTS

Withholding or withdrawing life-sustaining treatment is not unusual when the treatment is regarded as futile. As opposed to euthanasia, limiting treatment is under certain circumstances legal. Core values--such as respect for the value of human life, the duty to save lives, equality, respect for patient autonomy, dignified death and professional integrity--may be given diverging emphases and interpretations. In many cases, the patient's capacity to consent is reduced, and it can be challenging to determine what is in the patient's best interest and when the treatment is futile. Good decision making processes and communication at the end of life is demanding, but may reduce and prevent many difficulties.

INTERPRETATION

Norwegian healthcare legislation provides relatively little and to some extent unclear guidance on withholding and withdrawing life-sustaining treatment. National guidelines have not been developed. More attention could be paid to systematic approaches and dialogue with patients, relatives and all healthcare professionals about these issues.

摘要

背景

随着医学的进步，关于何时停止以及何时撤销维持生命治疗出现了一场重要的伦理讨论。

材料与方法

收集并分析了关于停止和撤销维持生命治疗的文献，并将普遍规范与挪威法律法规进行了比较。

结果

当治疗被认为无效时，停止或撤销维持生命治疗并不罕见。与安乐死不同，在某些情况下限制治疗是合法的。诸如尊重人的生命价值、拯救生命的责任、平等、尊重患者自主权、有尊严地死亡和职业操守等核心价值观可能会有不同的侧重点和解释。在许多情况下，患者的同意能力会降低，确定什么符合患者的最大利益以及治疗何时无效可能具有挑战性。临终时良好的决策过程和沟通要求很高，但可以减少并避免许多困难。