Rydvall Anders, Lynöe Niels
Department of Surgical and Perioperative Sciences, Anaesthesiology, University Hospital of Northern Sweden, Lasarettsbacken SE-90185 Umeå, Sweden.
Crit Care. 2008;12(1):R13. doi: 10.1186/cc6786. Epub 2008 Feb 15.
Our objective was to investigate whether a consensus exists between the general public and health care providers regarding the reasoning and values at stake on the subject of life-sustaining treatment.
A postal questionnaire was sent to a random sample of members of the adult population (n = 989) and to a random sample of intensive care doctors and neurosurgeons (n = 410) practicing in Sweden in 2004. The questionnaire was based on a case involving a severely ill patient and presented arguments for and against withholding and withdrawing treatment, and providing treatment that might hasten death.
Approximately 70% of the physicians and 51% of the general public responded. A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded (for instance, belief that the first task of health care is to save life) and considerations regarding quality of life differed significantly between the two groups. Most physicians (94.1%) and members of the general public (77.7%) were prepared to withdraw treatment, and most (95.1% of physicians and 82% of members of the general public) agreed that sedation should be provided.
There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers be aware of the public's views, expectations, and preferences.
我们的目的是调查在维持生命治疗这一主题上，公众与医疗服务提供者在推理过程和所涉及的价值观方面是否存在共识。
2004年，我们向瑞典成年人口的随机样本（n = 989）以及重症监护医生和神经外科医生的随机样本（n = 410）邮寄了问卷。问卷基于一个涉及重症患者的案例，列出了支持和反对停止及撤销治疗以及提供可能加速死亡的治疗的论据。
约70%的医生和51%的公众回复了问卷。大多数医生（82.3%）表示会停止治疗，而只有少数公众（40.2%）会这样做；两组提出的论据（例如，认为医疗保健的首要任务是拯救生命）以及对生活质量的考量存在显著差异。大多数医生（94.1%）和公众（77.7%）准备撤销治疗，并且大多数人（95.1%的医生和82%的公众）同意应给予镇静治疗。
在重症监护情况下，医生和公众在评估和推理方式上确实存在相当大的差异，但患者病情越无望，两组的评估就越趋于一致，尽管他们优先考虑的论据不同。为避免不必要的争议和沟通不畅，医疗服务提供者了解公众的观点、期望和偏好非常重要。
