Hynninen M, Klepstad P, Petersson J, Skram U, Tallgren M
Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2008 Sep;52(8):1081-5. doi: 10.1111/j.1399-6576.2008.01636.x.
How ethical issues are dealt with varies considerably depending on the geographic and religious background of individuals. The views of Scandinavian physicians on end-of-life care were studied using a survey. The aim of this study was to clarify the actual processes of foregoing life-sustaining treatment in Scandinavia.
A questionnaire was developed and sent to 78 intensive care physicians working in Denmark, Finland, Norway and Sweden.
Forty-four responses were obtained (13 from Denmark, eight from Finland, 12 from Norway and 11 from Sweden); 89% of the respondents were from University Hospitals. Withholding and withdrawing of treatment were practiced in all intensive care units (ICUs) concerned, but written guidelines on end-of-life care existed in only one ICU. End-of-life care is usually arranged in the ICU. Religious support is available in most hospitals during office hours, but lacking in 26% of ICUs outside office hours. Vasoactive medication, renal replacement therapy, and artificial nutrition are among the therapies most likely to be discontinued during withdrawal of life support. Certain types of monitoring and organ support are still continued in many centers during end-of-life care.
Local written guidelines on end-of-life care are scarce in Scandinavian ICUs, which may explain the observed variability in the practices. Development of guidelines and monitoring how these instructions are carried out may help to improve the quality of care of dying ICU patients.
伦理问题的处理方式因个人的地理和宗教背景而有很大差异。我们通过一项调查研究了斯堪的纳维亚医生对临终关怀的看法。本研究的目的是阐明斯堪的纳维亚地区放弃维持生命治疗的实际过程。
设计了一份问卷并发送给在丹麦、芬兰、挪威和瑞典工作的78名重症监护医生。
共收到44份回复（丹麦13份、芬兰8份、挪威12份、瑞典11份）；89%的受访者来自大学医院。所有相关重症监护病房（ICU）都实施了治疗的 withhold（ withhold 可译为“ withhold 是指有意不给予或停止某种治疗措施” ）和撤除，但只有一个ICU有关于临终关怀的书面指南。临终关怀通常在ICU进行安排。大多数医院在办公时间可提供宗教支持，但26%的ICU在办公时间之外缺乏宗教支持。在撤除生命支持期间，血管活性药物、肾脏替代治疗和人工营养是最有可能停止的治疗方法。在许多中心，在临终关怀期间某些类型的监测和器官支持仍在继续。
斯堪的纳维亚ICU中关于临终关怀的本地书面指南很少，这可能解释了观察到的实践差异。制定指南并监测这些指南的执行情况可能有助于提高临终ICU患者的护理质量。
