Wellesley Hugo, Jenkins Ian A
Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
Paediatr Anaesth. 2009 Oct;19(10):972-8. doi: 10.1111/j.1460-9592.2009.03027.x.
Modern medicine gives us the ability to prolong life even in situations where it may not be right to do so. This article discusses some of the complex ethical and legal issues surrounding withholding and withdrawing life-sustaining treatment in children, including the concepts of futility, best interests and intolerability. We advocate the use of a structured framework to help guide decision-making, particularly in the more difficult situations. The lack of a morally or legally significant difference between withholding and withdrawing treatment is discussed, as is the role of the doctrine of double effect (particularly in relation to the use of neuromuscular blocking agents during withdrawal of ventilatory support).
现代医学使我们有能力延长生命，即使在某些情况下这样做可能并不恰当。本文讨论了围绕儿童生命维持治疗的 withhold（ withhold 在此处可理解为“ withhold 治疗”，即不开始进行某些治疗措施 ）和 withdraw（ withdraw 可理解为“ withdraw 治疗”，即停止正在进行的治疗措施 ）所涉及的一些复杂的伦理和法律问题，包括无效性、最佳利益和不可忍受性等概念。我们主张使用一个结构化框架来帮助指导决策，尤其是在更困难的情况下。文中讨论了 withhold 治疗和 withdraw 治疗在道德或法律上不存在重大差异的情况，以及双重效应原则的作用（特别是在撤掉通气支持过程中使用神经肌肉阻滞剂方面）。
