McGowan Claire M
Emerson Hospital, Concord, Massachusetts, USA.
Crit Care Nurse. 2011 Oct;31(5):64-9. doi: 10.4037/ccn2011550.
Critical care nurses are essential members of the health care team and often assist patients and patients' families who are facing end-of-life concerns. In that role, a nurse needs an understanding of many important factors, including legal implications associated with the end of life. Since the 1970s, courts have decided several cases that have established legal principles in end-of-life care. Courts have found that competent adults have the right to refuse or discontinue medical interventions. For incompetent adults and children, decisions are made by a surrogate. In the absence of an advance directive or documentation of goals of care, the surrogate, in collaboration with the medical team, determines a plan of care, including decisions about end-of-life care. When issues of medical futility occur, attempts to work with patients and their families should be undertaken, but if the dispute cannot be resolved, a transfer in care may be the only option.
重症监护护士是医疗团队的重要成员，经常协助面临临终问题的患者及其家属。在这一角色中，护士需要了解许多重要因素，包括与临终相关的法律影响。自20世纪70年代以来，法院已经判决了几起确立临终护理法律原则的案件。法院认定，有行为能力的成年人有权拒绝或停止医疗干预。对于无行为能力的成年人和儿童，由代理人做出决定。在没有预先指示或护理目标文件的情况下，代理人与医疗团队合作，确定护理计划，包括有关临终护理的决定。当出现医疗无效问题时，应尝试与患者及其家属合作，但如果争议无法解决，转院护理可能是唯一的选择。
