Center of Excellence in Pulmonary Biology, Division of Pediatric Pulmonary, Allergy and Critical Care Medicine, Department of Pediatrics, Stanford University Medical School, Stanford, CA, USA.
Acta Paediatr. 2012 Apr;101(4):333-6. doi: 10.1111/j.1651-2227.2011.02531.x. Epub 2011 Dec 13.
As the community of physicians and nurses dedicated to the care of critically ill children has gained ever more well-developed skill sets, the decision to either continue or forego life-sustaining measures has become less time-sensitive. As a result, there is greater opportunity for careful consideration and discussion. The core principle in making decisions about whether to continue or forego life-sustaining measures is the best interests of the child. However, there are many clinical situations wherein factors other than the child's best interests may influence treatment decisions. The present report seeks to examine the notion that in the arena of paediatric critical care medicine, the decision-making process regarding life-sustaining measures may place insufficient priority upon the child's best interests. We examine actual, de-identified clinical situations, encountered in the critical care arena in two categories: (i) cases that challenge the imperative to act in the child's best interests, and (ii) cases that compromise the ability of parents and caregivers to use child-centred, best-interests approaches to decision-making. Clarity surrounding the implications of a clinical decision for the patient is essential. Decisions that are not focused squarely on the child's best interests may compromise the delivery of optimally ethical end-of-life care.
The cases and analysis may benefit parents and caregivers as they struggle with the difficult ethical issues that accompany decisions to continue or forego life-sustaining measures in children.
随着专门从事危重病儿童护理的医生和护士群体获得了越来越完善的技能，继续或放弃维持生命的措施的决策变得不那么紧迫了。因此，有更多的机会进行仔细的考虑和讨论。决定是否继续或放弃维持生命的措施的核心原则是儿童的最大利益。然而，在许多临床情况下，除了儿童的最大利益之外，其他因素可能会影响治疗决策。本报告旨在探讨这样一种观点，即在儿科危重病医学领域，关于维持生命的措施的决策过程可能没有充分重视儿童的最大利益。我们研究了在两个类别中遇到的实际、去识别的临床情况：（i）挑战为儿童最大利益行事的必要性的情况，以及（ii）使父母和照顾者无法使用以儿童为中心、以最大利益为基础的决策方法的情况。围绕临床决策对患者的影响达成明确认识至关重要。不直接关注儿童最大利益的决策可能会影响提供最佳道德临终关怀的能力。
这些案例和分析可能使父母和照顾者受益，因为他们在决定是否继续或放弃维持生命的措施时，会遇到伴随而来的困难的伦理问题。
