Carnevale Franco A, Farrell Catherine, Cremer Robin, Canoui Pierre, Séguret Sylvie, Gaudreault Josée, de Bérail Brune, Lacroix Jacques, Leclerc Francis, Hubert Philippe
Montreal Children's Hospital, Canada.
J Child Health Care. 2012 Jun;16(2):109-23. doi: 10.1177/1367493511420184. Epub 2012 Jan 13.
This study examined (a) how physicians and nurses in France and Quebec make decisions about life-sustaining therapies (LSTs) for critically ill children and (b) corresponding ethical challenges. A focus groups design was used. A total of 21 physicians and 24 nurses participated (plus 9 physicians and 13 nurses from a prior secondary analysis). Principal differences related to roles: French participants regarded physicians as responsible for LST decisions, whereas Quebec participants recognized parents as formal decision-makers. Physicians stated they welcomed nurses' input but found they often did not participate, while nurses said they wanted to contribute but felt excluded. The LST limitations were based on conditions resulting in long-term consequences, irreversibility, continued deterioration, inability to engage in relationships and loss of autonomy. Ethical challenges related to: the fear of making errors in the face of uncertainty; struggling with patient/family consequences of one's actions; questioning the parental role and dealing with relational difficulties between physicians and nurses.
（a）法国和魁北克的医生和护士如何为重症儿童做出维持生命治疗（LST）的决策，以及（b）相应的伦理挑战。采用了焦点小组设计。共有21名医生和24名护士参与（另外还有来自之前二次分析的9名医生和13名护士）。主要差异与角色有关：法国参与者认为医生负责LST决策，而魁北克参与者认可父母为正式决策者。医生表示他们欢迎护士的意见，但发现护士常常不参与，而护士则称他们想做出贡献但感觉被排除在外。LST的局限性基于会导致长期后果、不可逆转、持续恶化、无法建立人际关系以及丧失自主性的状况。伦理挑战包括：在面对不确定性时对犯错的恐惧；纠结于自身行为对患者/家庭造成的后果；质疑父母的角色以及应对医生和护士之间的关系难题。
