Patel Akshar Yogesh
Saint Louis University, School of Medicine, St Louis, MO 63104, USA.
Am J Hosp Palliat Care. 2012 Dec;29(8):667-9. doi: 10.1177/1049909112438461. Epub 2012 Mar 2.
Historically, medicine has been warned, "first, do no harm." In contemporary practice, however, the emergency response has generally been to err on the side of action with resuscitation efforts. Typically, it is only later on when medical therapy is considered futile that treatment is withdrawn. In such circumstances, a do-not-resuscitate (DNR) order is typically enacted as a part of an advance directive. However, when such patients attempt suicide, the approach to their care becomes complicated. Is the DNR order valid in a suicidal patient? What is the role of patient autonomy? How should an ethics consultant advise? This case details the method by which such issues should be approached in the emergent care of patients who have DNR order and attempt suicide.
从历史上看，医学一直被警示“首要的是，不造成伤害”。然而，在当代医疗实践中，急救反应通常是在复苏努力方面倾向于采取行动。通常，只有在后来认为医疗治疗无效时才会停止治疗。在这种情况下，不进行心肺复苏（DNR）医嘱通常作为预先指示的一部分被制定。然而，当这类患者试图自杀时，对他们的护理方式就变得复杂了。DNR医嘱在自杀患者中是否有效？患者自主权的作用是什么？伦理顾问应如何提供建议？本案例详细介绍了在有DNR医嘱且试图自杀的患者的紧急护理中处理此类问题的方法。
