Institute for Practical Ethics, University of Virginia, USA.
J Law Med Ethics. 2012 Spring;40(1):45-50. doi: 10.1111/j.1748-720X.2012.00644.x.
End-of-life care, particularly for patients with advanced dementia, tests the medical covenant, both the integrity and aptness of what physicians have to offer and the fidelity with which they offer it. This article considers five ways of justifying the unilateral withholding of future treatment: (1) an affirmation of professional autonomy; (2) a defense of professional integrity; (3) a parentalist exercise of power on behalf of the patient and/or family; (4) a protection of the interests of third parties (footing the bill); or (5) a protection of the interests of second parties (the physician or other providers). The article concludes with a sixth response to care for the stricken patient and family that seeks to attend more fully to the clinical reality of bonded humans in the throes of disease and death.
终末期关怀，特别是对患有晚期痴呆症的患者，检验了医疗契约，包括医生提供的内容的完整性和适当性，以及他们提供内容的忠实性。本文考虑了五种为单方面拒绝未来治疗辩护的方式：（1）对专业自主权的肯定；（2）对专业诚信的辩护；（3）代表患者和/或家属行使家长式权力；（4）保护第三方的利益（支付费用）；或者（5）保护第二方的利益（医生或其他提供者）。本文最后提出了第六种应对患病和垂死患者及其家庭的护理方案，旨在更全面地关注处于疾病和死亡痛苦中的有情感联系的人类的临床现实。
