Wilkinson Dominic, Savulescu Julian
Women's and Children's Hospital, Adelaide University of Oxford, St Cross College, Oxford, and Oxford Uehiro Centre for Practical Ethics and Oxford Centre for Neuroethics.
Bioethics. 2014 Mar;28(3):127-37. doi: 10.1111/j.1467-8519.2012.01981.x. Epub 2012 Jul 5.
Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively weak reasons to restrict rationing to withholding treatment. On the contrary, resource allocation provides a strong argument in favour of equivalence: non-equivalence causes preventable death in critically ill patients. We outline two proposals for increasing equivalence in practice: (1) reduction of the mortality threshold for treatment withdrawal, (2) time-limited trials of intensive care. These strategies would help to move practice towards more rational treatment limitation decisions.
伦理分析、专业指南和法律裁决均支持维持生命治疗的等效性论点：如果停止治疗是合乎伦理的，那么撤回同样的治疗也应是合乎伦理的。在本文中，我们探究了为何大多数医学专业人员不同意伦理分析结论的原因。临床医生认为资源分配是停止但非撤回重症监护治疗的合理理由。我们分析了支持非等效性的五个论点，发现将配给限制在停止治疗上的理由相对薄弱。相反，资源分配为等效性提供了有力论据：非等效性会导致重症患者出现可预防的死亡。我们概述了在实践中提高等效性的两项提议：（1）降低治疗撤回的死亡率阈值，（2）进行重症监护的限时试验。这些策略将有助于推动实践朝着更合理的治疗限制决策发展。
