Department of Neurosurgery, Sir Charles Gairdner Hospital, Hospital Avenue, Perth 6009, Australia.
J Med Ethics. 2012 Nov;38(11):657-61. doi: 10.1136/medethics-2012-100672. Epub 2012 Jul 17.
In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have demonstrated many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features.
在临床医学的各个领域，人们越来越意识到，必须根据生活质量和成本效益来评估结果，而不仅仅是生存时间。当考虑对严重创伤性脑损伤进行去骨瓣减压术时，尤其如此。该手术本身在技术上很简单，涉及暂时切除颅骨穹窿的一大块，以便为受伤的大脑提供可以扩张的额外空间。许多研究表明，许多患者会进行良好的长期功能恢复，然而，并非总是如此，许多患者存活下来，但却留下严重的神经认知障碍。不幸的是，这些患者中有许多是以前健康状况良好的年轻成年人，因此，他们可能会在多年的时间里处于他们可能认为无法接受的状态，这就引发了一些关于同意和资源分配的伦理问题。为了解决这些问题，我们使用了 Jonsen 提出的分析框架，该框架要求系统地考虑医疗适应症、患者偏好、生活质量和背景特征。
