Department of Anaesthesia and Intensive Care, Medical School of Catania, Policlinico-Vittorio Emanuele, Via S.Sofia, 78 95123 Catania, Italy.
J Crit Care. 2013 Feb;28(1):14-21. doi: 10.1016/j.jcrc.2012.07.005. Epub 2012 Sep 13.
Resuscitation has the ability to reverse premature death. It can also prolong terminal illness, increase discomfort, and consume resources. The do-not-resuscitate (DNR) order and advance directives are still a debated issue in critical care. This review will focus on several aspects, regarding withholding and/or withdrawing therapies and advance directives in different continents. It is widely known that there is a great diversity of cultural and religious beliefs in society, and therefore, some critical ethical and legal issues have still to be solved. To achieve a consensus, we believe in the priority of continuing education and training programs for health care professionals. It is our opinion that a serious reflection on ethical values and principles would be useful to understand the definition of medical professionalism to make it possible to undertake the best way to avoid futile and aggressive care. There is evidence of the lack of DNR order policy worldwide. Therefore, it appears clear that there is a need for standardization. To improve the attitude about the DNR order, it is necessary to achieve several goals such as: increased communication, consensus on law, increased trust among patients and health care systems, and improved standards and quality of care to respect the patient's will and the family's role.
复苏有逆转过早死亡的能力。它也可以延长终末期疾病，增加不适，并消耗资源。在重症监护中，不复苏（DNR）命令和预先指示仍然是一个有争议的问题。本综述将重点关注不同大陆在停止和/或撤回治疗和预先指示方面的几个方面。众所周知，社会存在着巨大的文化和宗教信仰多样性，因此，一些关键的伦理和法律问题仍有待解决。为了达成共识，我们相信优先考虑为医疗保健专业人员提供继续教育和培训计划。我们认为，认真思考伦理价值观和原则将有助于理解医疗专业精神的定义，从而有可能采取最佳方式避免无效和激进的护理。有证据表明，全世界都缺乏 DNR 命令政策。因此，显然需要标准化。为了改善对 DNR 命令的态度，需要实现几个目标，如：加强沟通、法律共识、增加患者和医疗保健系统之间的信任，以及提高标准和护理质量，以尊重患者的意愿和家庭的角色。
