Robinson Institute, Discipline of Obstetrics and Gynecology, University of Adelaide, North Adelaide, South Australia, Australia.
J Med Ethics. 2013 Aug;39(8):502-6. doi: 10.1136/medethics-2012-100745. Epub 2013 Jan 26.
Are there some newborn infants whose short- and long-term care costs are so great that treatment should not be provided and they should be allowed to die? Public discourse and academic debate about the ethics of newborn intensive care has often shied away from this question. There has been enough ink spilt over whether or when for the infant's sake it might be better not to provide life-saving treatment. The further question of not saving infants because of inadequate resources has seemed too difficult, too controversial, or perhaps too outrageous to even consider. However, Roman Catholic ethicist Charles Camosy has recently challenged this, arguing that costs should be a primary consideration in decision-making in neonatal intensive care. In the first part of this paper I will outline and critique Camosy's central argument, which he calls the 'social quality of life (sQOL)' model. Although there are some conceptual problems with the way the argument is presented, even those who do not share Camosy's Catholic background have good reason to accept his key point that resources should be considered in intensive care treatment decisions for all patients. In the second part of the paper, I explore the ways in which we might identify which infants are too expensive to treat. I argue that both traditional personal 'quality of life' and Camosy's 'sQOL' should factor into these decisions, and I outline two practical proposals.
是否存在一些新生儿，其短期和长期护理费用如此之高，以至于不应提供治疗，而应允许其死亡？公众讨论和学术辩论关于新生儿重症监护的伦理问题常常回避这个问题。已经有足够的笔墨讨论出于婴儿的利益，不提供救生治疗是否更好。不因为资源不足而拯救婴儿的进一步问题似乎太难、太有争议，或者太离谱而无法考虑。然而，罗马天主教伦理学家查尔斯·卡莫西（Charles Camosy）最近对此提出了质疑，他认为成本应成为新生儿重症监护决策中的主要考虑因素。在本文的第一部分，我将概述并批评卡莫西的核心论点，他称之为“社会生活质量（sQOL）”模型。尽管该论点的表述存在一些概念问题，但即使那些不认同卡莫西天主教背景的人也有充分的理由接受他的关键点，即资源应在所有患者的重症监护治疗决策中加以考虑。在本文的第二部分，我探讨了我们可能确定哪些婴儿治疗费用过高的方法。我认为，传统的个人“生活质量”和卡莫西的“sQOL”都应该成为这些决策的因素，并概述了两个实际建议。
