Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108.
Pediatrics. 2014 Jan;133(1):123-8. doi: 10.1542/peds.2013-1001. Epub 2013 Dec 23.
Doctors have no ethical obligation to provide futile treatment. This has been true since the time of Hippocrates who warned physicians not to treat patients who were "overmastered by their disease." This principle remains valid today but, as the Society for Critical Care Medicine notes, it is difficult to identify treatment as absolutely futile in all but a few clinical situations. Far more common, they note, are "treatments that are extremely unlikely to be beneficial, are extremely costly, or are of uncertain benefit." These, they say, "may be considered inappropriate and hence inadvisable, but should not be labeled futile." So what should doctors do when they have a case that seems close to the futility threshold but does not, perhaps, quite cross it? In such cases, is it appropriate to make unilateral decisions to withhold life-sustaining treatment even if the family objects? Or should treatment be provided knowing that it might cause pain and suffering to an infant with no likelihood of benefit? To address these questions, we present a case of an extremely premature infant with a giant omphalocele and ask 3 neonatologists, Dr Dalia Feltman of Evanston Hospital, Dr Theophil Stokes of the Walter Reed Medical Center, and Dr Jennifer Kett, a neonatologist and fellow in bioethics at Seattle Children's Hospital, to comment.
医生没有提供无效治疗的道德义务。自希波克拉底时代以来，这一直是事实，他警告医生不要治疗那些“被疾病压倒”的患者。这一原则今天仍然有效，但正如危重病医学会指出的那样，除了少数临床情况外，很难确定治疗是绝对无效的。他们指出，更常见的是“极不可能有益、极其昂贵或疗效不确定的治疗方法”。他们说，“这些治疗方法可能被认为不合适，因此不建议使用，但不应被贴上无效的标签”。那么，当医生遇到一个似乎接近无效门槛但又不完全符合的病例时，他们应该怎么做呢？在这种情况下，是否可以单方面决定拒绝维持生命的治疗，即使家属反对？还是应该提供治疗，即使知道这可能会给没有获益可能的婴儿带来痛苦和痛苦？为了解决这些问题，我们提出了一个患有巨大脐膨出的极早产儿的病例，并请 Evanston 医院的 Dalia Feltman 医生、Walter Reed 医疗中心的 Theophil Stokes 医生和西雅图儿童医院的新生儿科医生兼生物伦理学研究员 Jennifer Kett 医生对此发表评论。
