Martín Hortigüela María Elena
Hospital General Universitario de Alicante. Pintor Baeza, 2, 03003 Alicante.
Cuad Bioet. 2015 May-Aug;26(87):223-39.
Nowadays, most of the deaths in neonatal ages take place in neonatal intensive care units and a significative number of these are involved in decisions of withholding or withdrawing medical care. The growing complexity of the health care in neonatal settings entails that end-of-life decision-making occurs more frequently. Personal views and attitudes on the best care of the severely ill newborns can be different, since to define objectively the ″best interests″ for the infant is not easy at all. The question of how to best care for such infants is ongoing, and there remain deep divisions within the field. The aim of this issue is to review the different criteria used in the western world, Europe, especially in the Netherlands, and the EEUU and the current debate on neonatal euthanasia. Poor vital prognosis, current and future quality of life and, after the Groningen protocol, unbearable suffering are the criteria commonly used in neonatal end-of-life decisions, including euthanasia. It is necessary to distinguish the decisions, in which euthanasia is chosen, of which they are an appropriate limit of therapeutic effort.
如今,大多数新生儿死亡发生在新生儿重症监护病房,其中相当一部分涉及到医疗护理的 withhold 或 withdraw 决策。新生儿护理日益复杂,这使得临终决策更为频繁地出现。对于重症新生儿的最佳护理,个人观点和态度可能不同,因为要客观界定婴儿的“最大利益”绝非易事。如何最佳护理此类婴儿的问题仍在持续,该领域内仍存在深刻分歧。本期的目的是回顾西方世界、欧洲尤其是荷兰和美国所使用的不同标准,以及当前关于新生儿安乐死的辩论。不良的生命预后、当前和未来的生活质量,以及在格罗宁根协议之后,无法忍受的痛苦是新生儿临终决策(包括安乐死)中常用的标准。有必要区分选择安乐死的决策与作为治疗努力适当限度的决策。