Wachter R M, Luce J M, Lo B, Raffin T A
Robert Wood Johnson Clinical Scholars Program, Stanford University 94305.
Chest. 1989 Mar;95(3):647-52. doi: 10.1378/chest.95.3.647.
Physicians increasingly are being called upon to make difficult decisions about intensive care for patients with the acquired immunodeficiency syndrome (AIDS). AIDS patients who require intensive care have a poor prognosis; the in-hospital mortality rate of those receiving mechanical ventilation for P carinii pneumonia is 86-100 percent in most studies. However, in the past year, two studies documenting improved outcome have been published. Physicians should understand these outcome data and use well-established ethical principles to allow informed competent patients with AIDS to express their preferences regarding intensive care. Patients should be encouraged to provide advanced directives regarding life-sustaining treatments or to designate surrogate decision-makers to be consulted should they lose mental competence. The health care system should provide alternatives to the ICU for compassionate terminal care. However, arbitrary policies denying intensive care to AIDS patients for whom it is medically indicated and desired are not warranted.
越来越多地要求医生对获得性免疫缺陷综合征（艾滋病）患者的重症监护做出艰难决策。需要重症监护的艾滋病患者预后不佳；在大多数研究中，因卡氏肺孢子虫肺炎接受机械通气的患者院内死亡率为86% - 100%。然而，在过去一年中，两项记录了改善结果的研究已发表。医生应了解这些结果数据，并运用既定的伦理原则，让有行为能力且了解情况的艾滋病患者表达他们对重症监护的偏好。应鼓励患者提供关于维持生命治疗的预先指示，或指定替代决策者，以便在他们丧失心智能力时进行咨询。医疗保健系统应为临终关怀提供重症监护病房以外的替代方案。然而，对于有医学指征且有需求的艾滋病患者，随意制定拒绝重症监护的政策是不合理的。
