Somers Emma, Grey Carl, Satkoske Valerie
aInternal Medicine West Virginia University School of Medicine bGeriatrics and Supportive Care, Department of Internal Medicine, West Virginia University School of Medicine cWest Virginia Center for Health Ethics and Law, West Virginia University dDepartment of Medical Education, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Curr Opin Support Palliat Care. 2016 Sep;10(3):208-13. doi: 10.1097/SPC.0000000000000225.
This article explores various cultural perspectives of withholding and withdrawing of life-sustaining treatment utilizing a case involving artificial nutrition and hydration (ANH) to guide ethical discussion.
In the United States, there is a general consensus in the medical, ethical, and legal communities that the withholding and withdrawing of life-sustaining treatment are morally equivalent at the end of life. Despite this consensus, the withdrawal of treatment is still emotionally difficult, particularly with ANH. Recent literature challenges the evidence base that feeding tubes for people with advanced dementia lead to significant harm. In light of these new findings, we will reconsider end-of-life decision making that concerns ANH to determine whether these new findings undermine previous ethical arguments and to consider how to best educate and support patients and families during the decision-making process.
Despite many believing that there is no ethical, medical, or moral difference between withholding and withdrawing of life-sustaining treatment, there is no denying it is emotionally taxing, particularly withdrawal of ANH. Upholding the patient's values during high-quality shared decision making, facilitating rapport, and utilizing time limited trials will help, even when treatment is considered medically ineffective.
本文通过一个涉及人工营养与水化（ANH）的案例，探讨了在维持生命治疗的撤除和 withholding 方面的各种文化观点，以指导伦理讨论。
在美国，医学、伦理和法律界普遍达成共识，即在生命末期，维持生命治疗的撤除和 withholding 在道德上是等同的。尽管有这一共识，但撤除治疗在情感上仍然困难，尤其是涉及 ANH 时。近期文献对晚期痴呆患者的饲管会导致重大伤害这一证据基础提出了质疑。鉴于这些新发现，我们将重新审视涉及 ANH 的临终决策，以确定这些新发现是否削弱了先前的伦理观点，并考虑在决策过程中如何最好地教育和支持患者及家属。
尽管许多人认为维持生命治疗的撤除和 withholding 在伦理、医学或道德上没有差异，但不可否认的是，这在情感上是有压力的，尤其是撤除 ANH 时。在高质量的共同决策过程中坚持患者的价值观、促进融洽关系并采用限时试验会有所帮助，即使在治疗被认为医学上无效时也是如此。
