Aghabarary Maryam, Dehghan Nayeri Nahid
PhD Student in Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Professor, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
J Med Ethics Hist Med. 2016 Oct 20;9:11. eCollection 2016.
Concerns over limited medical equipment and resources, particularly in intensive care units (ICUs), have raised the issue of medical futility. Medical futility draws a contrast between physician's authority and patients' autonomy and it is one of the major issues of end-of-life ethical decision-making. The aim of this study was to review medical futility and its challenges. In this systematized review study, a comprehensive search of the existing literature was performed using an internet search with broad keywords to access related articles in both Persian and English databases. Finally, 89 articles were selected and surveyed. Medical futility is a complex, ambiguous, subjective, situation-specific, value-laden, and goal-dependent concept which is almost always surrounded by some degrees of uncertainty; hence, there is no objective and valid criterion for its determination. This concept is affected by many different factors such as physicians' and patients' value systems, medical goals, and sociocultural and religious context, and individuals' emotions and personal characteristics. It is difficult to achieve a clear consensus over the concept of medical futility; hence, it should be defined and determined at an individual level and based on the unique condition of each patient.
对医疗设备和资源有限的担忧，尤其是在重症监护病房（ICU），引发了医疗无效性的问题。医疗无效性凸显了医生的权威与患者自主权之间的矛盾，它是临终伦理决策的主要问题之一。本研究的目的是回顾医疗无效性及其面临的挑战。在这项系统评价研究中，通过互联网搜索，使用宽泛的关键词对现有文献进行全面检索，以获取波斯语和英语数据库中的相关文章。最后，筛选出89篇文章并进行研究。医疗无效性是一个复杂、模糊、主观、因具体情况而异、充满价值判断且依赖目标的概念，几乎总是伴随着一定程度的不确定性；因此，对于其判定不存在客观有效的标准。这一概念受到许多不同因素的影响，如医生和患者的价值体系、医疗目标、社会文化和宗教背景，以及个人情感和个人特征。很难就医疗无效性的概念达成明确的共识；因此，应该在个体层面上，根据每个患者的独特情况来定义和判定。
