Kitzinger Jenny, Kitzinger Celia, Cowley Jakki
School of Journalism, Media and Cultural Studies, Cardiff University, Cardiff, UK.
Department of Sociology, University of York, York, UK.
J Med Ethics. 2017 Jul;43(7):446-449. doi: 10.1136/medethics-2016-104118. Epub 2017 Jun 22.
In a landmark judgment in the English Court of Protection, the judge (Charles J) found it to be in the best interests of a minimally conscious patient for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the inevitable consequence that the patient would die. In making this judgment, it was accepted that the patient's level of consciousness - if CANH were continued and rehabilitation provided - might improve, and that he might become capable of expressing emotions and making simple choices. The decision to withdraw treatment relied on a best interests decision, which gave great weight to the patient's past wishes, feelings, values and beliefs, and brought a 'holistic' approach to understanding what this particular patient would have wanted. We draw on our own experience of supporting families, advocating for patients and training healthcare professionals in similar situations to consider the implications of the published judgment for policy and practice with patients in prolonged disorders of consciousness and their families.
在英国保护法庭的一项具有里程碑意义的判决中，法官（查尔斯法官）认定，停止对一名处于最低意识状态患者的临床辅助营养与水化治疗符合其最大利益，而这将不可避免地导致患者死亡。在做出这一判决时，人们承认，如果继续进行临床辅助营养与水化治疗并提供康复治疗，患者的意识水平可能会提高，并且他可能会变得能够表达情感并做出简单选择。停止治疗的决定基于一项最大利益决策，该决策高度重视患者过去的愿望、感受、价值观和信念，并采用了一种“整体”方法来理解这位特定患者原本会希望怎样。我们借鉴自身在类似情况下支持家庭、为患者维权以及培训医疗保健专业人员的经验，来思考已公布的判决对长期意识障碍患者及其家庭的政策和实践的影响。
