Sasso Corbaro Medical Humanities Foundation, Via Lugano 4b, CH-6500, Bellinzona, Switzerland.
Clinical Ethics Commission, Ente Ospedaliero Cantonale, CH-6500, Bellinzona, Switzerland.
Crit Care. 2018 Oct 11;22(1):260. doi: 10.1186/s13054-018-2187-6.
In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Whereas patient-centred approaches are widely discussed and fostered, managing communication in complex, especially end-of-life, situations in open intensive care units is still a point of debate and a possible source of conflict and moral distress. In particular, healthcare teams are often sceptical about the growing role of families in shared decision-making and their ability to represent patients' preferences. New perspectives on substituted relational autonomy are needed for overcoming this climate of suspicion and are discussed through recent literature in the field of medical ethics.
在重症监护中，当无意识的患者由机器辅助时，主要通过尊重自主权来确保人性，这可以通过预先指示来实现，或者主要通过与亲属合作来实现。虽然以患者为中心的方法得到了广泛的讨论和支持，但在开放式重症监护病房的复杂情况下，特别是在生命末期，管理沟通仍然是一个有争议的问题，也是冲突和道德困境的一个可能来源。特别是，医疗团队对家庭在共同决策中不断增长的作用及其代表患者偏好的能力持怀疑态度。需要通过医学伦理学领域的最新文献来讨论替代关系自主性的新观点，以克服这种怀疑气氛。
