Kass Joseph S, Lewis Ariane, Rubin Michael A
Continuum (Minneap Minn). 2018 Dec;24(6):1789-1793. doi: 10.1212/CON.0000000000000680.
Management of patients with terminal brain disorders can be medically, socially, and ethically complex. Although a growing number of feasible treatment options may exist, there are times when further treatment can no longer meaningfully improve either quality or length of life. Clinicians and patients should discuss goals of care while patients are capable of making their own decisions. However, because such discussions can be challenging, they are often postponed. These discussions are then conducted with patients' health care proxies after patients lose the capacity to make their own decisions. Disagreements may arise when a patient's surrogate desires continued aggressive interventions that are either biologically futile (incapable of producing the intended physiologic result) or potentially inappropriate (potentially capable of producing the patient's intended effect but in conflict with the medical team's ethical principles). This article explores best practices in addressing these types of conflicts in the critical care unit, but these concepts also broadly apply to other sites of care.
晚期脑部疾病患者的管理在医学、社会和伦理方面可能都很复杂。尽管可能存在越来越多可行的治疗选择，但有时进一步治疗已无法切实改善生活质量或延长生命。临床医生和患者应在患者有能力自行做决定时讨论护理目标。然而，由于此类讨论可能具有挑战性，它们常常被推迟。在患者失去自行做决定的能力后，这些讨论将与患者的医疗代理人进行。当患者的代理人希望继续进行积极干预时，可能会出现分歧，这些干预要么在生物学上是无效的（无法产生预期的生理结果），要么可能是不合适的（有可能产生患者预期的效果，但与医疗团队的伦理原则相冲突）。本文探讨了在重症监护病房处理这类冲突的最佳做法，但这些概念也广泛适用于其他护理场所。
