Department of Newborn Medicine, Boston Children's Hospital, Boston, MA.
Neoreviews. 2020 Apr;21(4):e217-e225. doi: 10.1542/neo.21-4-e217.
The ethical dilemmas and predominant frameworks surrounding decision making for critically ill newborns have evolved substantially over the last 40 years. A shared decision-making approach is now favored, involving an exchange of information between parents and clinicians that emphasizes parental values and preferences, resulting in a personalized approach to decision making. In this review, we summarize the history of clinical decision making with a focus on the NICU, highlight different models of decision making, describe the advantages and current limitations of shared decision making, and discuss the ongoing and future challenges of decision making in the NICU amidst medical innovations and emerging technologies.
在过去的 40 年中，围绕危重新生儿决策的伦理困境和主要框架发生了重大变化。现在倾向于采用共同决策方法，涉及父母和临床医生之间的信息交换，强调父母的价值观和偏好，从而形成个性化的决策方法。在这篇综述中，我们总结了临床决策的历史，重点介绍了 NICU，并强调了不同的决策模型，描述了共同决策的优点和当前局限性，并讨论了在医疗创新和新兴技术背景下，NICU 中决策面临的持续和未来挑战。
