Australian National University, Medical School, University of Canberra, Faculty of Health, Intensive Care Unit, Canberra Hospital, Canberra, Australia.
Cairns and Hinterland Hospital and Health Service, James Cook University School of Medicine and Dentistry, Cairns, Australia.
J Crit Care. 2020 Oct;59:166-171. doi: 10.1016/j.jcrc.2020.06.016. Epub 2020 Jul 4.
End-of-life (EOL) care has become an integral part of intensive care medicine and includes the exploration of possibilities for deceased organ and tissue donation. Donation physicians are specialist doctors with expertise in EOL processes encompassing organ and tissue donation, who contribute significantly to improvements in organ and tissue donation services in many countries around the world. Donation physicians are usually also intensive care physicians, and thus they may be faced with the dual obligation of caring for dying patients and their families in the intensive care unit (ICU), whilst at the same time ensuring organ and tissue donation is considered according to best practice. This dual obligation poses specific ethical challenges that need to be carefully understood by clinicians, institutions and health care networks. These obligations are complementary and provide a unique skillset to care for dying patients and their families in the ICU. In this paper we review current controversies around EOL care in the ICU, including the use of palliative analgesia and sedation specifically with regards to withdrawal of cardiorespiratory support, the usefulness of the so-called doctrine of double effect to guide ethical decision-making, and the management of potential or perceived conflicts of interest in the context of dual professional roles.
终末期（EOL）关怀已成为重症监护医学的一个组成部分，包括探索已故器官和组织捐献的可能性。捐献医师是专门从事 EOL 流程的专家，包括器官和组织捐献，他们为全球许多国家的器官和组织捐献服务的改善做出了重大贡献。捐献医师通常也是重症监护医师，因此他们可能面临在重症监护病房（ICU）照顾垂死患者及其家属的双重义务，同时确保根据最佳实践考虑器官和组织捐献。这种双重义务带来了特定的伦理挑战，临床医生、机构和医疗保健网络需要仔细理解。这些义务是互补的，为 ICU 中垂死患者及其家属的护理提供了独特的技能。在本文中，我们回顾了 ICU 中 EOL 关怀的当前争议，包括使用姑息性镇痛和镇静，特别是在停止心肺支持方面，所谓的双重效应学说在指导伦理决策方面的有用性，以及在双重专业角色背景下管理潜在或感知的利益冲突。
