Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, 2 George St, Brisbane, Queensland, 4000, Australia.
J Bioeth Inq. 2020 Sep;17(3):407-421. doi: 10.1007/s11673-020-09994-7. Epub 2020 Sep 22.
This paper investigates the content of Australian policies that address withholding or withdrawing life-sustaining treatment to analyse the guidance they provide to doctors about the allocation of resources.
All publicly available non-institutional policies on withholding and withdrawing life-sustaining treatment were identified, including codes of conduct and government and professional organization guidelines. The policies that referred to resource allocation were isolated and analysed using qualitative thematic analysis. Eight Australian policies addressed both withholding and withdrawing life-sustaining treatment and resource allocation.
Four resource-related themes were identified: (1) doctors' ethical duties to consider resource allocation; (2) balancing ethical obligations to patient and society; (3) fair process and transparent resource allocation; and (4) legal guidance on distributive justice as a rationale to limit life-sustaining treatment.
Of the policies that addressed resource allocation, this review found broad agreement about the existence of doctors' duties to consider the stewardship of scarce resources in decision-making. However, there was disparity in the guidance about how to reconcile competing duties to patient and society. There is a need to better address the difficult and confronting issue of the role of scarce resources in decisions about life-sustaining treatment.
本文研究了澳大利亚解决保留和撤销生命维持治疗的政策内容，以分析其为医生提供的关于资源配置的指导意见。
确定了所有可公开获得的关于保留和撤销生命维持治疗的非机构政策，包括行为准则以及政府和专业组织的指南。使用定性主题分析方法对涉及资源分配的政策进行了隔离和分析。有八项澳大利亚政策涉及保留和撤销生命维持治疗以及资源分配。
确定了四个与资源相关的主题：（1）医生有考虑资源配置的伦理责任；（2）平衡对患者和社会的伦理义务；（3）公平的程序和透明的资源分配；（4）关于分配正义的法律指导，作为限制生命维持治疗的理由。
在涉及资源配置的政策中，本综述发现，医生在决策中考虑稀缺资源管理职责的存在存在广泛共识。然而，在如何调和对患者和社会的竞争义务方面存在差异。需要更好地解决稀缺资源在决定生命维持治疗中的作用这一困难和棘手的问题。
