Lo B, Raffin T A, Cohen N H, Wachter R M, Luce J M, Hopewell P C
Division of General Internal Medicine, University of California San Francisco.
Rev Infect Dis. 1987 Nov-Dec;9(6):1163-7. doi: 10.1093/clinids/9.6.1163.
AIDS presents ethical dilemmas about intensive care. Even with intensive care the outcome for patients with AIDS is poor. Care givers have no ethical or medical obligation to provide futile care. Decisions concerning competent patients should be made jointly by physicians and the informed patients themselves. For incompetent patients decisions should be made jointly by physicians and appropriate patient-surrogates in light of the previously expressed wishes of the patients. Care givers should encourage patients with AIDS to express their preferences about life-sustaining treatment in order to avoid dilemmas should these patients later become incompetent. The AIDS epidemic may force more explicit discussions about the allocation of limited health-care resources, such as intensive care. Such allocation decisions should not discriminate against patients with AIDS.
艾滋病在重症监护方面带来了伦理困境。即便进行重症监护，艾滋病患者的预后依然很差。护理人员没有提供无效治疗的伦理或医学义务。对于有行为能力的患者，相关决策应由医生和充分知情的患者本人共同做出。对于无行为能力的患者，医生应根据患者先前表达的意愿，与合适的患者代理人共同做出决策。护理人员应鼓励艾滋病患者表达他们对维持生命治疗的偏好，以免这些患者日后丧失行为能力时出现困境。艾滋病的流行可能促使人们就有限医疗资源（如重症监护）的分配展开更明确的讨论。此类分配决策不应歧视艾滋病患者。
