Medical Student at the Yale University School of Medicine in New Haven, Connecticut USA.
Professor of Surgery at the Yale University School of Medicine and Department of Surgery in New Haven, Connecticut USA.
J Clin Ethics. 2021 Spring;32(1):48-60.
The principal aim of this study was to investigate the function and effectiveness of an institutional policy that outlines a procedure to limit medically futile interventions. We were interested in the attitudes and opinions of careproviders and the members of the Yale New Haven Hospital Ethics Committee that use this policy, the Conscientious Practice Policy (CPP), to address questions on appropriate interventions in the setting of medical futility.
In 2019, we conducted three focus groups of members of the Yale New Haven Hospital Ethics Committee and critical care physicians, asking participants questions concerning their use of the Yale New Haven Hospital's policy on limiting futile interventions. Focus group transcript results were coded into common themes using a conventional analysis approach.
The overarching finding was that the CPP had various levels of interpretation that prevented its effective and consistent use. This was supported by the four main themes from the focus groups: (1) Mixed perceptions regarding communication between careproviders and family members and surrogates before the CPP was invoked contributed to complexity in decision making. (2) It was ineffective to use an ethics consultation to decide whether or not to invoke the CPP. (3) It was necessary to address moral distress in the absence of a policy. (4) The use of the CPP was inconsistent for different patients, based on the degree to which family members and surrogates persisted in their resistance to limiting medically futile interventions, careproviders' comfort with directly making decisions, and bias towards members of certain groups.
The CPP, as it has been used at the Yale New Haven Hospital, has been ineffective in rationally, fairly, and consistently resolving conflicts regarding the appropriateness of ending medically futile interventions. The CPP, as well as similar policies at other institutions, may benefit from restructuring the policy to more closely align with policies at other institutions where outcomes have been more successful.
本研究的主要目的是调查一项规定限制无医疗价值干预程序的机构政策的功能和效果。我们感兴趣的是使用该政策（有良心的实践政策，CPP）来解决医疗无效情况下适当干预问题的医护人员和耶鲁纽黑文医院伦理委员会成员的态度和意见。
2019 年，我们对耶鲁纽黑文医院伦理委员会成员和重症监护医师进行了三次焦点小组讨论，向参与者询问了他们使用耶鲁纽黑文医院限制无益干预政策的情况。使用传统分析方法对焦点小组的转录结果进行编码，得出常见主题。
总体发现是，CPP 存在不同程度的解释，从而阻碍了其有效和一致的使用。这四个主要主题支持了这一发现：（1）在 CPP 被援引之前，医护人员与家属和代理人之间的沟通存在不同的看法，这导致了决策的复杂性。（2）使用伦理咨询来决定是否援引 CPP 是无效的。（3）在没有政策的情况下，必须解决道德困境。（4）由于家属和代理人坚持限制无益医疗干预的程度、医护人员直接做出决策的舒适度以及对某些群体成员的偏见，CPP 对不同患者的使用不一致。
在耶鲁纽黑文医院使用的 CPP 在合理、公正和一致地解决有关结束无益医疗干预的适当性的冲突方面一直没有效果。CPP 以及其他机构的类似政策可能受益于对政策进行重组，使其更符合其他机构的政策，这些机构的结果更为成功。
