Brennan T A
Division of General Medicine, Brigham and Women's Hospital, MA 02115.
JAMA. 1988 Aug 12;260(6):803-7.
Decisions to limit care for terminally ill patients present a number of ethical and legal issues. For the past 13 years, the Optimum Care Committee (OCC) of the Massachusetts General Hospital, Boston, has provided advice for physicians faced with such issues. I have reviewed the experience of the committee with the 73 cases on which it provided consultation from 1974 through 1986. In addition, I have compared these cases with those of all 113 patients at the Massachusetts General Hospital who were accorded do-not-resuscitate status without OCC input during a three-month period and found that the two groups differed significantly on a number of clinical variables. I have also found that the OCC cases fall into six categories, each of which presents different ethical and legal issues. In addition, the use of the OCC within the hospital is increasing especially with regard to certain categories of cases. The committee has dealt with controversial issues in a consistent and ethically forthright manner, but legal and moral questions remain. More discussion of the role of ethics committees in withdrawal-of-care cases is needed.
限制对绝症患者的治疗决策引发了一系列伦理和法律问题。在过去13年里，波士顿麻省总医院的最佳护理委员会（OCC）一直为面临此类问题的医生提供建议。我回顾了该委员会在1974年至1986年期间就73例病例提供咨询的经验。此外，我将这些病例与麻省总医院在三个月内未经OCC参与就被给予不进行心肺复苏状态的所有113名患者的病例进行了比较，发现两组在一些临床变量上存在显著差异。我还发现OCC的病例可分为六类，每一类都呈现出不同的伦理和法律问题。此外，该委员会在医院内的使用正在增加，尤其是在某些类别的病例方面。委员会以一致且符合伦理道德的方式处理了有争议的问题，但法律和道德问题仍然存在。在撤掉治疗的病例中，需要对伦理委员会的作用进行更多讨论。
