La Puma J, Stocking C B, Silverstein M D, DiMartini A, Siegler M
Section of Clinical Ethics, Lutheran General Hospital, Park Ridge, IL 60068.
JAMA. 1988 Aug 12;260(6):808-11.
A newly established formal ethics consultation service in a university teaching hospital was prospectively evaluated. A physician-ethicist interviewed and examined patients, interviewed family and others as needed, and entered a formal consultation note in the medical record. The requesting physician and the consultant independently completed structured questionnaires. Fifty-one consultation requests were received from 45 physicians from seven departments between July 1, 1986, and June 30, 1987. Seventeen (33%) of 51 patients were in the intensive care unit, and 19 patients (37%) were fully oriented at the time of consultation. Overall, 61% of the patients survived to leave the hospital. The requesting physician sought assistance with withholding or withdrawing life-sustaining treatment in 49% of cases, with resuscitation issues in 37%, and with legal issues in 31%. Assistance with more than one issue was sought in 39 cases (76%). In 36 cases (71%), the requesting physician stated that the consultation was "very important" in patient management, in clarifying ethical issues, or in learning about medical ethics. We conclude that ethics consultation performed by physician-ethicists provides useful, clinically acceptable assistance in a teaching hospital.
对一所大学教学医院新设立的正式伦理咨询服务进行了前瞻性评估。一位医生伦理学家对患者进行访谈和检查，必要时对患者家属及其他人员进行访谈，并在病历中录入正式的咨询记录。提出咨询请求的医生和咨询顾问分别独立完成结构化问卷。在1986年7月1日至1987年6月30日期间，共收到来自七个科室45位医生的51份咨询请求。51例患者中有17例（33%）在重症监护病房，19例患者（37%）在咨询时意识完全清醒。总体而言，61%的患者存活出院。提出咨询请求的医生在49%的病例中寻求关于停止或撤销维持生命治疗的帮助，37%的病例涉及复苏问题，31%的病例涉及法律问题。39例（76%）寻求了不止一个问题的帮助。在36例（71%）中，提出咨询请求的医生表示该咨询在患者管理、阐明伦理问题或了解医学伦理方面“非常重要”。我们得出结论，医生伦理学家进行的伦理咨询在教学医院提供了有用的、临床上可接受的帮助。
