Clinical Ethicist at Maine Medical Center in Portland, Maine, and is Adjunct Faculty at Saint Joseph's College of Maine in Standish, Maine USA.
J Clin Ethics. 2021 Fall;32(3):241-246.
The topic of withholding the Heimlich maneuver as part of a do-not-attempt-to-resuscitate (DNAR) order or an advance directive has not been widely discussed in the clinical ethics literature. This discussion addresses a request by family members to withhold the Heimlich maneuver from a patient in a long-term care facility. A request to forgo the Heimlich maneuver seems to have prima facie categorical similarities to justifications for withholding life-saving treatments such as cardiopulmonary resuscitation (CPR). Further examination reveals significant distinctions. Such distinctions call into question the ethical appropriateness of including the Heimlich maneuver among interventions to be withheld as part of end-of-life care planning, and encourages a broader discussion of an increasingly uncritical deference to autonomy in end-of-life decision making. Most notably, the Heimlich maneuver is the only intervention known to effectively relieve the distressing symptoms of accidental choking. The Heimlich maneuver serves a palliative function and is the standard of care for accidental choking. The Heimlich maneuver should not be conflated with other life-prolonging interventions that may be withheld as part of end-of-life care planning.
在临床伦理文献中，尚未广泛讨论将海姆利希手法（Heimlich maneuver）作为不复苏（DNAR）医嘱或预先指示的一部分予以保留的问题。本讨论涉及到家庭成员要求对长期护理机构中的患者不实施海姆利希手法的请求。不实施海姆利希手法的请求似乎与为避免心肺复苏术（CPR）等救生治疗措施而提出的理由在本质上具有相同的类别。进一步的研究揭示了显著的区别。这些区别使得将海姆利希手法作为临终关怀计划中应予以保留的干预措施之一的伦理适当性受到质疑，并鼓励对临终决策中对自主权的日益不加批判的尊重进行更广泛的讨论。最重要的是，海姆利希手法是唯一已知可有效缓解意外窒息引起的痛苦症状的干预措施。海姆利希手法具有姑息作用，是意外窒息的标准治疗方法。海姆利希手法不应与其他可能作为临终关怀计划的一部分而被保留的延长生命的干预措施相混淆。
