Voultsos Polychronis, Tsompanian Anna, Tsaroucha Alexandra K
Laboratory of Forensic Medicine & Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, GR, Greece.
Postgraduate Program on Bioethics, Democritus University of Thrace, School of Medicine, Dragana, 68100, Alexandroupolis, GR, Greece.
BMC Nurs. 2021 Dec 20;20(1):254. doi: 10.1186/s12912-021-00785-y.
Providing futile medical care is an ever-timely ethical problem in clinical practice. While nursing personnel are very closely involved in providing direct care to patients nearing the end of life, their role in end-of-life decision-making remains unclear.
This was a prospective qualitative study conducted with experienced nursing professionals from December 2020 through May 2021. Individual in-depth qualitative interviews were conducted with sixteen participants. We performed a thematic analysis of the data.
Importantly, many participants were half-hearted in their attitude towards accepting or defining futile medical care. Furthermore, interestingly, a list of well-described circumstances emerged, under which the dying process is most likely to be a "bad and undignified" process. These circumstances reflected situations revolving around a) pain and suffering, b) treating patients with respect, c) the appearance and image of the patient body, and d) the interaction between patients and their relatives. Fear of legal action, the lack of a regulatory framework, physicians being pressured by (mostly uninformed) family members and physicians' personal motives were reported as important reasons behind providing futile medical care. The nursing professional's role as a participant in decisions on futile care and as a mediator between physicians and patients (and family members) was highlighted. Furthermore, the patient's role in decisions on futile care was prioritized. The patient's effort to keep themselves alive was also highlighted. This effort impacts nursing professionals' willingness to provide care. Providing futile care is a major factor that negatively affects nursing professionals' inner attitude towards performing their duties. Finally, the psychological benefits of providing futile medical care were highlighted, and the importance of the lack of adequately developed end-of-life care facilities in Greece was emphasized.
These findings enforce our opinion that futile medical care should be conceptualized in the strict sense of the term, namely, as caring for a brain-dead individual or a patient in a medical condition whose continuation would most likely go against the patient's presumed preference (strictly understood). Our findings were consistent with prior literature. However, we identified some issues that are of clinical importance.
在临床实践中，提供无效的医疗护理是一个一直备受关注的伦理问题。虽然护理人员在为临终患者提供直接护理方面密切参与，但他们在临终决策中的作用仍不明确。
这是一项前瞻性定性研究，于2020年12月至2021年5月对经验丰富的护理专业人员进行。对16名参与者进行了个体深入定性访谈。我们对数据进行了主题分析。
重要的是，许多参与者对接受或界定无效医疗护理的态度不坚决。此外，有趣的是，出现了一系列详细描述的情况，在这些情况下，死亡过程最有可能是一个“糟糕且不体面”的过程。这些情况反映了围绕以下方面的情况：a）疼痛和痛苦，b）尊重患者，c）患者身体的外观和形象，d）患者与其亲属之间的互动。据报告，担心法律诉讼、缺乏监管框架、医生受到（大多不知情的）家庭成员的压力以及医生的个人动机是提供无效医疗护理背后的重要原因。强调了护理专业人员作为无效护理决策参与者以及医生与患者（及家庭成员）之间调解人的角色。此外，患者在无效护理决策中的作用被置于优先地位。还强调了患者维持生命的努力。这种努力影响护理专业人员提供护理的意愿。提供无效护理是对护理专业人员履行职责的内在态度产生负面影响的一个主要因素。最后，强调了提供无效医疗护理的心理益处，并强调了希腊缺乏充分发展的临终护理设施的重要性。
这些发现强化了我们的观点，即无效医疗护理应从该术语的严格意义上进行概念化，即，护理脑死亡个体或处于某种医疗状况下的患者，继续治疗很可能违背患者假定的偏好（严格理解）。我们的发现与先前的文献一致。然而，我们确定了一些具有临床重要性的问题。
